Medicare: The Essentials

884 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
884
On SlideShare
0
From Embeds
0
Number of Embeds
86
Actions
Shares
0
Downloads
23
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 1767, 2561
  • 2569
  • 1790
  • 1790
  • 1927
  • 2590/2592
  • 2584
  • 1795
  • 1800,2585, 2951
  • 1804
  • 1807
  • 2594, 2956
  • 1812
  • Medicare: The Essentials

    1. 1. 19.1 20.5 22.825.528.231.0 33.2 34.3 35.8 36.3 37.0 37.9 38.8 39.6 40.5 41.9 43.32.23.02.93.34.45.46.7 7.0 7.3 7.5 7.8 8.0 8.48.58.719.1 20.525.028.531.134.237.639.642.5 43.3 44.3 45.4 46.5 47.7 48.850.452.01966 1970 1975 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013Nonelderly Disabled (Under Age 65) Elderly (Age 65 and Older)NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare prior to 1972.SOURCE: Centers for Medicare & Medicaid Services, Medicare Enrollment: Hospital Insurance and/or Supplemental Medical InsurancePrograms for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2011: Selected Calendar Years 1966-2011; 2012-2013, HHS Budgetin Brief, FY2014.Medicare Enrollment, 1966 - 2013
    2. 2. SOURCE: Calculation based on Kaiser Family Foundation analysis of the CMS State/County Market Penetration file, March 2012;and 2011 population estimates from the United States Census Bureau.Medicare Beneficiaries as a Percent of StatePopulations, 2012National Average, 2012 = 16%10% - 14% 15% – 16% 17% – 18% 19% – 21%8 states, DC 18 states 19 states 5 statesDC13%18%18%10%15% 19%13% 13%16%17%19%13%16%15%15%16%17%16% 18%16%21%14%17%15%17%17%18%16%14%18%16%16%16%16%16%17%17%17%18%18%17%17%12%11%19%15%15%21%15%17%18%
    3. 3. 20.424.928.431.134.337.6 39.742.647.755.664.373.581.586.51970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary MedicalInsurance Trust Funds.Medicare Enrollment, 1970 – 2035Historical ProjectedIn millions:
    4. 4. 1.9%3.0%2.4%0.9%0.4%39.747.764.381.588.9 92.40%1%2%3%4%5%6%7%8%9%10%01020304050607080901002000 2010 2020 2030 2040 2050SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary MedicalInsurance Trust Funds.Projected Change in Medicare Enrollment, 2000-2050Medicare Enrollment(in millions)Average AnnualGrowth in Enrollment
    5. 5. 50%50%40%27%23%20%17%15%13%5%NOTE: ADL is activity of daily living.SOURCE: Urban Institute and Kaiser Family Foundation analysis, 2012; Kaiser Family Foundation analysis of the Centers forMedicare & Medicaid Services Medicare Current Beneficiary 2009 Cost and Use file.Characteristics of the Medicare PopulationPercent of total Medicare population:Income below $22,502Savings below $77,4823+ Chronic ConditionsFair/Poor HealthCognitive/MentalImpairmentDually Eligible forMedicare and MedicaidUnder-65 Disabled2+ ADL LimitationsAge 85+Long-term CareFacility Resident
    6. 6. $22,502$24,797$15,252$13,805$16,183$23,809$22,699$17,410$24,625$20,920Total White Black Hispanic Underage 65Age65-74Age75-84Age 85or olderMale FemaleSOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.Median Income Among Medicare Beneficiaries, Overalland by Race/Ethnicity and Age, 2012Race /Ethnicity Age Gender
    7. 7. 25% had incomes below $14,00050% had incomes below $22,5005% had incomes above $88,900NOTE: Total household income for couples is split equally between husbands and wives to estimate income for marriedbeneficiaries.SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.Distribution of Medicare Beneficiaries by IncomeLevel, 2012
    8. 8. Percent of total Medicare population:2%5%9%19%28%77%SOURCES: Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009Cost and Use file.Medicare Beneficiaries’ Utilization of Selected Medicaland Long-Term Care Services, 2009Physician Office VisitEmergency Room VisitInpatient Hospital StayHome Health VisitSkilled NursingFacility StayHospice Visits
