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Fast Facts About Medicare
Number of People Receiving Medicare (2007):
Total Medicare beneficiaries
|
44.1 million
|
Part A (Hospital Insurance, HI) beneficiaries
|
43.8 million
|
Part B (Supplementary Medical Insurance, SMI) beneficiaries
|
40.9 million
|
Note: Government estimates project Total of 38.2 million seniors in 2007 |
|
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
Status of Medicare Trust Funds:
Medicare Trust Funds (billions): |
HI (Part A) |
SMI (Part B) |
Total |
Assets at end of 2006 |
$305.4 |
$33.1 |
$338.5 |
Total income in 2007 Payroll taxes |
$223.7 $191.9 |
$238.2 $0 |
$461.9 $191.9 |
Total expenditures in 2007 • Benefits |
$203.1 $200.2 |
$228.5 $225.1 |
$431.6 $425.3 |
Net change in assets |
$20.7 |
$9.7 |
$30.4 |
Assets at end of 2007 |
$326.0 |
$42.9 |
$368.9 |
Average Benefit per Enrollee (2007):
Total: $10,460
- Part A: $4573
- Part B: $4,312
- Part D: $1,575
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%
Medicare Part A Benefits (2008):
Hospital Benefits |
- Initial deductible: $1,024 - Daily co-insurance:
|
Skilled Nursing Facility Benefits |
- Deductible: $0 - Daily co-insurance:
- No benefits starting the 101st day |
Home Health Services Benefits |
- No deductible - No co-insurance |
Care in Psychiatric Hospitals |
- One lifetime benefit up to 190 days - 60 non-renewable “lifetime reserve” days |
Hospice Benefits |
Benefits for physician services and treatment of conditions not related to the terminal illness |
Medicare Part B
Financing:
- About 25% by monthly premiums;
- About 75% from general federal revenues
Medicare Part B Benefits (2008):
Coverage |
Physician and outpatient hospital care, lab tests, medical supplies, homehealth, and preventive services |
Standard Monthly premiums |
$96.40 |
Initial deductible |
$135.00 |
Co-pay |
20% of covered expenses, but no more than $952.00 for each service |
Penalty for late enrollment |
10% of monthly premium for each full 12 months for life (Exception: late enrollment due to cancellation of an employer-sponsored group insurance) |
Medicare Part D
Financing:
- About 25% by monthly premiums;
- About 75% from general federal revenues
Medicare Part D Benefits (2006):
Coverage |
Outpatient prescription drug |
Monthly premiums |
About $27.93* |
Annual deductible |
$275* |
Co-insurance |
25% of drug costs between $256 and $2,510*: |
Coverage gap |
100% out-of-pocket spending of drug costs between $2,511~$4,050* |
Catastrophic Coverage |
5% co-insurance or co-payment of $2 for generics and $5 for brand name from catastophic threshold of $4,050 in out-of-pocket drug costs |
Extra help |
Benefit for people with income less than $15,600 for an individual ($21,000 for a married couple living together) |
Penalty for late enrollment |
1% of the national average premium for each month delayed 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 rise by the annual percentage increase in part D expenditures thereafter
Supplemental Insurance
Medigap:
- Each state offers up to 12 standard plans ( Plans A ~ L) in 2008 .
- Starting 2006, plans H, I, or J may still be sold without drug benefits. People who already have one of these plans may be able to keep it. Also, Plans K and L are new policies introduced in 2006. In addition, there might be new types of Medigap policies available.
- 28.8% of all non-institutionalized Medicare beneficiaries had benefits in 2004.
Employer-sponsored benefits:
- 31.9% of all non-institutionalized Medicare beneficiaries had benefits in 2004
Benefit for dual eligibles:
- 12.5 million (28%) of Medicare beneficiaries are dual eligibles in January 2008
- 6.2 million receive full Medicaid benefits and assistance with Medicare premiums and cost-sharing
- 3.2 million others only receive assistance with their Medicare premiums and cost-sharing.
Qualified Medicare Beneficiaries |
- Entitled to Medicare Part A - Asset test
- Monthly income limit:
- Coverage: Medicare Part A & B premiums, deductibles and |
Specified Low-Income Medicare Beneficiaries (SLMBs) |
- Entitled to Medicare Part A - Asset test:
- Monthly income limit:
- Coverage: Medicare Part B premiums only |
Qualifying Individuals |
- Limited number of beneficiaries per year - Entitled to Medicare Part A - Asset test:
- Monthly income limit:
- Coverage: Medicare Part B premiums only |
Medicaid Only |
- Entitled to Medicare Part A and/or Part B and are eligible for - 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, don't have end-state renal disease, and live in the plan's service area
- Also known as Medicare+Choice or Medicare Health Plans
- Benefits are provided by private insurance companies
- Premiums, cost sharing, and coverage vary by plan
- 727 plans in March 2008, up 123 contracts since March 2007
- 9.7 million enrollees (22%) in 2008, up 1.4 million (3.1%) since March 2007