117 Medicare statistics to know

Medicare, now 50 years old, provides health insurance for Americans over the age of 65. Soon after the program's inception in 1966, there were approximately 19 million older citizens enrolled, in 50 years that number has grown to nearly 56 million.

Here are 100 statistics to know about Medicare, based on the most recent available data.

Medicare spending
1. In fiscal year 2015, Medicare benefits will total $605.9 billion.
2. Gross fee for service spending for Part A will total $203.1 billion.
3. Gross fee for service spending for Part B will total $167.8 billion.
4. Gross fee for service spending for Part C will total $149.8 billion.
5. Gross fee for service spending for Part D will total $85.2 billion.
6. The total number of Medicare enrollees in 2015 is projected to be 55.2 million.
7. In fiscal year 2013, Medicare made up 20 percent of national health expenditures.
8. In 2014, Medicare benefit payments totaled $597.2 billion, according to the Congressional Budget Office.
9. As members of the Baby Boom generation reach the Medicare eligibility age, an additional 19.1 million people are expected to enroll in the program over the next 11 years.
10. Twenty-seven percent of Medicare-enrolled physicians reported using an EHR in 2013, according to CMS.
11. Forty-five percent of Medicare-enrolled physicians participate in the Medicare Physician Quality reporting program.

Medicare Part B covers two types of services: Medically necessary services and preventive services. A patient pays nothing for these services if they receive them from a provider who accepts assignment, or agrees to be paid directly by Medicare. The following items are the 10 services with the most Medicare Part B spending for 2012, according to CMS.

12. Internal Medicine — $9.33 billion
13. Ophthalmology — $5.93 billion
14. Cardiology — $5.29 billion
15. Ambulance Service Supplier — $4.95 billion
16. Clinical Laboratory (billing independently) — $4.82 billion
17. Family Practice — $4.79 billion
18. Hematology/Oncology — $4.78 billion
19. Medical Supply Company — $4.51 billion
20. Diagnostic Radiology — $3.98 billion
21. Medical Supply Company with Respiratory Therapist — $3.01 billion

The following items are the 10 diagnostic related group descriptions with the most allowable payments to hospitals for fiscal year 2013, according to CMS. Also included is the total number of patient discharges associated with each diagnostic.

22. Major joint replacement or reattachment of lower extremity — $6.6 billion for 446,148 total discharges
23. Septicemia or severe sepsis — $5.6 billion for 398,004 total discharges
24. Heart failure and shock with major complicating or comorbid condition — $2.1 billion for 194,697 total discharges
25. Simple pneumonia and pleurisy — $1.5 billion for 145,931 total discharges
26. Heart failure and shock with comorbid condition — $1.4 billion for 198,483 total discharges
27. Chronic obstructive pulmonary disease — $1.3 billion for 152,880 total discharges
28. Simple pneumonia and pleurisy with comorbid condition —$1.3 billion for 182,388 total discharges
29. Esophagitis, gastroenterology and miscellaneous digestive disorders — $1.1 billion for 199,292 total discharges
30. Renal failure — $1.1 billion for 154,280 total discharges
31. Kidney and urinary tract infections — $982.5 million for 175,529 total discharges

The following 10 states had the highest Medicare hospital spending by claim for 2013, according to CMS.

32. Texas
33. California
34. Florida
35. New York
36. Pennsylvania
37. Ohio
38. Illinois
39. Georgia
40. Tennessee
41. Michigan

42. Medicare's Acute Care Hospital Inpatient Prospective Payment System enables hospitals to contract with Medicare to furnish inpatient care. Hospitals receive payment of predetermined IPPS rates on either a per discharge or per case basis.

43. In 2012, CMS began its Readmissions Reduction Program. Under this program, acute care hospitals with excess readmissions for certain conditions within 30 days of initial discharge that receive payment under IPPS run the risk of Medicare payment reductions.

The following five statistics are the average charges submitted to Medicare from IPPS hospitals and the amount actually received by the hospital.

44. Level 1 Hospital Clinic Visits
Average charges submitted — $163.4
Average total payment — $107.6
45. Level 2 Hospital Clinic Visits
Average charges submitted — $213.5
Average total payment — $150
46. Level 3 Hospital Clinic Visits
Average charges submitted — $294
Average total payment — $198.4
47. Level 4 Hospital Clinic Visits
Average charges submitted — $377.4
Average total payment — $250.4
48. Level 5 Hospital Clinic Visits
Average charges submitted — $473
Average total payment — $296.9

Medicare Advantage
Medicare Advantage is an insurance program made up of PPOs or HMOs that substitutes for Medicare Part A and B benefits. While Parts A and B are processed through CMS, Medicare Advantage is processed through commercial insurance companies receiving federal compensation. Medicare Advantage is sometimes referred to as Medicare Part C.

49. The Medicare Advantage program made up 26 percent of benefit payments in fiscal year 2015, followed by hospital inpatient services at 23 percent. The remaining payments were divided among physician payments, hospice, durable medical equipment, home health and other services.

50. In 2015, 378 Medicare Advantage plans were discontinued and 309 new plans were made available, for a total of 1,945.

51. The average number of Medicare Advantage plans available to beneficiaries has fallen from 48 per beneficiary in 2009 to 18 in 2015.

52. The Medicare Part D plan coverage gap refers to the period of time after an enrollee has spent a certain amount of money for covered prescription drugs and must pay for additional medications out of pocket up to a certain limit. In 2013, more than 4.8 million beneficiaries reached the coverage gap and saved more than $4.5 billion on their medications due to the prescription drug discount program.

Top 5 participating plans in Medicare Advantage based on membership or enrollment
53. UnitedHealth Group — 2,275,768
54. Humana — 1,589,563
55. Kaiser Permanente — 1,125,946
56. aetna — 1,231,700
57. Cigna — 1,012,306

Distribution of Medicare Advantage Plans by type in 2015
58. HMO — 66 percent
59. Local PPO —24 percent
60. PFF — 4 percent
61. Other — 4 percent
62. Regional PPO — 2 percent

The following five items are the weighted average monthly premiums for Medicare Advantage prescription drug plans, according to a Kaiser Family Foundation report.

63. In total, plans are up an average of $7 per month from 2014, an increase of more than 20 percent.
64. HMOs are up 22 percent, from $26 in 2014 to $32 in 2015.
65. Local PPOs are up 23 percent, from $57 in 2014 to $70 in 2015.
66. PFFs are up 15 percent, from $47 in 2014 to $53 in 2015.
67. Regional PPOs are up 25 percent, from $28 in 2014 to $34 in 2015.

Medicare offers star ratings as a tool to help consumers choose a provider. They are determined by CMS using Medicare data, patient surveys and Outcome and Assessment Information Sets performed for each facility. The following 10 states have the highest overall Medicare quality of patient care star ratings, according to CMS.

68. Rhode Island — 75.886
69. North Dakota — 75.704
70. South Carolina — 75.660
71. Massachusetts — 75.356
72. South Dakota — 75.334
73. Utah — 75.304
74. Pennsylvania — 75.1
75. Kansas — 75.052
76. Vermont — 75.043
77. New Jersey — 75.026

Physicians and Medicare
The following 10 states have the highest number of physicians currently enrolled in Medicare, according to CMS.

78. California — 180,101
79. Pennsylvania — 164,030
80. New York — 136,548
81. Texas — 127,623
82. Florida — 108,243
83. Illinois — 86,176
84. Michigan — 72,216
85. Ohio — 70,141
86. Massachusetts — 68,916
87. Virginia — 61,111

The following 20 primary specialties had the highest number of Medicare enrolled physicians in 2013, according to CMS.

88. Internal medicine — 239,869
89. Nurse practitioner — 188,590
90. Family practice — 175,659
91. Diagnostic radiology — 87,536
92. Physical therapy — 76,618
93. Certified registered nurse anesthetist — 74,631
94. Anesthesiology — 69,580
95. Obstetrics/gynecology — 68,867
96. Cardiovascular disease (cardiology) — 64,911
97. Clinical social worker — 58,041
98. Chiropractic — 57,256
99. Psychiatry — 53,716
100. General surgery — 51,688
101. Clinical psychologist — 51,508
102. Orthopedic surgery — 47,616
103. Optometry — 46,221
104. Ophthalmology — 37,361
105. Emergency medicine — 35,434
106. Neurology — 34,780
107. Gastroenterology — 29,868

The following 10 specialties received the highest Medicare incentive payments for demonstrating meaningful use as of June 2015, according to CMS.

108. Family practice — $1 billion
109. Internal medicine — $992.1 million
110. Cardiovascular disease (cardiology) — $391.8 million
111. Orthopedic surgery — $311.8 million
112. Obstetrics/gynecology — $182 million
113. Gastroenterology — $232 million
114. General Surgery — $223.1 million
115. Ophthalmology — $210.5 million
116. Neurology — $174 million
117. Urology — $165.9 million

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