    9. 9. NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-LIS enrollees ($6,734 for LIS enrollees), whichcorresponds to TrOOP spending of $4,750.SOURCE: Kaiser Family Foundation illustration based on CMS standard benefit parameter update for 2013. Amounts rounded tonearest dollar.Standard Medicare Prescription Drug Benefit, 2013Deductible = $325Initial CoverageLimit = $2,970 inTotal Drug CostsPlan pays 75%Plan pays 15%; Medicare pays 80%Enrolleepays 5%Enrolleepays25%CatastrophicCoverage Limit =$6,733.75* inEstimatedTotal Drug CostsBrand-name drugsEnrollee pays 47.5%;Plan pays 2.5%50% manufacturer discountGeneric drugsEnrollee pays 79%;Plan pays 21%INITIALCOVERAGEPERIODCOVERAGEGAPCATASTROPHICCOVERAGEDEDUCTIBLE
    10. 10. SOURCE: Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services (CMS) PDP landscape source file, 2013.Number of Medicare Part D Stand-Alone PrescriptionDrug Plans, by State, 201323 – 29 plans 30 – 31 plans 32 plans 33 – 38 plans12 states, DC 18 states 13 states 7 statesU.S. Total, 2013= 1,031DC2930332329 3032 2930293430233232 313231 323028293032293132322928293028303233313038313233323230313038323033
    11. 11. Part D non-LISenrollees21.7 million43%Part D LISenrollees11.0 million22%Employer subsidy4.5 millionAll other13.5 million26%SOURCE: 2012 Medicare Trustees report.NOTE: LIS is low-income subsidy. Total Part D and Medicare enrollment based on 2012 intermediate estimates.Prescription Drug Coverage Among MedicareBeneficiaries in 2012Total Medicare Enrollment in 2012 = 50.7 millionTotal Part D Enrollment (excluding employer subsidy) = 32.7 million9%
    12. 12. 6.9 6.86.25.6 5.3 5.3 5.66.88.49.710.511.111.913.114.41999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013NOTE: 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, 2008-2013, and MPR, “TrackingMedicare Health and Prescription Drug Plans Monthly Report,” 2001-2007; enrollment numbers from March of the respectiveyear, with the exception of 2006, which is from April.Total Medicare Private Health Plan Enrollment, 1999-2013In millions:% of MedicareBeneficiaries18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28%
    13. 13. TraditionalFee-for-serviceMedicare72%HMO 65%Local PPO 22%Regional PPO 7%PFFS 3%Other 3%MedicareAdvantage28%NOTE: PFFS is Private Fee-for-Service plans, PPOs are preferred provider organizations, and HMOs are Health MaintenanceOrganizations. Other includes MSAs, cost plans, and demonstration plans. Includes enrollees in Special Needs Plans as well asother Medicare Advantage plans.SOURCE: MPR / KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage enrollment files, 2013.Distribution of Enrollment in Medicare AdvantagePlans, by Plan Type, 2013Total Medicare Advantage Enrollment, 2013 = 14.4 Million
    14. 14. 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, 2013.Share of Medicare Beneficiaries Enrolled in MedicareAdvantage Plans, by State, 2013National Average, 2013 = 28%< 10% 10% - 19% 20% - 29% ≥30%(6 states) (14 states + DC) (15 states) (15 states)DC 10%35%22%0%38% 17%37% 35%23%7%36%25%46%30%11% 21%14%12% 22%26%17%8%18%49%12%24%15%12%32%5%16%29%33%20%12%37%16%42%39%20%13%29%27%33%7%15%28%21%3%33%27%
    15. 15. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2008, and Kaiser Commission on Medicaidand the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.Dually eligible beneficiaries comprise 20% of the Medicarepopulation and 15% of the Medicaid population, 2008DualEligibles9 millionMedicare37 millionMedicaid51 millionTotal Medicare beneficiaries, 2008:46 millionTotal Medicaid beneficiaries, 2008:60 million
    16. 16. 20%31%15%39%80%69%85%61%SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2008, and KaiserCommission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.Dual eligible beneficiaries as a share of Medicare andMedicaid population and spending, 2008Total MedicareSpending, 2008:$424 BillionTotal MedicarePopulation, 2008:46 MillionTotal MedicaidSpending, 2008:$330 BillionTotal MedicaidPopulation, 2008:60 MillionDual Eligibles as a Share of theMedicare Population and MedicareSpending, 2008:Dual Eligibles as a Share of theMedicaid Population and MedicaidSpending, 2008:
    17. 17. Employer-Sponsored31%MedicareAdvantage25%Medigap15%Medicaid15%Other Public/Private1%12%NOTE: Numbers do not sum due to rounding.SOURCE: Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009Cost and Use file.Sources of Supplemental Coverage Among MedicareBeneficiaries, 2009Total Number of Beneficiaries, 2009: 47.2 MillionNo SupplementalCoverage
