1966 1970 1975 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013

19.1 20.5 22.8 25.5 28.2 31.0 33.2 34.3 35.8 36.3 37.0 37.9 38.8 39.6 40.5 41.9 43.32.168

2.9632.907

3.2524.409

5.3716.723 7.022 7.297 7.516 7.755 8.033 8.375 8.5

8.7

19.1 20.525.0

28.531.1

34.237.6

39.642.5 43.3 44.3 45.4 46.5 47.7 48.8 50.4 52.0

Elderly (Age 65 and Older) Nonelderly Disabled (Under Age 65)

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 Insurance Programs for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2011: Selected Calendar Years 1966-2011; 2012-2013, HHS Budget in Brief, FY2014.

Medicare Enrollment, 1966-2013

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 State Populations, 2012

National Average, 2012 = 16%

10% - 14% 15% – 16% 17% – 18% 19% – 21%8 states, DC 18 states 19 states 5 states

DC 13%

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%

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

20.424.9

28.431.1

34.337.6 39.7

42.647.7

55.6

64.3

73.5

81.586.5

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Medicare Enrollment, 1970-2035

Historical ProjectedIn millions:

0

10

20

30

40

50

60

70

80

90

100

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

1.9%

3.0%2.4%

0.9%0.4%

39.747.7

64.3

81.588.9

92.4

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Projected Change in Medicare Enrollment, 2000-2050

Medicare Enrollment (in millions)

Average Annual Growth in Enrollment

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 for Medicare & Medicaid Services Medicare Current Beneficiary 2009 Cost and Use file.

Characteristics of the Medicare PopulationPercent of total Medicare population:

Income below $22,502

Savings below $77,482

3+ Chronic Conditions

Fair/Poor Health

Cognitive/Mental Impairment

Dually Eligible for Medicare and Medicaid

Under-65 Disabled

2+ ADL Limitations

Age 85+

Long-term Care Facility Resident

Total White Black Hispanic Underage 65

Age 65-74

Age75-84

Age 85 or older

Male Female

22502

24797

1525213805

16183

2380922699

17410

24625

20920

SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.

Median Income Among Medicare Beneficiaries, Overall and by Race/Ethnicity, Age, and Gender, 2012

Race /Ethnicity Age Gender

25% had incomes below $14,000

50% had incomes below $22,500

5% had incomes above $88,900

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 Level, 2012

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 2009 Cost and Use file.

Medicare Beneficiaries’ Utilization of Selected Medical and Long-Term Care Services, 2009

Physician Office Visit

Emergency Room Visit

Inpatient Hospital Stay

Home Health Visit

Skilled Nursing Facility Stay

Hospice Visits

NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-LIS enrollees ($6,734 for LIS enrollees), which corresponds to TrOOP spending of $4,750.SOURCE: Kaiser Family Foundation illustration based on CMS standard benefit parameter update for 2013. Amounts rounded to nearest dollar.

Standard Medicare Prescription Drug Benefit, 2013

Deductible = $325

Initial Coverage Limit = $2,970 in Total Drug Costs

Plan pays 75%

Plan pays 15%; Medicare pays 80%Enrolleepays 5%

Enrollee pays 25%

CatastrophicCoverage Limit =

$6,955 in Estimated

Total Drug Costs

Brand-name drugs Enrollee pays 47.5%;

Plan pays 2.5%50% manufacturer discount

Generic drugsEnrollee pays 79%;

Plan pays 21%

INITIAL COVERAGE

PERIOD

COVERAGE GAP

CATASTROPHIC COVERAGE

DEDUCTIBLE

SOURCE: Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services (CMS) PDP landscape source file, 2013.

Number of Medicare Part D Stand-Alone Prescription Drug Plans, by State, 2013

23 – 29 plans 30 – 31 plans 32 plans 33 – 38 plans12 states, DC 18 states 13 states 7 states

U.S. Total, 2013= 1,031

DC 29

30

33

23

29 30

32 29

30

29

34

30

23

32

32 31

32

31 32

30

28

29

3032

29

31

32

3229

28

29

30

28

30

32

33

31

30

38

31

32

33

32

32

30

31

30

38

32

3033

Part D non-LIS enrollees24.4 million

47%

Part D LIS enrollees

11.3 million22%

Employer subsidy3.2 million

All other13.4 million

26%

NOTE: Does not sum to 100% due to rounding. LIS is low-income subsidy. Total Part D and Medicare enrollment based on 2012 intermediate estimates. SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Prescription Drug Coverage Among Medicare Beneficiaries in 2013

