Figure 1 Selected Demographic Characteristics of Medicare Beneficiaries

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

Figure 2 Selected Measures of Health Status of the Medicare Population, 2010 Percent of all Medicare beneficiaries: 4+ Chronic Conditions 45% Functional Impairment (1+ ADL Limitations) 34% Cognitive/Mental Impairment Fair/Poor Health 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.

Figure 3 Distribution of Medicare Beneficiaries By Income, 2013 5%: incomes above $93, 900 50%: incomes below $23, 500 25%: incomes below $14, 400 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.

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

Figure 5 Distribution of Average Household Spending by Medicare and Non-Medicare Households, 2012 Medicare Household Spending Housing $11, 673* 34. 3% Transportation $5, 087* 15. 0% Other $7, 321* 21. 5%* Health Care $4, 722* 13. 9%* Food $5, 189* 15. 3% Average Household Spending, 2012 = $33, 993* Non-Medicare Household Spending Housing $ 16, 976 32. 0% Transportation Health $ 9, 660 $ 2, 772 Care 18. 2% 5. 2% Food $ 7, 890 14. 9% Other $ 15, 702 29. 6% Average Household Spending, 2012 = $53, 000 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.

Figure 6 Distribution of Average Total Out-of-Pocket Spending on Services and Premiums by Medicare Beneficiaries, 2010 Premiums 42% $2, 000 Services 58% $2, 746 18% Long-term care facility 14% Medical providers and supplies 11% Prescription drugs 6% 3% 3% 2% 1% Dental Inpatient hospital Skilled nursing facility Outpatient hospital Home health Average Total Out-of-Pocket Spending on Services and Premiums, 2010: $4, 745 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.

Figure 7 Medicare Beneficiaries’ Average Total Out-of-Pocket Spending on Services and Premiums, by Self-Reported Health Status and Age, 2010 $ 8, 276 Total Services $ 5, 767 $ 5, 537 $ 5, 247 $ 4, 742 $ 4, 094 $ 1, 797 $ 4, 131 $ 1, 858 $ 6, 012 $ 4, 054 $ 2, 649 $ 4, 230 $ 4, 246 $ 3, 023 $ 2, 845 $ 1, 956 $ 2, 074 $ 2, 297 Excellent $ 2, 274 Very good $ 2, 093 Good Health status $ 1, 537 $ 1, 291 Fair Poor $ 2, 098 $ 948 Under 65 65 -74 Age $ 2, 402 $ 2, 264 75 -84 85+ 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.

Figure 8 Standard Medicare Prescription Drug Benefit, 2015 CATASTROPHIC COVERAGE Enrollee pays 5% Plan pays 15%; Medicare pays 80% Brand-name drugs Enrollee pays 45% Plan pays 5% 50% manufacturer discount COVERAGE GAP (“Doughnut Hole”) Catastrophic Coverage Limit = $7, 062 in Estimated Total Drug Costs* Generic drugs Enrollee pays 65% Plan pays 35% Initial Coverage Limit = $2, 960 in Total Drug Costs INITIAL COVERAGE PERIOD DEDUCTIBLE Enrollee pays 25% Plan pays 75% Enrollee pays 100% Deductible = $320 NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($ 6, 680 for LIS enrollees), which corresponds to True Out-of-Pocket (Tr. OOP) 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.

Figure 9 Distribution of Sources of Prescription Drug Coverage Among Medicare Beneficiaries, 2014 All other 13. 3 million 25% Employer subsidy 2. 6 million 5% Part D non-LIS enrollees 26. 6 million 49% Part D LIS enrollees 11. 5 million 21% Total Medicare Enrollment, 2014 = 54. 0 million Total Part D Enrollment (excluding employer plans), 2014 = 38. 1 million 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.

