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"…Medicare has been a boon to the elderly and their children. Surveys show that beneficiaries are overwhelmingly satisfied with their care. Before Medicare, only 56 percent of the elderly had hospital insurance; the program has contributed to an increase in life expectancy and a sharp reduction in poverty among the elderly."

Robert Pear, Walt Bogdanich, Some Successful Models Ignored as Congress Works on Drug Bill, NY Times, p.1 (9/4/2003)



General Medicare

Category Statistics Source and Notes
# of people with Medicare 52.3 Million (2013) http://www.ncpssm.org/Medicare/MedicareFastFacts (site visited October 16, 2015)
# of elders (65 & older) w/ Medicare 43.5 Million (2013) http://www.ncpssm.org/Medicare/MedicareFastFacts (site visited October 16, 2015)
# of people w/ Medicare who are younger than 65 & disabled 8.8 Million (2013) http://www.ncpssm.org/Medicare/MedicareFastFacts (site visited October 16, 2015)
% of people w/ Medicare who are younger than 65 & disabled 16.8% (2013) http://www.ncpssm.org/Medicare/MedicareFastFacts (site visited October 16, 2015)
# of ESRD Patients on Medicare 447,990 (2012) http://kff.org/medicare/state-indicator/enrollees-with-esrd/ (site visited September 11, 2015)
% of elders (65 & older) w/ health insurance before Medicare existed 54% (2009 analysis of a 1965 population) http://www.cdc.gov/nchs/data/nhsr/nhsr017.pdf (site visited September 2, 2015)
% of elders (65 & older) w/ health insurance now 98.4% (2013) https://www.census.gov/content/dam/Census/library/
publications/2014/demo/p60-250.pdf
(site visited September 2, 2015)
Annual Income of Medicare beneficiaries 25% below $14,000
5% Greater than $93,900
http://kff.org/report-section/income-and-assets-of-medicare-beneficiaries-2013-2030-issue-brief-income-of-medicare-beneficiaries/ (site visited September 2, 2015)
% with Income less than $24,150 50% (2014) http://kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2014-2030/ (site visited November 16, 2015)
Income < 400% FPL ($43,320) 77% (2005) June 2008 MedPAC data book, page 25.
Income > $80,000 4% (2002) Kaiser Medicare Chartbook 2005, page 6.
Medicare administrative costs 1.7% of expenditures (2006) CMS Data Compendium 2007, "Medicare Administrative Expenses Selected Fiscal Years."
Medicare Advantage (private plans) average non-medical costs 13.1% broken down by:
Marketing & sales (2.4%), Adminstration (6.6%), Reinsurance (.1%) and profit (4%) (projected for 2007)
GAO-08-359 February 2008, p. 27.
Last time the Medicare tax rate was increased 1985 (from 1.35% to 1.45%)

 

Since 1994, no cap on maximum taxable earnings for Medicare

Marilyn Moon, Urban Institute.

 

CMS Data Compendium 2007, "Medicare Annual Maximum Taxable Earnings, 1966-2007."

Spending increase per beneficiary 5.4% (2002-2006) June 2008 MedPAC data book, page 9.
Private Health Insurance Spending increase per beneficiary 7.7% (2002-2006) June 2008 MedPAC data book, page 9.

Medicare Advantage (Medicare Managed Care: Private Plans)

Category Statistics Source and Notes
# of Medicare Advantage (MA) contracts 523 (2008) Kaiser Family Foundation, Medicare Advantage Contracts: 2008.
# of beneficiaries in MA plans 8.9 million (2008)

 

Increased from 4.6 million in 2003

March 2008 MedPAC report, p. 244.
% of people in Medicare who are enrolled in MA plans 20% (2007)

 

Increased from 11% in 2004

March 2008 MedPAC report, p. 237.
# of enrollees in plans offering Prescription Drugs 7.63 million (2008) CMS, Prescription Drug Coverage Enrollment Information, Beneficiaries with Prescription Drug Coverage.
Access to MA 100% of beneficiaries have access to MA plans March 2008 MedPAC report, p. 237.
Medicare Advantage Plan Enrollment, by Plan Type

 

CCP = Coordinated Care Plans

HMO = Health Maintenance Organization

PPO = Preferred Provider   Organization

PFFS = Private Fee For Service

MSA = Medical Savings Account

CCP

 

Local HMO

Local PPO

6,262,374

 

5,788,677

473,697

PFFS 1,661,889
Regional PPO 146,013
MSA 1,268
PPO Demo 0
Other Demo 2,718
Cost 312,363
Kaiser Family Foundation, Medicare Advantage Plan Enrollment, by Plan Type.
Medicare Advantage Plan Penetration, by Plan Type (2007)
CCP