Total Medicare Enrollment in 2013= 52.3 millionTotal Part D Enrollment (excluding employer subsidy) = 35.7 million

6%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

6.9 6.86.2

5.6 5.3 5.3 5.66.8

8.49.7

10.511.1

11.913.1

14.4

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, 2008-2013, and MPR, “Tracking Medicare Health and Prescription Drug Plans Monthly Report,” 2001-2007; enrollment numbers from March of the respective year, with the exception of 2006, which is from April.

Total Medicare Private Health Plan Enrollment, 1999-2013

In millions:

% of Medicare Beneficiaries 18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28%

TraditionalFee-for-service

Medicare 72%

HMO 65%

Local PPO 22%Regional PPO

7%PFFS 3%

Other 3%

NOTE: PFFS is Private Fee-for-Service plans, PPOs are preferred provider organizations, and HMOs are Health Maintenance Organizations. Other includes MSAs, cost plans, and demonstration plans. Includes enrollees in Special Needs Plans as well as other 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 Advantage Plans, by Plan Type, 2013

Total Medicare Advantage Enrollment, 2013 = 14.4 Million

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 Medicare Advantage Plans, by State, 2013

National 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%

SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2008, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.

Dually eligible beneficiaries comprise 20% of the Medicare population and 15% of the Medicaid population, 2008

Dual Eligibles

9 million

Medicare37 million

Medicaid51 million

Total Medicare beneficiaries, 2008: 46 million

Total Medicaid beneficiaries, 2008: 60 million

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 Kaiser Commission 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 and Medicaid population and spending, 2008

Total Medicare Spending, 2008:

$424 Billion

Total Medicare Population, 2008:

46 Million

Total Medicaid Spending, 2008:

$330 Billion

Total Medicaid Population, 2008:

60 Million

Dual Eligibles as a Share of the Medicare Population and Medicare

Spending, 2008:

Dual Eligibles as a Share of the Medicaid Population and Medicaid

Spending, 2008:

Employer-Sponsored31%

Medicare Advantage

25%

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 Survey, 2009 Cost and Use file.

Sources of Supplemental Coverage Among Medicare Beneficiaries, 2009

Total Number of Beneficiaries, 2009: 47.2 Million

No Supplemental Coverage

1997 1998 1999 2000 2001 2002 2003 2004 2005 20060%

2%

4%

6%

8%

10%

12%

14%

16%

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%

NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures. Annual amounts for the components 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 Percent of Income Among Medicare Beneficiaries, 1997-2006

Total health care out-of-pocket

Premium out-of-pocket

Nonpremium out-of-pocket

1997 1998 1999 2000 2001 2002 2003 2004 2005 20060%

10%

20%

30%

40%

50%

60%

70%

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% 51.7%56.3%

59.2% 58.4% 59.8%57.9% 57.8%

NOTES: 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 of Income Among Medicare Beneficiaries, By Spending Percentile, 1997-2006

90th percentile

75th percentile

50th percentile (median)

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 Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Part B and Part D Out-of-Pocket Spending as a Share of Average Social Security Benefit, 1970-2010

Average Monthly Social Security benefit payment$604 $772 $906 $1,001 $1,151

Average monthly out-of-pocket spending on Part B and Part D$39 $53 $111 $136 $299

6% 7% 12% 14%26%

1970 1980 1990 2000 2010

Distribution of Average Household Spending by Medicare and Non-Medicare Households, 2010

Housing1094035%

$4,106 13%

$4,527 15%

Food476615%

Other648021%

SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense Files, 2010.

Non-Medicare Household SpendingMedicare Household Spending

Average Household Spending = $49,641Average Household Spending = $30,818

Health Care

Transportation

Housing1682434%

$8,188 16% $2,450

Food736415%

Other1481530%

Health Care5%

Transportation

Other213%

Nondefense Discretionary

17%

Defense19%

Social Security22%

Medicare116%

Medicaid7%

Net Interest6%

Chart Title

NOTE: FY is fiscal year. 1Amount for Medicare excludes offsetting premium receipts (premiums paid by beneficiaries, amount paid to providers and later recovered, and state contribution (clawback) payments to Medicare Part D). 2Other category includes other mandatory 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, 2012

Total Federal Spending, FY2012 = $3.5 TrillionFederal Spending on Medicare, FY2012 = $551 Billion

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023

$586 $597 $615 $671 $695 $722

$794 $849

$911

$1,018 $1,064

SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.