    18. 18. 11.9% 11.8% 12.0%12.8%14.0%14.9%15.5% 15.6% 15.6%16.2%5.5% 5.3% 5.4% 5.5%6.0%6.5% 6.7% 6.9%7.4%8.0%4.1% 4.2% 4.4%4.9% 5.2% 5.5% 5.8% 5.6% 5.5% 5.4%0%2%4%6%8%10%12%14%16%18%1997 1998 1999 2000 2001 2002 2003 2004 2005 2006NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures. Annual amounts for thecomponents of total health care spending do not sum to total amounts because values shown are median, not mean, values.SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use files, 1997-2006.Median Out-of-Pocket Health Care Spending As a Percentof Income Among Medicare Beneficiaries, 1997–2006Total health careout-of-pocketPremiumout-of-pocketNonpremiumout-of-pocket
    19. 19. 11.9% 11.8% 12.0% 12.8% 14.0% 14.9% 15.5% 15.6% 15.6% 16.2%23.9% 23.9% 24.9% 26.2% 27.4%29.2% 29.9% 30.1% 29.9% 30.1%47.5% 49.1% 50.0%51.8%56.3%59.2% 58.4% 59.8%57.9% 57.8%0%10%20%30%40%50%60%70%1997 1998 1999 2000 2001 2002 2003 2004 2005 2006NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures.SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use files, 1997-2006.Out-of-Pocket Health Care Spending As a Percent ofIncome Among Medicare Beneficiaries, By SpendingPercentile, 1997–200690th percentile75th percentile50th percentile(median)
    20. 20. NOTE: SMI is Supplementary Medical Insurance. Out-of-pocket spending includes SMI (Part B and Part D) premiums and out-of-pocket cost-sharing expenses for SMI covered services.SOURCE: Kaiser Family Foundation analysis based on data from 2012 Annual Report of the Boards of Trustees of the FederalHospital Insurance and Federal Supplementary Medical Insurance Trust Funds.Part B and Part D Out-of-Pocket Spending as a Share ofAverage Social Security Benefit, 1970 – 2010Average Monthly Social Security benefit payment$604 $772 $906 $1,001 $1,151Average monthly out-of-pocket spending on Part B and Part D$39 $53 $111 $136 $2996% 7% 12% 14%26%1970 1980 1990 2000 2010
    21. 21. Distribution of Average Household Spending byMedicare and Non-Medicare Households, 2010Housing$10,94036%$4,10613%$4,52715%Food$4,76615%Other$6,48021%SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and ExpenseFiles, 2010.Non-Medicare Household SpendingMedicare Household SpendingAverage Household Spending =$49,641Average Household Spending =$30,818Health CareTransportationHousing$16,82434%$8,18816% $2,450Food$7,36415%Other$14,81530%HealthCare5%Transportation
    22. 22. Other213%NondefenseDiscretionary17%Defense19%Social Security22%Medicare116%Medicaid7%Net Interest6%NOTE: FY is fiscal year. 1Amount for Medicare excludes offsetting premium receipts (premiums paid by beneficiaries, amount paidto providers and later recovered, and state contribution (clawback) payments to Medicare Part D). 2Other category includes othermandatory outlays, offsetting receipts, and negative outlays for Troubled Asset Relief Program (TARP).SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.Medicare as a Share of the Federal Budget, 2012Total Federal Spending, FY2012 = $3.5 TrillionFederal Spending on Medicare, FY 2012 = $551 Billion
    23. 23. $586 $597 $615$671 $695 $722$794$849$911$1,018$1,0642013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.Projected Medicare Spending, 2013 – 2023In billions:
    24. 24. 8.5%12.1%15.1%16.9%1990 2000 2010 2020SOURCE: CBO Budget and Economic Outlook, January 2011 (for 1990-2010 data) and May 2013 (for 2020 data).Medicare as a share of Federal Budget Outlays, and asa share of Gross Domestic Product (GDP), 1990-20201.9%2.2%3.6% 3.7%1990 2000 2010 2020Medicare Spending as a Shareof Federal Budget OutlaysMedicare Spending as a Shareof Gross Domestic Product (GDP)Total Federal Outlays (trillions)$1.3 $1.8 $3.5 $5.0Gross Domestic Product (trillions)$5.7 $9.8 $14.5 $22.9