Figure 10 Medicare Private Plan Enrollment, 1999 -2014 In millions: 6. 9 6. 8 6. 2 8. 4 5. 6 5. 3 5. 6 9. 7 10. 5 11. 1 11. 9 13. 1 14. 4 15. 7 6. 8 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 % of Medicare 18% 17% 15% 14% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28% 30% Beneficiaries 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.

Figure 11 Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans by State, 2014 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.

Figure 12 Distribution of Sources of Supplemental Coverage Among Medicare Beneficiaries, 2010 Medigap only 15% No supplemental coverage Employer-sponsored + Medigap 4% 14% Other coverage/ combinations 6% 26% Medicaid only Employer-sponsored only 13% 4% Medicare Advantage + Medicaid 15% 3% Medicare Advantage only Medicare Advantage + Employer-sponsored Total Medicare Beneficiaries, 2010 = 48. 4 Million SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.

Figure 13 Percent of Large Firms (200+ Workers) Offering Retiree Health Benefits to Active Workers, 1988 -2014 66% 46% 36% 40% 40% 34% 37% 35% 36% 35% 32% 34% 32% 29% 28% 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.

Figure 14 Number of Beneficiaries Enrolled in Medicare, Medicaid, and Both Programs, 2010 Medicare 40 million Dually eligible 10 million Total Medicare beneficiaries, 2010: 50 million Medicaid 56 million Total Medicaid beneficiaries, 2010: 66 million 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 FY 2010 MSIS.

Figure 15 Dual-Eligible Beneficiaries as a Share of Medicare and Medicaid Enrollment and Spending, 2010 Dual-eligible beneficiaries Non-dual eligible beneficiaries Medicare 20% 80% Total Medicare enrollment, 2010: 48. 9 million Medicaid 14% 34% 86% 66% Total Medicare spending, 2010: $498. 9 Billion 66% Total Medicaid enrollment, 2010: 67. 2 Million Total Medicaid spending, 2010: $340. 5 billion SOURCE Medicare Payment Advisory Commission and Medicaid and CHIP Payment and Access Commission, Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid (January 2015).

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

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

Figure 18 Measures of Access to Care Among Medicare Beneficiaries by Demographic Characteristics, 2012 During the past year, percent of beneficiaries reporting that they… …had trouble getting needed care Overall Age 11% 6% 65+ $20, 000 -$39, 999 28% 17% <65 8% 4% <$20, 000 Income …delayed getting health care due to cost 18% 10% 11% 5% >$40, 000 3% Health Exc. /V. Good/Good Status Fair/Poor 3% 5% 7% 13% 22% 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.

Figure 19 Percent of Office-Based Physicians Accepting New Patients with Medicare and Other Types of Insurance, 2012 Medicare 91% Private non-capitated 91% Private capitated 72%* Medicaid 71%* Uninsured 47%* 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.

Figure 20 Percent of Physicians Accepting New Medicare Patients by State, 2012 ≤ 80% 81% - 89% ≥ 90% (4 states) (16 states, DC) (30 states) 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.

Figure 21 Accountable Care Organizations (ACOs) in Medicare, 2015 Pioneer ACO participants Medicare Shared Savings Program participants 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.

Figure 22 National Average Readmission Rate (%) Medicare Hospital Readmission Rates, 2005 -2013 Diagnosis of initial hospitalization Heart Failure Heart Attack Pneumonia 26 25 24 23 24. 5 24. 7 24. 8 24. 7 23. 0 22 21 20 19. 9 19. 8 19. 7 18. 3 19 18 17 18. 2 18. 3 18. 4 18. 5 16 15 July 2005 June 2008 July 2006 June 2009 July 2007 June 2010 22. 7 July 2008 June 2011 17. 8 17. 6 17. 3 July 2009 June 2012 July 2010 June 2013 Performance (measurement) Time Period 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.

