Medicare: An Overview

1. Figure 1
Gender Race/Ethnicity Age
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Selected Demographic Characteristics of Medicare
Beneficiaries, 2010
Male
45%
Female
55%
White
77%
Black
10%
Hispanic 9%
75-84
27%
<65
16%
65-74
44%
85+
13%
Other 5%

2. Figure 2
45%
34%
31%
26%
NOTE: ADL is activity of daily living.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Selected Measures of Health Status of the Medicare
Population, 2010
Percent of all Medicare beneficiaries:
4+ Chronic
Conditions
Functional
Impairment
(1+ ADL Limitations)
Cognitive/Mental
Impairment
Fair/Poor Health

3. Figure 3
25%: incomes below $14,400
50%: incomes below $23,500
5%: incomes above $93,900
NOTE: Total household income for couples is split equally between husbands and wives to estimate income for married
beneficiaries.
SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.
Distribution of Medicare Beneficiaries By Income, 2013

4. Figure 4
Percent of Traditional
Medicare population with:
3%
5%
9%
19%
78%
89%
NOTE: Analysis excludes beneficiaries enrolled in Medicare Advantage.
SOURCES: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Medicare Beneficiaries’ Utilization of Selected Medicare-
Covered Services, 2010
Prescription drug
use
Physician office visit
Inpatient hospital
stay
Home health visit
Skilled nursing
facility stay
Hospice days

5. Figure 5
Housing
$16,976
32.0%
$9,660
18.2% $2,772
5.2%
Food
$7,890
14.9%
Other
$15,702
29.6%
Housing
$11,673*
34.3%
$5,087*
15.0%
Health Care
$4,722*
13.9%*
Food
$5,189*
15.3%Other
$7,321*
21.5%*
NOTE: *Estimate statistically significantly different from the non-Medicare household estimate at the 95 percent confidence level.
SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense
Files, 2012.
Distribution of Average Household Spending by Medicare
and Non-Medicare Households, 2012
Transportation
Transportation
Health
Care
Non-Medicare Household SpendingMedicare Household Spending
Average Household Spending, 2012 =
$53,000
Average Household Spending, 2012 =
$33,993*

6. Figure 6
42%
$2,000
18%
14%
11%
6%
3%
3%
2%1%
58%
$2,746
NOTE: Analysis excludes beneficiaries enrolled in Medicare Advantage plans. Premiums includes Medicare Parts A and B and other
types of health insurance beneficiaries may have (Medigap, employer-sponsored insurance, and other public and private sources).
Estimates do not sum to total due to rounding.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Distribution of Average Total Out-of-Pocket Spending on
Services and Premiums by Medicare Beneficiaries, 2010
Average Total Out-of-Pocket Spending on Services and Premiums, 2010: $4,745
Long-term care facility
Medical providers and
supplies
Prescription drugs
Dental
Inpatient hospital
Skilled nursing facility
Outpatient hospital
Home health
Premiums Services

7. Figure 7
$2,297 $2,274 $2,093
$1,537 $1,291 $948
$2,098 $2,402 $2,264
$1,797 $1,858
$2,649
$4,230
$4,246
$2,074
$1,956
$2,845
$6,012
$4,094 $4,131
$4,742
$5,767 $5,537
$3,023
$4,054
$5,247
$8,276
Excellent Very good Good Fair Poor Under 65 65-74 75-84 85+
Services
Premiums
NOTE: Analysis excludes beneficiaries enrolled in Medicare Advantage plans. Premiums includes Medicare Parts A and B and other
types of health insurance beneficiaries may have (Medigap, employer-sponsored insurance, and other public and private sources).
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Medicare Beneficiaries’ Average Total Out-of-Pocket
Spending on Services and Premiums, by Self-Reported
Health Status and Age, 2010
AgeHealth status

