Social Insurance

1
Social Insurance

• Medicaid and Medicare

2
Introduction

• No longer will older Americans be denied the
  healing miracle of modern medicine. No longer
  will illness crush and destroy the savings that
  they have so carefully put away over a lifetime
  so that they might enjoy dignity in their later
  years. No longer will young families see their
  own incomes, and their own hopes, eaten away
  simply because they are carrying out their deep
  moral obligations to their parents, and to their
  uncles, and their aunts. President Lyndon Johnson

3
Medicaid

• Social Insurance for the poor

4
Other Social Insurance Programs

• State Childrens Health Insurance Program (SCHIP)
• Veterans Administration

5
Crowding Out

• When private insurance take up falls after
  introduction of increases in public benefits.
• Concerns over public option.

6
HHS Estimates of Low-Income Subsidy Eligibility
and Participation Under the Medicare Drug
Benefit, 2008
Eligible but not receiving subsidy
2.6 million 21
Full dual eligibles automatically receiving
subsidy
Eligible but estimated to have other drug coverage
.5 million 4
6.2 million 49
Applied for and receiving subsidy
1.5 million 12
Future anticipated facilitated enrollment lt0.1
million (0.5)
1.7 million 13
MSP and SSI recipients automatically receiving
subsidy
Total Eligible for Low-Income Subsidies 12.5
million
NOTES MSP is Medicare Savings Program SSI is
Supplemental Security Income. SOURCE Kaiser
Family Foundation, based on HHS data, January 31,
2008 ( Data as of January 2008).
7
Medicaid Today
Health Insurance Coverage 29 million children
15 million adults in low-income families 14
million elderly and persons with disabilities
Assistance to Medicare Beneficiaries 7.5
million aged and disabled 19 of Medicare
beneficiaries
Long-Term Care Assistance 1 million nursing home
residents 41 of long-term care services
MEDICAID
State Capacity for Health Coverage 43 of federal
funds to states
Support for Health Care System and Safety-net 16
of national spending on health services and
supplies
Source Kaiser Commission on Medicaid and the
Uninsured, 2008
8
Medicaids Role for Selected Populations
Percent with Medicaid Coverage
Families
Aged Disabled
Note Poor is defined as living below the
federal poverty level, which was 17,600 for a
family of 3 in 2008. SOURCE Kaiser Commission
on Medicaid and the Uninsured, Kaiser Family
Foundation, and Urban Institute estimates Birth
data NGA, MCH Update.
9
Medicaid Enrollees and Expendituresby Enrollment
Group, 2005
Elderly 10
Elderly 28
Disabled 14
Adults 26
Disabled 42
Children 50
Adults 12
Children 18
Total 59 million
Total 275 billion
SOURCE Kaiser Commission on Medicaid and the
Uninsured and Urban Institute estimates based on
2005 MSIS data.
10
Medicaid Payments Per Enrolleeby Acute and
Long-Term Care, 2005
13,524
11,839
2,102
1,617
SOURCE Kaiser Commission on Medicaid and the
Uninsured and Urban Institute estimates based on
2005 MSIS data.
11
Medicaid Enrollment Growth Average Annual Growth
Rates, 2000-2006
Aged/Disabled
Families
SOURCE Kaiser Commission on Medicaid and the
Uninsured and Urban Institute estimates based on
KCMU Medicaid enrollment data collected by Health
Management Associates from 44 states inflated
proportionally to national totals, 2007.
12
Overall Average Annual Total Medicaid Spending
Growth, 2000-2006
Adjusted 05-06
02-04
05-06
00-02
04-05
Annual Spending at End of Period (billions)
295.9
315.0
257.3
314.5
310.8
NOTE Adjusted expenditures exclude all
prescription drug spending for dual eligibles to
remove the effect of their transition to Medicare
Part D in 2006. SOURCE Kaiser Commission on
Medicaid and the Uninsured and Urban Institute,
2007 estimates based on data from HCFA Financial
Management Reports, 2006 (HCFA-64/CMS-64).
13
Medicaid and SCHIP Enrollment of Children,
1998-2005
Millions of Children
SOURCE Kaiser Commission on Medicaid and the
Uninsured and Urban Institute analysis of
HCFA-2082, MSIS, and SEDS data, 2007.
14
Income and Health Status of Medicaid and the
Low-Income Privately Insured, 2002
Percent of Enrolled Adults
Low-Income and Privately Insured
Medicaid
Poor
Fair or Poor Health
Health Conditions that limit work
SOURCE Coughlin et. al, Assessing Access to
Care Under Medicaid Evidence for the National
and Thirteen States, Health Affairs
24(4)1073-1083. Based on a 2002 NSAF analysis
for Kaiser Commission on Medicaid and the
Uninsured.
15
Concentration of Health Spending in the Medicaid
Population, 2001
lt25,000 in Costs 96
lt25,000 in Costs 52
gt25,000 in Costs
Children 3

• gt25,000 in Costs
• Children (.2)
• Adults (.1)
• Disabled (1.6)
• Elderly (1.8)

Adults 1
Disabled 25
Elderly 20
Total 46.9 million
Total 180.0 billion
SOURCE Kaiser Commission on Medicaid and the
Uninsured/Urban Institute estimates based on MSIS
2001 data.
16
Medicaid Expenditures by Service, 2006
DSH Payments 5.6
Inpatient 14.1
Home Health and Personal Care 14.8
Physician/ Lab/ X-ray 3.8
Mental Health 1.0
Outpatient/Clinic 6.8
ICF/MR 4.3
Acute Care 58.5
Long-Term Care 35.8
Drugs 5.5
Nursing Facilities 15.7
Other Acute 6.9
Payments to Medicare 3.3
Payments to MCOs 18.0
Total 304.0 billion
NOTE Total may not add to 100 due to rounding.
Excludes administrative spending, adjustments and
payments to the territories. SOURCE Urban
Institute estimates based on data from CMS (Form
64), prepared for the Kaiser Commission on
Medicaid and the Uninsured.
17
Medicaid in the Health System, 2006
Medicaid as a share of national health care
spending
Total National Spending (billions)
2,106
648
660
125
217
NOTE Does not include spending on SCHIP SOURCE
Kaiser Commission on Medicaid and the Uninsured,
based on A Catlin et al, National Health
Spending in 2006 A Year of Change for
Prescription Drugs, Health Affairs 27(1)14-29,
January/February 2008. Based on National Health
Care Expenditure Data, CMS, Office of the
Actuary.
18
Medicaid Financing of Safety-Net Providers
Public Hospital Net Revenues by Payer, 2004
Health Center Revenues by Payer, 2006
Total 29 billion
Total 8.1 billion
SOURCE Kaiser Commission on Medicaid and the
Uninsured, based on Americas Public Hospitals
and Health Systems, 2004, National Association of
Public Hospitals and Health Systems, October
2006. KCMU Analysis of 2006 UDS Data from HRSA.
19
National Spending on Nursing Home and Home Health
Care, 2006
Nursing Home Care
Home Health Care
Total 124.9 billion
Total 52.7 billion
Note Medicaid percentage includes spending
through SCHIP. Other includes private and public
funds SOURCE Kaiser Commission on Medicaid and
the Uninsured, based on Health Affairs
January/February 2008, CMS, National Health
Accounts.
20
Growth in Medicaid Long-Term Care Expenditures,
1990-2006
109
In Billions
100
92
41
37
32
75
30
54
20
59
32
63
70
68
13
80
87
Note Home and community-based care includes
home health, personal care services and home and
community-based service waivers. SOURCE Kaiser
Commission on Medicaid and the Uninsured and
Urban Institute analysis of HCFA/CMS-64 data.
21
Impact of Unemployment Growth on Medicaid and
SCHIP and the Number Uninsured
3.4
1.4
State
1.1
1.0

1

Increase in National Unemployment Rate
2.0
Federal
Increase in Medicaid and SCHIP Enrollment (million
)
Increase in Uninsured (million)
Increase in Medicaid and SCHIP Spending (billion)
Source Stan Dorn, Bowen Garrett, John Holahan,
and Aimee Williams, Medicaid, SCHIP and Economic
Downturn Policy Challenges and Policy Responses,
prepared for the Kaiser Commission on Medicaid
and the Uninsured, April 2008
22
State Authorized Childrens Eligibility for
Medicaid/SCHIP by Income, January 2008
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
WV
DE
NV
IL
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
lt 200 FPL (6 states)
200-250 FPL (22 states)
Effective gt250 FPL (23 states)

The Federal Poverty Line (FPL) for a family of
three in 2007 is 17,170 per year. Effective
eligibility higher than 250 FPL accounts for
earnings disregards. IL uses state funds to
cover children above 200 FPL. SOURCE Based on
a national survey conducted by the Center on
Budget and Policy Priorities for the Kaiser
Commission on Medicaid and the Uninsured., 2008.
23
Authorized Medicaid Eligibility for Working
Parents by Income, January 2008
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
DE
NV
IL
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
lt 50 FPL (12 states)
50 - 99 FPL (21 states)
US Median Eligibility 63 FPL
100 or higher FPL (18 states including DC)
NOTE The Federal Poverty Line (FPL) for a family
of three in 2008 is 17,600 per year. AR, IN,
UT operate waivers allowing higher-income parents
to enroll, but the coverage has higher
cost-sharing and reduced benefits. SOURCE Based
on a national survey conducted by the Center on
Budget and Policy Priorities for the Kaiser
Commission on Medicaid and the Uninsured, 2008.

24
Nearly Two-Thirds of States Expanded Access to
Medicaid and SCHIP, July 06 January 08
Number of States With
25
Community Hospital Payment-to-Cost Ratios, by
Source of Revenue, 1980-2006
Note Payment-to-cost ratios show the degree to
which payments from each payer cover the costs of
treating its patients. They cannot be used to
compare payment levels across payers, however,
because the service mix and intensity vary. Data
are for community hospitals. Medicaid includes
Medicaid Disproportionate Share payments.
Source American Hospital Association and
Avalere Health, Avalere Health analysis of 2006
American Hospital Association Annual Survey data,
for community hospitals, Trendwatch Chartbook
2008, Trends Affecting Hospitals and Health
Systems, April 2008, Table 4.4, p. A-35, at
http//www.aha.org/aha/trendwatch/chartbook/2008/0
8appendix4.pdf.
26
Medicaid Managed Care and Traditional Enrollment,
1990-2004
Enrollment (in millions)
44.4
42.7
40.1
36.6
33.7
33.4
33.6
33.4
33.2
31.9
32.1
30.9
30.9
28.3
25.3
Note Numbers may not produce totals because of
rounding. These figures represent point-in-time
enrollment as of June 30 of each reporting year.
Total Medicaid enrollment for 1996-2004 was
collected by states at the same time the managed
care enrollment numbers were collected, instead
of using the CMS 2082 Medicaid data reporting
system as in previous years. The unduplicated
managed care enrollment data include enrollees
receiving comprehensive benefits and limited
benefits. This table also provides unduplicated
national figures for the Total Medicaid
population and Other population. The statistics
also include individuals enrolled in State health
care reform programs that expand eligibility
beyond traditional Medicaid eligibility
standards. Source Kaiser Family Foundation,
Trends and Indicators in the Changing Health Care
Marketplace, 2002, May 2002, Exhibit 2.8, p.23,
at http//www.kff.org/insurance/3161-index.cfm,
using and updated with data from the Centers for
Medicare and Medicaid Services, at
http//new.cms.hhs.gov/MedicaidDataSourcesGenInfo/
04_MdManCrEnrllRep.asp.
27
Enrollment in Medicare Managed Care and
Traditional Medicare, 1990-2005
Note Total Medicare enrollment includes
beneficiaries with HI and/or SMI coverage.
Medicare managed care enrollment is enrollment in
what Medicare calls CCPs (Coordinated Care
Plans), which include health maintenance
organizations (HMOs), provider-sponsored
organizations (PSOs), and preferred provider
organizations (PPOs).
Source Kaiser Family Foundation calculations
using CCP enrollment data from the Centers for
Medicare and Medicaid Services' monthly Medicare
Managed Care Contract Reports for December 1 of
each year, at http//www.cms.hhs.gov/HealthPlanRep
FileData/04_Monthly.aspTopOfPage (Zipped Monthly
Summary (MMCC) Text Report, CCP plans), and total
Medicare enrollment data from the 2006 Annual
Report of the Boards of Trustees of the Federal
Hospital Insurance and Federal Supplementary
Medical Insurance Trust Funds, May 1, 2006, Table
III.A3, p. 34, at http//www.cms.hhs.gov/ReportsTr
ustFunds/downloads/tr2006.pdf
28
Per Enrollee Growth in Medicare Spending and
Private Health Insurance Premiums (for Common
Benefits), 1970-2006
Notes Per enrollee includes primary
policy-holder plus dependents. Common benefits
include hospital services, physician and clinical
services, other professional services, and
durable medical products they exclude, for
example, prescription drugs, home health care,
non-durable medical products, and nursing home
care. Source Centers for Medicare and Medicaid
Services, Office of the Actuary, National Health
Statistics Group, Table 13, at http//www.cms.hhs.
gov/NationalHealthExpendData/downloads/tables.pdf.
29
Cumulative Change in Family Health Insurance
Premiums and Federal Poverty Level, 1996 - 2004
Source Premium data from Agency for Healthcare
Research and Quality, Medical Expenditure Panel
Survey, 1996-2004, at http//www.meps.ahrq.gov/mep
sweb/ Federal Poverty Level based on HHS Federal
Poverty Guidelines (1996 through 2004) at
http//aspe.hhs.gov/poverty/figures-fed-reg.shtml.
Rate of growth based on change for one person
(change for 4 person family would be 20.8 rather
than 20.3 over the period).
30
American Public's Experience with Long-Term Care,
2007
At any time during the past 3 years, was a member
of your immediate family or someone you know well
receiving long-term care in a nursing home, at
home, or in some other type of facility?
Yes
No
Dont know/ Refused
Source KFF Update on the Publics Views of
Nursing Homes and Long-Term Care Services
(conducted October 1 October 10, 2007)
31
Median Out-of-Pocket Health Spending as of
Income
Financial Burden of Health Spending Among
Medicare Beneficiaries, 1997-2003
Note Difference between 1997 and 2003 is
statistically significant at .05 level. Source
Kaiser/UCLA analysis of Medicare Current
Beneficiary Survey Cost and Use files, 1997-2003.
32
Percent Change in Medicaid Spending and
Enrollment, FY 2001-2008
Projected
Notes Enrollment percentage changes from June to
June of each year. Spending growth percentage
changes in state fiscal year.
Source KCMU survey of Medicaid Officials in 50
states and DC conducted by Health Management
Associates, October 2007.
33
Distribution of the Increase in Uninsured
Children, by Income, 2005-2006
400 FPL
150,000
21.2
200-399 FPL
340,000
47.5
lt200 FPL
220,000
31.3
710,000 Uninsured Children
Note 200 to 399 of the federal poverty level
(FPL) is roughly 40,000-80,000 in annual income
for a family of four in 2006.
Source KCMU/Urban Institute analysis of the
March 2007 CPS.
34
Percent of Seniors Who Did Not Fill or Delayed
Filling Prescriptions Due to Cost, by Source of
Drug Coverage, 2006
(Among Non-Institutionalized Seniors Taking 1 or
More Rx)
NOTES Did not fill or delayed filling
prescriptions due to cost refers to within the
past twelve months. VA is Department of Veterans
Affairs. Reference group for statistical
significance is Part D coverage (plt0.05).
SOURCE Kaiser/Commonwealth/Tufts-New England
Medical Center National Survey of Seniors and
Prescription Drugs, 2006.
35
Distribution of Uninsured Children, 2004
Not Eligible gt300 FPL
Not Eligible lt300 FPL
Not Eligible on the Basis of Immigration Status
1.7 Million Eligible for SCHIP
5.4 Million Uninsured Children are Eligible but
Unenrolled in SCHIP or Medicaid
3.7 Million Eligible for Medicaid
8 Million Uninsured Children
SOURCE Urban Institute analysis of the 2005
Annual Social and Economic Supplement to the CPS
for KCMU. Data has been adjusted for the
Medicaid undercount.
36
Medicare

• Social Insurance for the elderly
• Description 1965
• Medicare Part A, B, C,

37
Characteristics of the Medicare Population, 2006
Percent of total Medicare population
Income less than 200 FPL
3 chronic conditions
Cognitive/mental impairment
Fair/poor health
Less than high school education
2 ADL limitations
Under-65 disabled
Age 85
Long-term care facility resident
NOTES ADL is activity of daily living. The
federal poverty (FPL) threshold for people age 65
and over was 9,669/individual and 12,201/couple
in 2006.SOURCE Income data from US Census
Bureau, Current Population Survey published on
statehealthfacts.org all other data from Kaiser
Family Foundation analysis of the Medicare
Current Beneficiary Survey 2006 Access to Care
file.
38
Medicare Enrollment, by Eligibility Status,
2001-2007
In millions
44.0
43.0
42.5
41.7
41.1
41.0
40.1
SOURCE Kaiser Family Foundation, based on Annual
Report of the Boards of Trustees of the Federal
Hospital Insurance and Federal Supplementary
Medical Insurance Trust Funds, 2002-2008.
39
Medicare Part A

• Medicare Part A is a type of hospital insurance
  provided by Medicare. The coverage provided by
  Part A includes inpatient care in hospitals,
  nursing homes, skilled nursing facilities, and
  critical access hospitals. Part A does not
  include long-term or custodial care. If you meet
  specific requirements, then you may also be
  eligible for hospice or home health care.
• Fiscal Intermediaries handle the claims for the
  Medicare Part A plan. These are private insurance
  companies that act as agents for the federal
  government in processing and paying Medicare
  claims.

40
Medicare Part A (Health Insurance) Trust Fund
Balance, 2001-2019Under High Cost, Low Cost,
and Intermediate Assumptions
Fund balance as of annual expenditures
Low cost
Actual Projected
Intermediate
High cost
NOTE The Medicare Trustees recommend that the HI
Trust Fund assets should be maintained at a level
of at least 100 of annual expenditures. SOURCE
Kaiser Family Foundation, based on 2008 Annual
Report of the Boards of Trustees of the Federal
Hospital Insurance and Federal Supplementary
Medical Insurance Trust Funds.
41
Medicare Part B

• Medicare Part B is a medical insurance provided
  by the federal government to eligible
  beneficiaries. The coverage provided by Part B
  includes medically necessary doctor's services,
  outpatient care, and most other services that
  Part A does not cover such as some physical or
  occupational therapies and some home health care
  services. Part B covers preventive services as
  well.

42
Medicare Part C

• Medicare Part C combines your Part A and Part B
  options and must cover all medically needed
  services. The difference is that private
  insurance companies that are approved by Medicare
  provide this type of coverage. In most cases,
  Part C is a lower-cost alternative to the
  Original Medicare Plan, and providers usually
  offer extra benefits and include prescription
  drug coverage (Part D).
• Part C plans often have networks, and you must
  use the doctors or hospitals that belong to the
  plan. These plans help you coordinate and manage
  your overall care. Part C includes specialized
  care for people who need a large amount of health
  care services. If you find yourself needing
  medical attention while traveling out of your
  plan coverage area, you will still be covered for
  emergency or urgent care services.

43
Medicare Part D

• Prescription Drug Coverage
• Donut hole 3,600
• Changes by year
• Part D is prescription drug coverage insurance
  that is provided by private companies approved by
  Medicare. You need to enroll when you first
  become eligible to keep from paying a penalty
  cost later. Part D was designed to help people
  with Medicare to lower their prescription drug
  costs and to protect against future costs. A
  prescription drug plan will also enable you to
  have greater access to medically necessary drugs.

44
Donut Hole
Total drug spend TrOOP Out-of-pocket cost Portion covered by Medicare
0295 0295 Deductible is out-of-pocket No Medicare coverage of costs
2952,700 295896.25 25 out-of-pocket 75 covered by Medicare
2,7006,154 896.254,350.25 All costs are out-of-pocket No Medicare coverage of costs
over 6,154 over 4,350.25 5 out-of-pocket 95 covered by Medicare
45
Effects of Medicare Part D

• Shang and Goldman 2007
• Overall, a 1 increase in prescription drug
  spending is associated with a 2.06 reduction in
  Medicare spending. Furthermore, the substitution
  effect decreases as income rises, and thus
  provides support for the low-income assistance
  program of Medicare Part D.

46
Prescription Drug Coverage Among Medicare
Beneficiaries, by Income, 2006
10,000 or less
10,001-20,000
20,001-30,000
30,001-40,000
40,001 or more
(N6.4 mil) (N9.4 mil) (N7.0 mil)
(N5.7 mil) (N6.7 mil)
NOTES Percents rounded to the nearest whole
number. Nweighted estimate of number of
beneficiaries milmillion. SOURCE Kaiser
Family Foundation analysis of the CMS Medicare
Current Beneficiary Survey Access to Care File,
2006.
47
HHS Estimates of Prescription Drug Coverage
Among Medicare Beneficiaries, 2008
No Drug Coverage
4.6million10
Stand-Alone PDPs
Other Creditable Drug Coverage1
11.2million25
4.0million9
Total in Part D Plans 25.4 Million (57)
10.2million23
6.2million14
Dual Eligibles in PDPs
Retiree DrugCoverage2
8.0million18
Medicare Advantage Drug Plans3
Total Number of Beneficiaries 44.2 Million
NOTES Estimates do not sum to 100 due to
rounding. 1Includes Veterans Affairs, Indian
Health Service, state pharmacy assistance
programs, employer plans for active workers,
Medigap, multiple sources, and other sources.
2Includes Retiree Drug Subsidy (RDS) coverage
retiree coverage without RDS and FEHBP and
TRICARE retiree coverage. 3Includes 0.4 million
enrolled in other Medicare health plan types.
PDP Prescription Drug Plan. SOURCE Kaiser
Family Foundation analysis of HHS data, January
31, 2008 (Data as of January 2008).
48
Standard Medicare Prescription Drug Benefit, 2008
Plan Pays 15 Medicare Pays 80
Enrollee Pays 5
5,726 in Total Drug Costs (4,050 out of
pocket)
3,216 Coverage Gap (Doughnut Hole)
Enrollee Pays 100
2,510 in Total Drug Costs
Enrollee Pays 25
Plan Pays 75
275 Deductible
320 Average Annual Premium
NOTE Annual premium amount based on 26.70
national average monthly beneficiary premium
(CBO, March 2008). Amounts for premium, coverage
gap, and catastrophic coverage threshold rounded
to nearest dollar. SOURCE Kaiser Family
Foundation illustration of standard Medicare drug
benefit for 2008 (standard benefit parameter
update from CMS, April 2007).
49
Medicare Part D Enrollees Who Reached the
Coverage Gap in 2007
Excludes Part D Enrollees Who Receive Low-Income
Subsidies and Non-Users
Did not reach the coverage gap
Reached the coverage gap
NOTES Estimates based on analysis of retail
pharmacy claims for 1.9 million Part D enrollees
in 2007.SOURCE Georgetown University/NORC/Kaiser
Family Foundation analysis of IMS Health LRx
database, 2007.
50
The Standard Medicare Part D Benefit Coverage
Gap, 2006-2017
Amount of beneficiary out- of-pocket costs in
the gap
Actual
Projected
SOURCE Kaiser Family Foundation, based on 2008
Annual Report of the Boards of Trustees of the
Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds.
51
Financing Medicare

• Part A
• Payroll Taxes
• Medicare FICA is uncapped and 2.9 split 50/50
  with the employer

52
Medicare Cost Containment

• Diagnostic Related Groups (DRGs)
• Move towards risk adjustments
• Reforming Physician Reimursements
• Limits balance billing (115 of Medicare rate)
• Growth Rates Capped
• Medicare Managed Care
• Selection Bias in Medicare HMOs

53
Medicare Spending as a Share of Total Federal
Outlays, FY2009
FY 2009 Total Outlays 3.0 trillion
SOURCE Kaiser Family Foundation, based on OMB,
Fiscal Year 2009 Budget, February 2008 Baseline
Category Totals.
54
Supplemental Coverage Among Medicare
Beneficiaries, by Income, 2006
10,000 or less
10,001-20,000
20,001-30,000
30,001-40,000
40,001 or more
(N6.4 mil) (N9.4 mil) (N7.0 mil)
(N5.7 mil) (N6.7 mil)
NOTES Percents rounded to the nearest whole
number. Nweighted estimate of number of
beneficiaries milmillion. SOURCE Kaiser
Family Foundation analysis of the CMS Medicare
Current Beneficiary Survey Access to Care File,
2006.
55
Medicare Benefit Payments, by Type of Service,
2007
4
7
Part A Part B Part D
Part A and B
4
30
4
20
5
11
18
Medicare Advantage (Part C)
Total Benefit Payments 426 billion
NOTE Does not include administrative expenses
such as spending for implementation of the
Medicare drug benefit and the Medicare Advantage
program. SOURCE Kaiser Family Foundation,
based on Congressional Budget Office, Medicare
Baseline, March 2008.
56
Estimated Sources of Medicare Revenue, FY2009
PART A 243.5 Billion
PART D 60.9 Billion
PART B 202.4 Billion
TOTAL 506.8 Billion
SOURCE 2008 Annual Report of the Boards of
Trustees of the Federal Hospital Insurance and
Federal Supplementary Medical Insurance Trust
Funds.
57
Distribution of Total Medicare Beneficiaries and
Spending, 2005
Average per capita Medicare spending (FFS only)
7,064
Average per capita Medicare spending among top
10 (FFS only) 44,220
Total Number of FFS Beneficiaries 37.5 million
Total Medicare Spending 265 billion
NOTE FFS is fee-for-service. Includes
noninstitutionalized and institutionalized
Medicare fee-for-service beneficiaries, excluding
Medicare managed care enrollees. SOURCE Kaiser
Family Foundation analysis of the CMS Medicare
Current Beneficiary Survey Cost Use file, 2005.
58
Medicare Beneficiaries and The Number of Workers
Per Beneficiary
Number of workers per beneficiary
Millions of beneficiaries
SOURCE Kaiser Family Foundation, based on 2001
and 2008 Annual Reports of the Boards of Trustees
of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds.
59
Median Out-of-Pocket Health Care Spending as a
Percent of Income for Elderly vs. Non-Elderly
Households, 1998-2003
Elderly
Non-Elderly
SOURCE Kaiser Family Foundation/UCLA analysis of
Consumer Expenditure Survey, 1998-2003.
60
Projected Medicare Outlays, 2008-2018
Total outlays in billions
16 16 16 17
17 18 18 19 20 20 20
3 3 3 3 3
3 4 4 4 4
4
Share of Federal Budget
Gross Domestic Product
NOTE Numbers have been rounded to nearest whole
number. SOURCE Kaiser Family Foundation, based
on Congressional Budget Office, The Budget and
Economic Outlook An Update, January 2008.
61
Medicare Advantage Enrollment, 1999-2008
Enrollment in millions
NOTE Includes local HMOs, PSOs, and PPOs,
regional PPOs, PFFS plans, Cost contracts,
Demonstrations, HCPP, and PACE contracts.
SOURCE Kaiser Family Foundation, based on
Mathematica Policy Research, Inc. Tracking
Medicare Health and Prescription Drug Plans
Monthly Report December 1999-2007. CMS Medicare
Advantage, Cost, PACE, Demo, and Prescription
Drug Plan Contract Report, Monthly Summary
Report, July 2008.
62
Average Payments to Medicare Advantage Plans
Relative to Traditional Fee-for-Service Medicare
Traditional Fee-for-Service Medicare 100
Medicare Advantage Plan Types
SOURCE Kaiser Family Foundation, based on
Medicare Payment Advisory Commission, March 2008.
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Percentage of Children Without Health Insurance,
By Poverty Level, 1997-2005
23
Children below 200 of poverty
21
14
6
Children above 200 of poverty
5
5
Notes Survey method change in 2005 affects
comparison with earlier years slightly. Children
less than 18 years old. Source L. Ku, Medicaid
Improving Health, Saving Lives, Center on Budget
and Policy Priorities analysis of National Health
Interview Survey data, August 2005.
65
Medicare Private Fee-for-Service Enrollment as a
Share of the Total Medicare Population, 2007
Private Fee-for-Service
Traditional Medicare
Medicare Advantage
HMO, PPO, and other
Total Medicare Beneficiaries 44 million
SOURCE Centers for Medicare and Medicaid
Services, Medicare Advantage, Cost, PACE, Demo
and Prescription Drug Plan Contract Report
Monthly Summary Report (Data as of May 2007).
66
Medicare Advantage and Other Sources of
Supplemental Coverage Among Medicare
Beneficiaries Below 150 FPL, by Race/Ethnicity
11 million
2.6 million
2 million
N
Note Coverage was assigned based on the
following hierarchy Medicare Advantage,
Medicaid, Private (employer-sponsored, Medigap),
other public and unknown source, and no coverage.
Source Kaiser Family Foundation analysis of
2003 Medicare Current Beneficiary Survey Cost and
Use File.
67
Total Medicare Private Health Plan Enrollment,
1999-2007
In millions
Note Includes local HMOs, PSOs, and PPOs,
regional PPOs, PFFS plans, Cost contracts,
Demonstrations, HCPP, and PACE contracts.
Source Mathematica Policy Research, Inc.
Tracking Medicare Health and Prescription Drug
Plans Monthly Report. December 1999-2006. CMS
Monthly Summary Report, February 2007.
68
Seniors' Views of the Medicare Rx Drug Benefit,
2006
Percent Agreeing That the Medicare Drug Benefit
73
Is too complicated
Helps people on Medicare save on their
prescriptions
68
Benefits private plans and drug companies too much
60
Notes Percents include those responding
"strongly agree" and "somewhat agree" margin of
error /- 4 points. Source KFF/HSPH The
Public's Health Care Agenda for the New Congress
and Presidential Campaign (conducted November
9-19, 2006).
69
Large Employers' Expected Medicare Rx Coverage
Strategy, 2007
Do Not Provide Rx Coverage 8
Other Strategy 14
Offer Rx Coverage, Taking Subsidy 78
Notes Virtually all companies not providing drug
coverage in 2007 discontinued drug coverage in
2006. "Other Strategy" includes supplementing
Medicare drug coverage, contracting with Medicare
drug plans, and becoming a Medicare drug plan.
Applies to plan with the largest number of age
65 retirees. Based on a non-probability sample
of private-sector firms with 1,000 or more
employees offering retiree health
benefits. Source Kaiser/Hewitt 2006 Survey of
Retiree Health Benefits, December 2006.
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