|
"...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 65 & older or
under 65 & disabled |
44.8 million projected for 2008
43.1 million
- 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees
for Selected Years." |
|
# of elders (65 & older) w/ Medicare |
37.6 projected for 2008
36.1 million
- 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees
for Selected Years." |
|
# of people w/ Medicare who are younger
than 65 & disabled |
7.1 projected for 2008
6.9 million
- 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees
for Selected Years." |
|
% of people w/ Medicare who are younger
than 65 & disabled |
15.8% projected for 2008
14.6% -
2004 ACTUAL |
June 2007 MedPAC data book, page 19. |
|
% of elders (65 & older) w/ health
insurance before Medicare existed |
50% |
Kaiser, 4/2003. |
|
% of elders (65 & older) w/ health
insurance now |
95% are covered by Medicare (2005)
87% of non-institutionalized seniors
also have supplemental insurance (2004) |
Administration on Aging, A Profile of Older Americans: 2006. |
|
Medicare beneficiary median family
income |
$20,400 (2002) |
Kaiser Medicare Chartbook 2005, page 6. |
|
Income less than 100% of the federal
poverty level |
16% (2005-2006) |
Kaiser Family Foundation, State Health Facts, "Distribution
of Medicare Enrollees by Federal Poverty Level." |
|
Income < 400% FPL (~$38,000) |
77% (2004) |
MedPAC Data Book June 2007, page 23. |
|
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 |
6.6% (2002-2005)
|
June 2007 MedPAC data book, 8. |
|
Spending increase per beneficiary |
8.0% (2002-2005) |
June 2007 MedPAC data book, 7. |
Medicare Part C
(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 at 100% of the Federal Poverty
Level |
7.7 million (18%) (2004) |
June 2007 MedPAC data book, page 23. |
|
# beneficiaries with incomes 100%-125% of the Federal
Poverty Level |
4.3 million (10%) (2004) |
June 2007 MedPAC data book, page 23. |
|
# beneficiaries with incomes 125%-200% of the Federal
Poverty Level |
9 million (21%) (2004) |
June 2007 MedPAC data book, page 23. |
|
# 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. |
Appeals
|
Category |
Statistics |
Source and Notes |
|
Rates of full and partial reversal of denials |
Under Construction |
|
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 |
20 (2003)
36 (1997) |
June 2007 MedPAC data book, page 136. |
|
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% |
|
