Medicare statistics 2025

In this article:

• What is Medicare?
• How many people are covered by Medicare?
• Medicare statistics by part
• Medicare drug coverage statistics
• Medicare trends in price
• Medicare fraud statistics
• Common conditions
• Medicare and COVID-19 statistics
• Medicare reform
• FAQs

In this article

• What is Medicare?
• How many people are covered by Medicare?
• Medicare statistics by part
• Medicare drug coverage statistics
• Medicare trends in price
• Medicare fraud statistics
• Common conditions
• Medicare and COVID-19 statistics
• Medicare reform
• FAQs

You have likely heard about Medicare while watching the news or seeing the money taken from your paycheck. But who is eligible for Medicare, and what does it actually do? This can be a complex topic. Let’s take a deeper look into what Medicare is all about.

What is Medicare?

“Medicare is a federal health insurance program for individuals 65 years or older and those younger than 65 with certain health conditions,” explains Claire Ernst, director of governmental affairs at the Medical Group Management Association (MGMA). “Medicare is divided into several parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).”

Established in 1965, the Medicare program originally covered those 65 years and older. Over the years, it has expanded coverage. It is offered to younger people under 65 who have been receiving Social Security Disability Insurance (SSDI) benefits for two years, those with end-stage renal disease, or those with amyotrophic lateral sclerosis (ALS). 

Medicare is administered by the United States Centers for Medicare and Medicaid Services (CMS). There are four major parts of Medicare. Broadly speaking, Medicare Part A covers inpatient hospital stays, hospice, and care while you are in a skilled nursing facility. Certain health services like doctor’s visits, outpatient care, and medical supplies are covered under Medicare Part B. Some Medicare beneficiaries choose to have their Medicare benefits administered through a private Medicare Advantage plan instead of traditional fee-for-service Medicare. This arrangement is sometimes referred to as “Part C” of Medicare. Medicare Part D covers prescription drugs and most recommended shots and vaccines, except those covered under Medicare Part B.

Given the four different parts of Medicare, enrollment can be confusing. In a 2022 Medicare survey by SingleCare, nearly two-thirds (65%) of respondents reported that they would not know which part(s) of Medicare they should enroll in. The following Medicare statistics and data could help clarify the popularity of each part of Medicare and the vast number of people that Medicare helps every year.

How many people are covered by Medicare?

• As of March 2023, 65,748,297 people are enrolled in Medicare. Of these people, 33,948,778 are enrolled in Original Medicare, and 31,799,519 are enrolled in Medicare Advantage or other health plans. (Center for Medicare Advocacy, 2023). 
• Medicare cost the U.S. $917 billion in 2020. It is estimated that by 2031, Medicare could cost up to $1.78 trillion (Statista, 2021). 
• Almost 4 out of 10 Medicare consumers are enrolled in Medicare Advantage plans (Kaiser Family Foundation, 2021). 

Medicare statistics by part

As of September 2024, 68 million people were enrolled in Medicare. Here is the breakdown of the number of people per plan at that time:

• 49.5% were enrolled in Original Medicare, while 50.5% were enrolled in Medicare Advantage or other Health Plans. 
• 80.4% of members had Part D prescription drug coverage.  
• 89.4% of members were 65 years or older. 

(Centers of Medicare & Medicaid Services, 2024)

Medicare drug coverage statistics

• $99.5 billion was spent on Medicare Part D programs in 2016.
• In 2016, 10 drugs accounted for 17% of all Part D spending. Here is a breakdown of the top drugs:
  • Harvoni, a treatment for Hepatitis C, accounted for $4.4 billion of spending.
  • Revlimid, a treatment for multiple myeloma, accounted for $2.6 billion of spending.
  • Lantus Solostar, a treatment for diabetes, accounted for $2.5 billion of spending.
  • Januvia, a treatment for diabetes, accounted for $2.4 billion of spending.
  • Crestor, a treatment for high cholesterol, accounted for $2.3 billion of spending.
  • Advair Diskus, a treatment for asthma and chronic obstructive pulmonary disease (COPD), accounted for $2.3 billion of spending.
• In 2017, 30% of the nation’s prescription drug spending was from Medicare consumers.
• In 2022, there were 766 Part D Drug Plans available, a decline from the 996 plans available in 2021.

(Kaiser Family Foundation, 2019)

Medicare trends in price

• In 2021, 10% of the federal budget was spent on Medicare. This number is projected to rise to 18% by 2032 (Kaiser Family Foundation, 2023).
• A 2023 Medicare Trustees report projected that the Medicare Part A fund will be depleted by 2028 (Kaiser Family Foundation, 2023).  
• Medicare consumers spent more out-of-pocket on prescription drugs in 2016 than on doctors’ visits and hospital care combined (The Commonwealth Fund, 2019).
• In 2025, the Medicare Part D donut hole was eliminated as part of the Inflation Reduction Act.

Medicare fraud statistics

Medicare fraud happens when someone (a doctor or Medicare beneficiary) knowingly deceives Medicare by receiving payment when they should not. 

“Examples of fraud range from knowingly submitting false claims to knowingly billing for services at a higher complexity level than the services provided,” Ernst says. “There are several federal laws that govern Medicare fraud and abuse, such as the False Claims Act and the Physician Self-Referral Law (Stark Law), and the Office of the Inspector General (OIG) is tasked with protecting the integrity of the program.” 

While CMS cannot account for all cases of fraud, they do have figures on improper payments.

• In 2020, Medicare estimated the improper payment rate was about 6.27% of all payments, which is around $25.74 billion in improper payments. This is a decrease from 2019 when rates were at 7.25%.
• An estimated $5.9 billion in improper payments to home health agencies has decreased due to CMS’s targeted actions to clarify policy and educate home health agencies. 
• Due to policy changes for service certification, skilled nursing facilities have experienced an estimated $1 billion decrease in improper payments.
• Medicare Part C (Medicare Advantage) estimated that improper payment rates were 6.78%, or $16.27 billion, in 2020. This is a decrease from past years due to Medicare Advantage companies requiring more medical records for validation.

(CMS, 2020)

Common conditions among Medicare consumers

• In 2022, 65.1 million Americans are enrolled in Medicare. High blood pressure was the most common chronic condition among Medicare beneficiaries, with a 65% prevalence rate. The top ten chronic conditions among Medicare consumers include:
  • High blood pressure – 65%
  • High cholesterol – 64%
  • Arthritis – 35%
  • Cataract – 26%
  • Diabetes – 26%
  • Anemia – 21%
  • Ischemic heart disease – 21%
  • Hypothyroidism – 21%
  • Depression – 19%
  • Chronic kidney disease 18%
• The same study found that blood pressure screenings were the most common use of Medicare services, with 96% of beneficiaries taking advantage of the service.

(CMS, 2024)

Medicare and COVID-19 statistics

• Of the Medicare consumers living in nursing homes, 2 in 5 Medicare had COVID-19 (or suspected COVID-19) in 2020 (U.S. Department of Health and Human Services, 2021).
• The average of deaths rose for Medicare consumers in nursing homes at 1,000 more deaths per day in April 2020 (U.S. Department of Health and Human Services, 2021). 
• Fifty-two percent of survey respondents—22% of which were Medicare-eligible—did not know that Medicare covers COVID tests, vaccines, and monoclonal antibody treatments (SingleCare, 2022).

Medicare reform

Medicare reform is a topic that comes up often. “The types of reform that people would like to see varies widely,” Ernst says. “Most notably, there has been a push from Democrats in Congress for the inclusion of dental, hearing, and vision benefits, but this has been met with opposition from many across the aisle because of what it could do to the solvency of the program.”

While 90% of Americans support expanding Medicare to include these items, and some in Congress say it is important, these changes are still ongoing. One of the biggest changes for 2025 is that the Medicare ‘donut hole’ has been eliminated. The donut hole refers to a gap in coverage that didn’t pay for prescription drugs on Medicare Part D after a certain threshold. However, in 2025, the coverage gap will finally be eliminated as part of the Inflation Reduction Act. 

Medicare questions and answers

What percentage of people are covered by Medicare?

In 2022, 18.7% of the population was covered by Medicare, a .3% increase from 2021. According to the Centers for Medicare and Medicaid Services, as of March 2023, 33,948,778 people were enrolled in Original Medicare, and 31,799,519 people were enrolled in Medicare Advantage plans.

What did Medicare cost in 2024? What does it cost in 2025?

Medicare Part A is free for most people receiving Social Security. In 2024, enrollees who paid for Part A of Medicare paid up to $505 every month, which increased to $518 per month in 2025.

Medicare Part B cost $185 per month in 2025. In 2024, Part B costs $174.70 per month. Depending on your income, your Part B premium may be higher.

Medicare Part C premiums vary by plan, but the average premium across all plans was $18.23 per month in 2024 and $17 per month in 2025.

Medicare Part D premiums also vary by plan, but the national basepremium was $34.70 per month in 2024 and will be $36.78 per month in 2025.

This is the cost of the monthly premium and does not include copays, coinsurance, or deductibles.

Some lower-income consumers may qualify for cost subsidies like Extra Help or a Medicare Savings Program, which could significantly lower these costs.

What are the most common health conditions of Medicare consumers?

The top five health conditions among Medicare consumers are high blood pressure, high cholesterol, arthritis, cataracts, and diabetes (CMS, 2024).

How much money does Medicare lose every year to fraud?

It is estimated that $25.74 billion was given for improper payments in 2020. This number changes each year due to changes implemented to prevent fraud (CMS, 2020).

How many people on Medicare have chronic conditions?

In 2017, 67.6% of Medicare consumers, or 33.7 million beneficiaries, were diagnosed with multiple chronic conditions. 

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