8. Figure 8
NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,680 for LIS
enrollees), which corresponds to True Out-of-Pocket (TrOOP) spending of $4,700 (the amount used to determine when an enrollee
reaches the catastrophic coverage threshold.
SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit for 2015 (standard benefit parameter update
from Centers for Medicare & Medicaid Services, 2014). Amounts rounded to nearest dollar.
Standard Medicare Prescription Drug Benefit, 2015
Deductible = $320
Initial Coverage
Limit = $2,960 in
Total Drug Costs
Plan pays 75%
Plan pays 15%; Medicare pays 80%Enrollee
pays 5%
Enrollee
pays
25%
Catastrophic
Coverage Limit =
$7,062 in
Estimated
Total Drug Costs*Brand-name drugs
Enrollee pays 45%
Plan pays 5%
50% manufacturer discount
Generic drugs
Enrollee pays 65%
Plan pays 35%
INITIAL
COVERAGE
PERIOD
COVERAGE
GAP
(“Doughnut Hole”)
CATASTROPHIC
COVERAGE
DEDUCTIBLE Enrollee pays 100%

9. Figure 9
Part D non-LIS
enrollees
26.6 million
49%
Part D LIS
enrollees
11.5 million
21%
Employer subsidy
2.6 million
All other
13.3 million
25%
NOTE: LIS is low-income subsidy. Total Part D and Medicare enrollment based on 2014 intermediate estimates. Part D non-LIS
enrollment includes enrollees in employer/group waiver plans (6.8 million in 2014).
SOURCE: Kaiser Family Foundation analysis of data from the 2014 Annual Report of the Boards of Trustees of the Federal Hospital
Insurance and Federal Supplementary Medical Insurance Trust Funds.
Distribution of Sources of Prescription Drug Coverage
Among Medicare Beneficiaries, 2014
Total Medicare Enrollment, 2014 = 54.0 million
Total Part D Enrollment (excluding employer plans), 2014 = 38.1 million
5%

10. Figure 10
6.9 6.8
6.2
5.6 5.3 5.3 5.6
6.8
8.4
9.7
10.5
11.1
11.9
13.1
14.4
15.7
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
NOTE: Includes MSAs, cost plans, demonstration plans, and Special Needs Plans as well as other Medicare Advantage plans.
SOURCE: MPR/Kaiser Family Foundation analysis of CMS Medicare Advantage enrollment files, 2008-2014, and MPR, “Tracking
Medicare Health and Prescription Drug Plans Monthly Report,” 1999-2007; enrollment numbers from March of the respective year,
with the exception of 2006, which is from April.
Medicare Private Plan Enrollment, 1999-2014
In millions:
% of Medicare
Beneficiaries
18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28% 30%

11. Figure 11
NOTE: Includes MSAs, cost plans and demonstrations. Includes Special Needs Plans as well as other Medicare Advantage plans.
SOURCE: MPR/Kaiser Family Foundation analysis of CMS State/County Market Penetration Files, 2014.
Share of Medicare Beneficiaries Enrolled in Medicare
Advantage Plans by State, 2014
National Average, 2014 = 30%
< 10% 10% - 19% 20% - 29% 30% - 39% ≥40%
(6 states) (12 states + DC) (14 states) (15 states) (3 states)
DC 11%
36%
24%
0%
38% 19%
38% 36%
24%
7%
38%
28%
46%
33%
16% 22%
14%
13% 24%
28%
20%
9%
20%51%
13%
26%
17%
13%
33%
6%
15%
30%
35%
28%
14%
38%
16%
43%
39%
22%
15%
32%
29%
34%
7%
15%
29%
24%
35%
30%
3%

12. Figure 12
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Distribution of Sources of Supplemental Coverage Among
Medicare Beneficiaries, 2010
Total Medicare Beneficiaries, 2010 = 48.4 Million
15%
4%
26%
3%
15%
4%
13%
6%
14%
Employer-sponsored +
Medigap
Medicare Advantage +
Medicaid
Medicare Advantage +
Employer-sponsored
Other coverage/
combinations
No supplemental
coverage
Medicare Advantage only
Medicaid only
Medigap only
Employer-sponsored
only

13. Figure 13
66%
46%
36%
40% 40% 40%
34%
37%
35% 36% 35%
32%
34%
32%
29% 28%
26% 26% 25%
28%
25%
1988 1991 1993 1995 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
NOTE: Tests found no statistical difference from estimate for the previous year shown (p<.05). No statistical tests are conducted
for years prior to 1999.
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2014; KPMG Survey of Employer-Sponsored Health
Benefits, 1991, 1993, 1995, 1998; The Health Insurance Association of America (HIAA), 1988.
Percent of Large Firms (200+ Workers) Offering Retiree
Health Benefits to Active Workers, 1988-2014