Figure 23 Distribution of Federal Outlays, 2014 Chart Title Social Security 24% Defense 17% Medicare 1 14% Nondefense Discretionary 17% Other 2 12% Medicaid, Exchange subsidies, Net CHIP Interest 9% 7% Total Federal Outlays, 2014 = $3. 5 Trillion Net Federal Medicare Outlays, 2014 = $505 Billion NOTE: All amounts are for federal fiscal year 2014. 1 Consists of Medicare spending minus income from premiums and other offsetting receipts. 2 Other 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).

Figure 24 Distribution of Medicare Benefit Payments, 2014 Home Health Skilled Nursing Facilities 3% 5% Hospital Outpatient Services 7% Outpatient Prescription Drugs 11% Other Services* 14% Medicare Advantage 26% Hospital Inpatient Services 23% Physician Payments 12% Total Medicare Benefit Payments, 2014 = $597 billion 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).

Figure 25 Distribution of Traditional Medicare Beneficiaries and Medicare Spending, 2010 10% Average per capita Traditional Medicare spending: $10, 584 58% Average per capita Traditional Medicare spending among top 10%: $61, 722 90% 42% Total Number of Traditional Medicare Beneficiaries, 2010: 36. 3 million Average per capita Traditional Medicare spending among bottom 90%: $4, 897 Total Traditional Medicare Spending, 2010: $385 billion NOTE: Excludes Medicare Advantage enrollees. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.

Figure 26 Percent of Personal Health Expenditures Accounted for by Medicare, 2013 43% 28% 26% 22% 22% <1% Total Services Home Health Prescription Care Drugs Hospital Services Physician Nursing Services Home Care Dental Services Expenditures in Billions Medicare Total $551 $34 $75 $243 $130 $35 $0. 5 $2, 469 $80 $271 $937 $587 $156 $111 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).

Figure 27 Medicare Spending and Percent of Federal Outlays and GDP, 2010 -2025 Actual Net Outlays Projected Net Outlays $981 $866 $833 $852 $527 $480 $466 $492 $505 $446 $560 $562 $574 $642 $688 $738 Share of: 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Federal Outlays 12. 9% 13. 3% 13. 2% 14. 4% 14. 3% 13. 9% 13. 6% 14. 3% 14. 5% 14. 8% 15. 2% 16. 2% GDP 3. 0% 3. 1% 2. 9% 3. 0% 2. 9% 2. 8% 3. 0% 3. 1% 3. 2% 3. 4% 3. 3% 3. 6% 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).

Figure 28 Historical and Projected Average Annual Growth Rate in Medicare Per Capita Spending and Other Measures Projected (2014 -2023) Actual (2000 -2013) 5. 5% 6. 1% 4. 7% 3. 5% 3. 7% 2. 9% Medicare per capita spending Private health insurance per capita spending GDP per capita 2. 4% CPI 2. 2% Medicare per capita spending* Private health insurance per capita spending GDP per capita 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). CPI

Figure 29 Sources of Medicare Revenue, 2013 General revenue 41% Payroll taxes 73% 88% State payments 38% 2% 2% 3% 13% Beneficiary premiums TOTAL 6% 5% Part A $575. 8 billion $251. 1 billion 1% 25% 2% 14% Taxation of Social Security benefits 13% Interest and other Part B Part D $255. 0 billion $69. 7 billion 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.

Figure 30 Solvency of the Medicare Part A Hospital Insurance Trust Fund 2030 2029 2026 2020 2018 2005 2006 2019 2024 2011 2012 2019 2017 2008 2009 2010 2013 Year of Medicare Trustees Report 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. 2014

Figure 31 Number of Medicare Beneficiaries and Number of Workers Per Beneficiary, 2000 -2050 Number of beneficiaries (in millions) In millions Number of workers per beneficiary 100 90 80 4. 0 70 60 50 40 81. 8 89. 2 92. 8 4. 5 4 3. 5 3. 4 64. 4 47. 7 2. 8 39. 7 3 2. 5 2. 3 2. 2 2. 3 2 1. 5 30 20 1 10 0. 5 0 2000 2010 2020 2030 2040 2050 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. 0