 

Local HMO

Local PPO

14.2%

 

13.1%

1.1%

PFFS 3.8%
Regional PPO 0.3%
MSA 0%
PPO Demo 0%
Other Demo 0%
Cost 0.7%
Kaiser Family Foundation, Medicare Advantage Plan Penetration, by Plan Type.
Medicare Advantage Contracts, by Plan Type (2008)
CCP

 

Local HMO

Local PPO

402

 

279

123

PFFS 70
Regional PPO 11
MSA 9
PPO Demo 0
Other Demo 15
Cost 16
Kaiser Family Foundation, Medicare Advantage Contracts, by Plan Type.
Special Needs Plans (SNP) Enrollment, by SNP Type (2007)
Total 1,130,264
Dual Eligible 815,569
Chronic or Disabling Condition 176,598
Institutional 138,097
CMS, Medicare Advantage Part D Enrollment Data, Special Needs Plan Data.
SNP Contracts by SNP Type (2008)
Total 443
Dual Eligible 270
Chronic or Disabling Condition 107
Institutional 66
CMS, Medicare Advantage Part D Enrollment Data, Special Needs Plan Data.
Cost of MA program in 2006 $59 billion GAO-08-359 Feb. 2008, page 1.
Average amount above a plan’s bid that CMS gives to MA plans $87 per member per month (2007)

 

$8.3 billion paid out in total (2007)

GAO-08-359 Feb. 2008, pages 6 and 3.
Average MA payment per beneficiary $783 per beneficiary per month (projected 2007) GAO-08-359 Feb. 2008, page 27.
Average traditional Medicare payment per beneficiary $699 per beneficiary per month (2007) Extrapolated from other data.
MA payment as a percent of traditional Medicare costs 113% (2008) March 2008 MedPAC report to the Congress, page 238.
Program payments that exceed traditional Medicare expenditures, by plan type (2006)
HMO 110%
Local PPO 117%
Regional PPO 110%
PFFS 119%
March 2008 MedPAC Report to Congress, pg. 247.
Excess MA payments $10 billion March 2008 MedPAC report to the Congress, page 246.
Excess MA payments over 10 years Projected excess payments of $149 billion (2009-2017) CBO, Medicare Advantage: Private Health Plans in Medicare, June 28, 2007.

Medicare Part D

Category Statistics Source and Notes
# of beneficiaries in Part D Plans 25.4 million (2008) CMS, Prescription Drug Coverage Enrollment Information, Beneficiaries with Prescription Drug Coverage.
# of beneficiaries in stand-alone Prescription Drug Plans (PDP) 17.39 million (2008) CMS, Prescription Drug Coverage Enrollment Information, Beneficiaries with Prescription Drug Coverage.
# of beneficiaries in MA-PDs and other Medicare health plans with drug coverage 8.01 million (2008) CMS, Prescription Drug Coverage Enrollment Information, Beneficiaries with Prescription Drug Coverage.
# of beneficiaries with non-Medicare drug coverage (Government and private retirees) 14.19 million (2008) CMS, Prescription Drug Coverage Enrollment Information, Beneficiaries with Prescription Drug Coverage.
Average # Part D plans per state (2008) 54 plans per state

 

Low: 47 (Alaska)

High: 63 (Pennsylvania)

Kaiser Family Foundation, Prescription Drug Plans.
Average premium for PDP for 2008 $39.86 (2008)

 

$36.66 (2007)

Kaiser Family Foundation, Average Premium for PDPs.
% of PDPs with coverage in donut hole 29% (2008) Avalere, Beneficiaries and the 2008 Medicare Part D Marketplace, slide 21.
# of PDPs with brand name coverage in donut hole 1 plan (2008) Avalere, Beneficiaries and the 2008 Medicare Part D Marketplace, slide 21.
# of plans that are Low-Income Subsidy eligible 495 (2008)

 

483 (2007)

411 (2006)

Kaiser Family Foundation, Prescription Drug Plans that are Low-Income Subsidy Eligible.

Low-Income Medicare Beneficiaries

Category Statistics Source and Notes
# beneficiaries with incomes below 100% of the Federal Poverty Level 6.9 million (16%)  (2005) June 2008 MedPAC data book, page 25.
# beneficiaries with incomes 100%-125% of the Federal Poverty Level 3.9 million (9%)  (2005) June 2008 MedPAC data book, page 25.
# beneficiaries with incomes 125%-200% of the Federal Poverty Level 8.7 million (20%)  (2005) June 2008 MedPAC data book, page 25.
# of beneficiaries estimated eligible for LIS 12.5 million (2008)

 

13.2 million (2007)

CMS, Prescription Drug Coverage Enrollment Information, LIS Eligible Beneficiaries.
# of beneficiaries enrolled in LIS 9.4 million (2008) Kaiser Family Foundation, Low-Income Subsidy Recipients.
% of beneficiaries enrolled in LIS who are deemed through another program 84% (2008) CMS, Prescription Drug Coverage, 2008 Enrollment Information.
% of estimated eligible beneficiaries enrolled in QMB 33% CBO, A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit.
% of estimated eligible beneficiaries enrolled in SLMB 13% CBO, A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit.
# of dual eligibles 7.5 million (2006) Kaiser Family Foundation, Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries.
# LIS enrollees whose plan lost benchmark status 2.56 million (2008) CMS, Limited Income and Resources.
# LIS enrollees reassigned to a new plan with the same sponsor 965,482 (2008) CMS, Limited Income and Resources, Reassignment Data.
# LIS enrollees reassigned to a new plan with a different sponsor 1.15 million (2008) CMS, Limited Income and Resources, Reassignment Data.
# LIS enrollees who must choose a new plan 442,719 CMS, Limited Income and Resources, Chooser Data.

Connecticut

Category Statistics Source and Notes
# of people w/ Medicare 540,170 (2008) Kaiser Family Foundation, (KFF) Total Medicare Beneficiaries.
# of people w/ Medicare Advantage 54,825 (2007) KFF, Total Medicare Advantage Enrollment.
# of uninsured 353,092 (2006) Kaiser Family Foundation, Health Insurance Coverage of the Total Population.
% of uninsured who are from working families 33% (2006) Kaiser Family Foundation, Uninsured Rates for the Non-Elderly by Family Work Status.
% increase in workers premiums, 2000-2004 58.8% CT Health Care for All, 2004.
% increase in workers salaries, 2000-2004 14.4% CT Health Care for All, 2004
% decrease in residents with employer provided health insurance 5% (2005-2006) Universal Health Care Foundation of Connecticut, Eroding Employer-Based Health Insurance Highlights Need for Real, Fundamental Change.
% of people w/ Medicare who are 65 and older 87.3% (2004)

 

US 84.6%

Kaiser Family Foundation, Distribution of Medicare Beneficiaries by Eligibility Category.
% of people w/ Medicare who are disabled 12.7% (2004)

 

US 15.3%

Kaiser Family Foundation, Distribution of Medicare Beneficiaries by Eligibility Category.
# of people Medicare enrollees who are at or below 100% of the Federal Poverty Level 14% (2005-2006)

 

US 16%

Kaiser Family Foundation, Distribution of Medicare Enrollees by Federal Poverty Level.

Miscellaneous

Category Statistics Source and Notes
# of overall US populace w/ chronic conditions 133 million (2005) Partnership for Solutions, Chronic Conditions: Making the Case for Ongoing Care.
% of non-institutionalized Medicare beneficiaries with at least one chronic condition 87% (2002) Kaiser Medicare Chartbook 2005, page 5.
% of Medicare spending on people with chronic conditions 1 CC = 3%
2 CC = 6%
3 CC = 10%
4 CC = 12%
5+ CC = 68 %  (2004)

 

99% of Medicare expenditures are for beneficiaries with 1 or more chronic conditions

Partnership for Solutions, Chronic Conditions: Making the Case for Ongoing Care, page 27.
Average length of hospital stay for Medicare beneficiaries for short-stay hospitals 5.6 days (2006)

 

6.0 days (2000)

CMS Data Compendium, Utilization, "Medicare Short-Stay Hospital Utilization."
Average length of  skilled nursing facility stay for Medicare beneficiaries per discharge 34 days (2006)

 

31 days (2000)

CMS Data Compendium, State Data, "Medicare Skilled Nursing Facility Utilization by State."
Average reimbursement per skilled nursing facility discharge $10,304 (2006) CMS Data Compendium 2006, State Data, "Medicare Skilled Nursing Facility Utilization by State."
Average # of home health visits per episode 19 (2006)
Visits down 57% since 1997 (pre-prospective payment)
June 2008 MedPAC data book, page 131- 132.
Mean out-of-pocket spending, by income quintile for the elderly population, as a share of income   1970 1987 2002 Glenn Follette and Louise Sheiner, The Federal Reserve Board, "The Sustainability of Health Spending Growth," table 11.
1 10% 15% 19%
2 9% 12% 13%
3 7% 9% 7%
4 5% 6% 5%
5 2% 3% 2%

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