    25. 25. NOTE: Excludes administrative expenses and is net of recoveries. *Includes hospice, durable medical equipment, Part Bdrugs, outpatient dialysis, ambulance, lab services, and other services.SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.Medicare Benefit Payments By Type of Service, 2012Total Benefit Payments = $536 billionHospitalInpatientServices26%5%PhysicianPayments13%6%4%OtherServices13%MedicareAdvantage23%OutpatientPrescriptionDrugs10%Home HealthHospital OutpatientServicesSkilled NursingFacilityPart APart BPart A and BPart CPart D
    26. 26. 21%44%28%25% 24% 24%TotalServices*Home HealthCareHospitalServicesPrescriptionDrugsPhysicianServicesNursing HomeCareNOTE: Total also includes dental care, durable medical equipment, other professional services, and other personal health care/products.SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, 2011 National Health Expenditure. Projections 2011-2021.Medicare’s Share of National Personal HealthExpenditures, by Type of Service, 2012Expenditures in BillionsMedicare $591 $34 $250 $69 $131 $38Total $2,809 $78 $885 $277 $550 $155
    27. 27. 90%43%10%57%NOTES: Excludes Medicare Advantage enrollees. Includes noninstitutionalized and institutionalized beneficiaries.SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2009.Distribution of Traditional Medicare Beneficiaries andMedicare Spending, 2009Total Number of TraditionalMedicare Beneficiaries:35.4 millionTotal TraditionalMedicare Spending:$343 billionAverage per capitaTraditional Medicarespending: $9,702Average per capitaTraditional Medicarespending amongtop 10%: $55,763Average per capitaTraditional Medicarespending amongbottom 90%: $4,584
    28. 28. 0%5%10%15%20%25%1970 1975 1980 1985 1990 1995 2000 2005 2010Medicare (Average Annual Growth, 1970-2011 = 7.9%)Private Health Insurance (Average Annual Growth, 1970-2011 = 9.1%)NOTE: Comparison includes benefits commonly covered by Medicare and Private Health Insurance. These benefits are hospitalservices, physician and clinical services, other professional services and durable medical products.SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group: National HealthExpenditure Historical Data, 2013.Annual Change in Per Enrollee Medicare and PrivateHealth Insurance Spending, 1970-2011MedicarePrivate Health Insurance
    29. 29. $536.9 billion $243.0 billion $227.0 billion $66.9 billion4% 6% 2%3%8%2%13%13% 1% 26%12%38%85%40%72% 75%TOTAL Part A Part B Part DGeneral revenuePayroll taxesBeneficiarypremiumsState paymentsTaxation of SocialSecurity benefitsInterest and otherSOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary MedicalInsurance Trust Funds.Estimated Sources of Medicare Revenue, 2012
    30. 30. 6.6%6.9%2.9%2.5%3.2%5.0%4.1%2.1%NOTE: *Assumes no reduction in physician fees under Medicare between 2012 and 2021.SOURCES: Kaiser Family Foundation analysis of data from Boards of Trustees, Congressional Budget Office, Centers for Medicare &Medicaid Services, U.S. Census Bureau.Historical and Projected Average Annual Growth Ratein Medicare Spending Per Capita and Other MeasuresActual (2000-2011) Projected (2012-2021)Medicarespendingper capitaPrivate healthinsurancespendingper capitaGDPper capitaCPI Medicarespendingper capita*Private healthinsurancespendingper capitaGDPper capitaCPI
    31. 31. $-$50$100$150$200$2502012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary MedicalInsurance Trust Funds.Medicare Part A Trust Fund Balance at Year End, 2012-2026In billions:
    32. 32. 1312131981112121515232828251610456761014131422026202420242029201720192019201820202019202620302029202520152008200120012001200119992002200520031994197220132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019801970NOTES: ‘Insolvency’ refers to the depletion of the trust fund. No insolvency projections were made for 1973-1975 and 1989. For allother years not displayed, the Hospital Insurance Trust Fund was projected to remain solvent for 17 or fewer years.SOURCE: Intermediate projections from 1970-2013 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance andFederal Supplementary Medical Insurance Trust Funds.Solvency Projections of the Medicare Part A TrustFund, 1970-2013Year ofTrustees’ReportProjected Number of Years to Insolvency and Projected Year of Insolvency:

    ×