Projected Medicare Spending, 2013-2023

In billions:

1990 2000 2010 2020

8.5%

12.1%

15.1%16.9%

SOURCE: 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 as a share of Gross Domestic Product (GDP), 1990-2020

1990 2000 2010 2020

1.9%2.2%

3.6% 3.7%

Medicare Spending as a Share of Federal Budget Outlays

Medicare Spending as a Share of Gross Domestic Product (GDP)

Total Federal Outlays (trillions)$1.3 $1.8 $3.5 $5.0

Gross Domestic Product (trillions)$5.7 $9.8 $14.5 $22.9

NOTE: Excludes administrative expenses and is net of recoveries. *Includes hospice, durable medical equipment, Part B drugs, outpatient dialysis, ambulance, lab services, and other services.SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.

Medicare Benefit Payments By Type of Service, 2012

Total Benefit Payments = $536 billion

Hospital Inpatient Services26%

5%

Physician Payments

13%

6%4%

Other Services13%

Medicare Advantage

23%

Outpatient Prescription Drugs

10%

Home Health Hospital Outpatient Services

Skilled Nursing Facility

Part A Part B Part A and B Part C Part D

Total Services*

Home Health Care

Hospital Services

Prescription Drugs

Physician Services

Nursing Home Care

21%

44%

28%25% 24% 24%

NOTE: 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, National Health Expenditure Projections 2011-2021, June 2012.

Medicare’s Share of National Personal Health Expenditures, by Type of Service, 2012

Expenditures in Billions (Projected)Medicare $591 $34 $250 $69 $131 $38Total $2,809 $78 $885 $277 $550 $155

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 and Medicare Spending, 2009

Total Number of Traditional Medicare Beneficiaries:

35.4 million

Total Traditional Medicare Spending:

$343 billion

Average per capita Traditional Medicare

spending: $9,702

Average per capita Traditional Medicare

spending among top 10%: $55,763

Average per capita Traditional Medicare

spending among bottom 90%: $4,584

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100%

5%

10%

15%

20%

25% Medicare (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 hospital services, 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 Health Expenditure Historical Data, 2013.

Annual Change in Per Enrollee Medicare and Private Health Insurance Spending, 1970-2011

Annu

al P

erce

nt C

han g

e

Medicare

Private Health Insurance

$532.6 billion $241.7 billion $229.1 billion $61.7 billion

TOTAL Part A Part B Part D4% 6% 3%3%

8%0.0155839279008637 0.13452188006483

13% 2% 25%13%

38%

85%

0.395418700713481

0.721518987341772

0.73419773095624

General revenue

Payroll taxes

Beneficiary premiums

State payments

Taxation of Social Security benefits

Interest and other

NOTE: Numbers may not sum due to rounding. Amounts are fiscal year totals. SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Sources of Medicare Revenue, 2012

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 Rate in Medicare Spending Per Capita and Other Measures

Actual (2000-2011) Projected (2012-2021)

Medicare spending per capita

Private health insurance spending per capita

GDP per capita

CPI Medicare spending

per capita*

Private health insurance spending per capita

GDP per capita

CPI

2012 2014 2016 2018 2020 2022 2024 20260%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Medicare Part A Trust Fund Balance at Beginning of the Year, as a Percentage of Annual Expenditures, 2012-2026In billions:

20132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019801970

1312

1319

811

1212

1515

232828

2516

104

56

76

1014

1314

2

20262024

20242029

20172019

20192018

20202019

202620302029

20252015

20082001

20012001

20011999

20022005

20031994

1972

NOTES: ‘Insolvency’ refers to the depletion of the trust fund. No insolvency projections were made for 1973-1975 and 1989. For all other 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 and Federal Supplementary Medical Insurance Trust Funds.

Solvency Projections of the Medicare Part A Trust Fund, 1970-2013

Year ofTrustees’Report

Projected Number of Years to Insolvency and Projected Year of Insolvency: