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Fast Facts About Medicare
Number of People Receiving Medicare (2010):
Total Medicare beneficiaries • Aged • Disabled |
47.5 million • 39.6 million • 7.9 million |
Part A (Hospital Insurance, HI) beneficiaries • Aged • Disabled |
47.1 million • 39.2 million • 7.9 million |
Part B (Supplementary Medical Insurance, SMI) beneficiaries • Aged • Disabled |
43.8 million • 36.7 million • 7.1 million |
Part C (Medicare Advantage) beneficiaries |
11.7 million |
Part D (Prescription Drug Benefit) beneficiaries |
34.5 million |
Medicare Eligibility:
- Individuals ages 65 and over, who are eligible for Social Security payments
- Individuals under 65 with a disability, who receive Social Security cash payments
- People of all ages with end-stage renal disease
Average Benefit per Enrollee (2010):
Total: $11,762
- Part A: $5,187
- Part B: $4,786
- Part D: $1,789
Status of Medicare Trust Funds:
Medicare Trust Funds (billions): |
HI (Part A) |
SMI (Part B) (Part D) |
Total |
Assets at end of 2009 |
$304.2 |
$75.5 $1.1 |
$380.8 |
Total income in 2010 Payroll taxes |
$215.6 $182.0 |
$208.8 $61.7 ----- ----- |
$486.0 $182.0 |
Total expenditures in 2010 Benefits |
$247.9 $244.5 |
$212.9 $62.0 $209.7 $61.7 |
$522.8 $515.8 |
Net change in assets |
$ -32.3 |
$ -4.1 $ -0.4 |
$ -36.8 |
Assets at end of 2010 |
$271.9 |
$ 71.4 $ 0.7 |
$344.0 |
Medicare Part A
Medicare Part A (HI) Financing and Tax Rate:
Financing: Primarily finance by payroll taxes
- Tax rate paid by employee: 1.45%
- Tax rate paid by employer: 1.45%
- Total tax rate paid by both employer-employee: 2.90%
- Total tax rate paid by self-employed: 2.90%
- Beginning in 2013, workers will pay an additional 0.9 percent of their earnings above $200,000 (for those who file an individual return) or $250,000 (for those who file a joint income tax return)
Medicare Part A Benefits (2011):
Hospital Benefits |
- Initial deductible: $1,132 - Daily co-insurance:
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Skilled Nursing Facility Benefits |
- Deductible: $0 - Daily co-insurance:
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Home Health Services Benefits |
- No deductible - No co-insurance |
Hospice Benefits |
- Deductible: $0 - Up to $5 co-payment per prescription for outpatient drugs for pain and symptom management |
Medicare Part B
Financing:
- About 25% by monthly premiums;
- About 75% from general federal revenues
Medicare Part B Benefits (2011):
Coverage |
Physician and outpatient care, medical supplies, home health, and preventive services |
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Standard Monthly premiums |
Monthly premiums have been means-tested since 2007 .
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Initial deductible |
$162.00 |
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Co-pay |
20% of covered expenses |
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Penalty for late enrollment |
10% of monthly premium for each full 12 months of late enrollment for life (Exception: late enrollment due to cancellation of an employer-sponsored group insurance) |
Medicare Part D
Financing:
• About 11% by monthly premiums;
• About 82% from general federal revenues
• About 7% from state payments and interest
Medicare Part D Benefits (2011):
Coverage |
Outpatient prescription drugs |
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Monthly premiums |
The national base beneficiary premium is $32.34. Beginning 2011, monthly premiums are mean-tested.
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Annual deductible |
$310* |
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Co-insurance |
25% of drug costs between $310 and $2,849*: |
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Coverage gap |
100% out-of-pocket spending for drug costs between $2,849~$4,550* . A 50% discount is available on covered brand-name prescription drugs at the time of purchase. |
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Extra help |
Benefit for people with income less than $16,245 for an individual ($21,855 for a married couple living together) |
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Penalty for late enrollment |
1% of the national average premium for each month not enrolled for life (Exception for late enrollment due to having prescription drug coverage that is as good as Medicare's) |
* Varies by individual plans and indexed to the annual percentage increase in part D expenditures thereafter
Supplemental Insurance
Medigap:
- Each state offers up to 10 standard plans in 2011.
- Starting June 1 2010, plans E, H, I, or J are no longer available to buy. People who already have one of these plans are able to continue with it. Also, Plans M and N are new policies introduced in 2010.
- 27% of all non-institutionalized Medicare beneficiaries had benefits in 2009.
- 34% of all non-institutionalized Medicare beneficiaries had benefits in 2009.
Employer-sponsored benefits:
Benefit for dual eligibles (those who qualify for Medicare and Medicaid benefits):
Qualified Medicare Beneficiaries |
- Entitled to Medicare Part A - Asset test
- Monthly income limit: Most states: $928 for an individual or $1,246 for a couple - Coverage: Medicare Part A & B premiums, deductibles and coinsurance. |
Specified Low-Income Medicare Beneficiaries (SLMBs) |
- Entitled to Medicare Part A - Asset test:
- Monthly income limit: Most states: $1,109 for an individual or $1,491 for a couple - Coverage: Medicare Part B premiums only |
Qualifying Individuals |
- Limited number of beneficiaries per year - Entitled to Medicare Part A - Asset test:
- Monthly income limit: Most states: $1,246 for an individual or $1,675 for a couple - Coverage: Medicare Part B premiums only |
Medicaid Only |
- Entitled to Medicare Part A and/or Part B and are eligible for full Medicaid benefits - Typically, these individuals need to spend down to qualify for - Coverage: Full Medicaid benefits, Medicare cost-sharing |
Note: Individual state might have less restrictive criteria for dual eligibility.
Medicare Advantage (MA)
- Eligibility to choose a MA plan: People who are enrolled in both Medicare A and B, pay the Part B monthly premium, do not have end-state renal disease, and live in the service area of the plan
- Formerly know as Medicare+Choice or Medicare Health Plans
- Benefits are provided by private insurance companies
- Premiums, cost sharing, and coverage vary by plan
- 11.7 Million enrollees (24.6% of all Medicare enrollees) in 2010
Government Relations and Policy, August 2011