14. Figure 14
SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from the Chronic Conditions Data
Warehouse, 2010, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on FY2010 MSIS.
Number of Beneficiaries Enrolled in Medicare, Medicaid,
and Both Programs, 2010
Dually
eligible
10 million
Medicare
40 million
Medicaid
56 million
Total Medicare beneficiaries, 2010:
50 million
Total Medicaid beneficiaries, 2010:
66 million

15. Figure 15
80%
66%
86%
66%
20%
34%
14%
34%
Dual-eligible beneficiaries Non-dual eligible beneficiaries
SOURCE Medicare Payment Advisory Commission and Medicaid and CHIP Payment and Access Commission, Data Book:
Beneficiaries Dually Eligible for Medicare and Medicaid (January 2015).
Dual-Eligible Beneficiaries as a Share of Medicare and
Medicaid Enrollment and Spending, 2010
Total Medicare
spending, 2010:
$498.9 Billion
Total Medicare
enrollment, 2010:
48.9 million
Total Medicaid
spending, 2010:
$340.5 billion
Total Medicaid
enrollment, 2010:
67.2 Million
Medicare Medicaid

16. Figure 16
2%
11%
22%
25%
63%
17%
39%
48%
56%
70%
LTC resident
Under age 65
fp health
cm impair
3+ Chronic
Conditions
Dual-eligible
Medicare
beneficiaries
All other
Medicare
beneficiaries
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Comparison of Characteristics of Dual-Eligible Medicare
Beneficiaries and All Other Medicare Beneficiaries
Percent of beneficiaries:
3+ chronic conditions
Cognitive/mental
impairment
Fair or poor health
Under age 65
Long-term care facility
resident

17. Figure 17
26%
14%
18%
10%
7%
13%
12%
Less than $2,500
$2,500-$5,000
$5,000-$10,000
$10,000-$15,000
$15,000-$20,000
$20,000-$40,000
$40,000 or more
SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from the Chronic Conditions Data
Warehouse, 2010.
Distribution of Dual-Eligible Medicare Beneficiaries, by
Amount of Medicare Spending, 2010
Average Spending, 2010 = $17,745
Median Spending, 2010 = $7,464

18. Figure 18
6%
17%
4%
10%
5%
3%
3%
13%
<65
65+
<$20,000
$20,000-$39,999
>$40,000
Exc./V. Good/Good
Fair/Poor
NOTE: Excludes respondents who did not have Medicare eligibility for the full calendar year, such as new enrollees and
decedents. Also excludes respondents who did not indicate incomes within specified ranges. All subgroup estimates are
statistically significantly different from ‘overall’ estimate.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2012 Access to Care file.
Measures of Access to Care Among Medicare
Beneficiaries by Demographic Characteristics, 2012
During the past year, percent of beneficiaries reporting that they…
Overall
Age
Income
Health
Status
11%
28%
8%
18%
11%
5%
7%
22%
…delayed getting health care due to cost…had trouble getting needed care

19. Figure 19
91%
91%
72%*
71%*
47%*
Medicare
Private non-capitated
Private capitated
Medicaid
Uninsured
NOTE: Pediatricians were excluded from Medicare and private non-capitated insurance categories. Physicians who did not respond
to relevant survey questions were also excluded. The survey did not ask responding physicians to distinguish Medicare Advantage
plans from traditional Medicare or other private insurance. Acceptance rates for patients with insurance status of self-pay or
worker’s compensation are not shown. *Indicates difference from Medicare is statistically significant at the 95% confidence level.
SOURCE: Kaiser Family Foundation analysis of National Ambulatory Medical Care Survey, National Electronic Health Records
Survey, 2012.
Percent of Office-Based Physicians Accepting New Patients
with Medicare and Other Types of Insurance, 2012

20. Figure 20
NOTE: Pediatricians are excluded from this analysis. Physicians were not asked to distinguish between patients in traditional
Medicare and Medicare Advantage plans.
SOURCE: Kaiser Family Foundation analysis of National Ambulatory Medical Care Survey, National Electronic Health Records
Survey, 2012.
Percent of Physicians Accepting New Medicare Patients by State,
2012
DC 83%
79%
87%
80%
86% 94%
89% 82%
91%
97%
98%
93%
84%
88%
94% 92%
93%
90% 94%
86%
81%
84%
92%92%
93%
94%
93%
92%
90%
86%
94%
81%
90%
95%
97%
90%
84%
79%
90%
95%
95%
93%
92%
88%
80%
87%
89%
84%
95%
91%
94%
≤80% 81% - 89% ≥90%
(4 states) (16 states, DC) (30 states)

21. Figure 21
NOTE: Medicare Shared Savings Programs (MSSPs) include 35 Advanced Payment Model participants. Two MSSP participants in
Puerto Rico are not displayed on the map.
SOURCE: Kaiser Family Foundation analysis of data on ACOs, as of March 4, 2015 from Data.CMS.gov.
Accountable Care Organizations (ACOs) in Medicare, 2015
Pioneer ACO participants
Medicare Shared Savings Program participants

22. Figure 22
NOTES: National readmission rates include Medicare fee-for-service unplanned hospitalizations for any cause within 30 days of
discharge from an initial hospitalization for either heart failure, heart attach, or pneumonia. Rates are risk-adjusted for certain
patient characteristics, such as age and other medical conditions.
SOURCE: Kaiser Family Foundation analysis of CMS Hospital Compare data files.
Medicare Hospital Readmission Rates, 2005-2013
24.5 24.7 24.8 24.7
23.0 22.7
19.9 19.9 19.8 19.7
18.3
17.8
18.2 18.3 18.4 18.5
17.6 17.3
15
16
17
18
19
20
21
22
23
24
25
26
July 2005-
June 2008
July 2006-
June 2009
July 2007-
June 2010
July 2008-
June 2011
July 2009-
June 2012
July 2010-
June 2013
NationalAverageReadmissionRate(%)
Performance (measurement) Time Period
Heart Failure
Heart Attack
Pneumonia
Diagnosis of initial
hospitalization

23. Figure 23
Other2
12%
Nondefense
Discretionary
17%
Defense
17%
Social Security
24%
Medicare1
14%
Medicaid,
Exchange
subsidies,
CHIP
9%
Net
Interest
7%
NOTE: All amounts are for federal fiscal year 2014. 1Consists of Medicare spending minus income from premiums and other
offsetting receipts. 2Other category includes spending on other mandatory outlays minus income from offsetting receipts).
SOURCE: Congressional Budget Office, Budget and Economic Outlook: 2015 to 2025 (January 2015).
Distribution of Federal Outlays, 2014
Total Federal Outlays, 2014 = $3.5 Trillion
Net Federal Medicare Outlays, 2014 = $505 Billion

24. Figure 24
Medicare
Advantage
26%
Hospital
Inpatient
Services
23%Physician
Payments
12%
Outpatient
Prescription
Drugs
11%
Hospital
Outpatient
Services
7%
Skilled
Nursing
Facilities
5%
Home
Health
3%
Other
Services*
14%
NOTE: *Other services includes ambulance services, ambulatory surgical centers, community mental health centers, durable
medical equipment, federally qualified health centers, hospice, hospital outpatient services not paid for using the outpatient
prospective payment system, outpatient dialysis, outpatient therapy services, lab services, rural health clinics, Part B drugs; also
includes amounts paid to providers and recovered.
SOURCE: Kaiser Family Foundation analysis of data from Congressional Budget Office, 2015 Medicare Baseline (March 2015).
Distribution of Medicare Benefit Payments, 2014
Total Medicare Benefit Payments, 2014 = $597 billion

25. Figure 25
90%
42%
10%
58%
NOTE: Excludes Medicare Advantage enrollees.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.
Distribution of Traditional Medicare Beneficiaries and
Medicare Spending, 2010
Total Number of Traditional
Medicare Beneficiaries, 2010:
36.3 million
Total Traditional
Medicare Spending, 2010:
$385 billion
Average per capita
Traditional Medicare
spending: $10,584
Average per capita
Traditional Medicare
spending among
top 10%: $61,722
Average per capita
Traditional Medicare
spending among
bottom 90%: $4,897

26. Figure 26
22%
43%
28% 26%
22% 22%
<1%
Total
Services
Home
Health Care
Prescription
Drugs
Hospital
Services
Physician
Services
Nursing
Home Care
Dental
Services
NOTE: Total also includes durable medical equipment, other professional services, and other personal health care/products.
Medicare spending does not exclude income from premiums and other offsetting receipts. Medicare coverage of nursing home
care reflects spending on freestanding skilled nursing facilities only (not custodial long-term care services).
SOURCE: Kaiser Family Foundation analysis of data from Centers for Medicare & Medicaid Services, Office of the Actuary, National
Health Statistics Group, National Health Expenditures Tables (December 2014).
Percent of Personal Health Expenditures Accounted for by
Medicare, 2013
Expenditures in Billions
Medicare $551 $34 $75 $243 $130 $35 $0.5
Total $2,469 $80 $271 $937 $587 $156 $111

27. Figure 27
$446
$480 $466 $492 $505 $527
$560 $562 $574
$642
$688
$738
$833 $852 $866
$981
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
NOTE: All amounts are for federal fiscal years; amounts are in billions and consist of Medicare spending minus income from
premiums and other offsetting receipts.
SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, Updated Budget Projections: 2015 to 2025
(March 2015); The 2014 Long-Term Budget Outlook (July 2014).
Medicare Spending and Percent of Federal Outlays and
GDP, 2010-2025
12.9% 13.3% 13.2% 14.2% 14.4% 14.3% 14.3% 13.9% 13.6% 14.3% 14.5% 14.8% 15.8% 15.8% 15.2% 16.2%
Share of:
Federal
Outlays
Actual Net Outlays Projected Net Outlays
3.0% 3.1% 2.9% 3.0% 2.9% 2.9% 3.0% 2.9% 2.8% 3.0% 3.1% 3.2% 3.4% 3.4% 3.3% 3.6%GDP

28. Figure 28
5.5%
6.1%
2.9%
2.4%
3.7%
4.7%
3.5%
2.2%
NOTE: *Assumes 0.6-percent physician payment rate increase from 2016 through 2023, consistent with the average update over
the 10-year period ending with March 31, 2015; based on the spending data from the 2014 Medicare Trustees report.
SOURCE: Kaiser Family Foundation analysis of Medicare spending data from Boards of Trustees and Congressional Budget Office
(CBO); private health insurance spending data from the CMS National Health Expenditure data; GDP data from CBO and U.S.
Census Bureau, and CPI data from the Bureau of Labor Statistics (historical) and CBO (projected).
Historical and Projected Average Annual Growth Rate in
Medicare Per Capita Spending and Other Measures
Actual (2000-2013) Projected (2014-2023)
Medicare
per capita
spending
Private health
insurance
per capita
spending
GDP
per capita
CPI Medicare
per capita
spending*
Private health
insurance
per capita
spending
GDP
per capita
CPI

29. Figure 29
$575.8 billion $251.1 billion $255.0 billion $69.7 billion
3% 5% 2%2%
6%2% 13%
13% 1%
25%
14%
38%
88%
41%
73% 73%
TOTAL Part A Part B Part D
General revenue
Payroll taxes
Beneficiary
premiums
State payments
Taxation of Social
Security benefits
Interest and other
SOURCE: Kaiser Family Foundation based on data from 2014 Annual Report of the Boards of Trustees of the Federal Hospital
Insurance and Federal Supplementary Medical Insurance Trust Funds.
Sources of Medicare Revenue, 2013

30. Figure 30
2020
2018
2019 2019
2017
2029
2024 2024
2026
2030
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
SOURCE: Intermediate projections from 2005-2014 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and
Federal Supplementary Medical Insurance Trust Funds.
Solvency of the Medicare Part A Hospital Insurance Trust
Fund
Year of Medicare Trustees Report

31. Figure 31
39.7
47.7
64.4
81.8
89.2
92.8
4.0
3.4
2.8
2.3 2.2 2.3
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
0
10
20
30
40
50
60
70
80
90
100
2000 2010 2020 2030 2040 2050
Number of beneficiaries (in millions)
Number of workers per beneficiary
SOURCE: Kaiser Family Foundation based on the 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance
and Federal Supplementary Medical Insurance Trust Funds.
Number of Medicare Beneficiaries and Number of Workers
Per Beneficiary, 2000-2050
In millions