Medicare statistics 2024

What is Medicare? | How many people have Medicare? | Medicare stats by plan | Medicare drug coverage stats | Medicare trends in price | Medicare consumer costs | Medicare fraud stats | Common conditions among Medicare consumers | Medicare and COVID-19 stats | Medicare reform | FAQs | Research

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 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 and is offered to individuals 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 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 through traditional fee-for-service Medicare. This arrangement is sometimes referred to as “Part C” of Medicare. Medicare Part D covers prescription drugs but also covers 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 could help clarify the popularity of each part of Medicare and the vast amount of people that Medicare helps every year.

How many people are covered by Medicare?

• More than 61 million Americans are covered by Medicare health plans at this time (National Committee to Preserve Social Security & Medicare, 2020).
• Of the 61 million recipients, around 14%—approximately 9 million people—are under 65 years of age (National Committee to Preserve Social Security & Medicare, 2020).
• 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 plan

In 2019, 61.2 million people enrolled with Medicare. Here is the breakdown of the number of people per plan at that time:

• 60.9 million people received Medicare Part A; 52.2 million of those people were 65 years or older.
• 56.1 million people received Medicare Part B; 48.2 million of those people were 65 years or older.
• 22.2 million people were enrolled in Medicare Part C, also known as Medicare Advantage.
• 47.2 million people received Medicare Part D.

(National Committee to Preserve Social Security & Medicare, 2020)

Medicare drug coverage statistics

• $99.5 billion were spent on Medicare Part D in 2016.
• In 2016, there were 10 drugs that 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 is from Medicare consumers.
• In 2022 were 766 Part D Drug Plans, which is a decline in offerings since in 2021 there were 996 plans available.

(Kaiser Family Foundation, 2019)

Medicare trends in price

• In 2018, 15% of the total federal spending budget was spent on Medicare. This number is projected to rise to 18% of the federal budget by 2029 (Kaiser Family Foundation, 2019).
• A 2019 Medicare Trustees report projected that the Medicare Part A fund will be depleted by 2026 (Kaiser Family Foundation, 2019).
• Medicare consumers spent more out-of-pocket on prescription drugs in 2016 than on doctors’ visits and hospital care combined (The Commonwealth Fund, 2019).

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, where rates were at 7.25%.
• There has been an estimated $5.9 billion decrease in improper payments to home health agencies due to targeted actions of CMS to clarify policy and educate home health agencies. 
• Skilled nursing facilities have had an estimated $1 billion decrease in improper payments due to policy changes for services certification.
• Medicare Part C (Medicare Advantage) estimated that for 2020 improper payment rates were at 6.78% or $16.27 billion. 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 2010, two-thirds of the Medicare population, or 21.4 million consumers had two or more chronic conditions. The most common chronic conditions of those who have Medicare and the percentage of consumers that have these conditions are:
  • High blood pressure – 58%
  • High cholesterol – 45%
  • Ischemic heart disease – 21%
  • Arthritis – 29%
  • Diabetes – 28%
• The same study found that more than 70% of women had two or more chronic conditions, while men only had 65%.
• 84% of Medicare consumers visited their health care provider at least once during the year 2010. The number of visits was higher for those with multiple chronic conditions.

(CMS, 2012)

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). 
• 52% 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 are for expanding Medicare to include these items and some in Congress say it is important, these changes have yet to be seen at the time that this article was published. “The idea of expansion has been around for a while, but recently has picked up steam since it was proposed as part of the budget reconciliation legislation currently working its way through Congress,” Ernst adds.

Medicare questions and answers

How many Medicare consumers were there in 2021?

The Medicare enrollment data for 2021 has not been released at the time that this article was written. However, there are more than 37 million Americans with Original Medicare and 23 million Americans with Medicare Advantage meaning the total number of Medicare consumers is more than 61 million (Kaiser Family Foundation, 2021).

What did Medicare cost in 2021? What does it cost in 2023?

Medicare Part A is free for most people receiving Social Security. Those enrollees that pay for Part A of Medicare paid up to $499 every month in 2022.  This increased to up to $506 per month in 2023.

Medicare Part B cost $164.90 per month in 2023. In 2022, Part B cost $170.10 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 $19 per month in 2022 and is $18 per month in 2023.

Medicare Part D premiums also vary by plan but the average premium was $33.37 per month in 2022 and is $32.74 per month in 2023.

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

Some consumers with lower incomes 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 that Medicare consumers have are high blood pressure, high cholesterol, ischemic heart disease, arthritis, and diabetes (CMS, 2012).

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, 66% of Medicare consumers had two or more chronic conditions. This number is even higher for those with one chronic condition (CMS, 2012).

Lea este artículo en español aquí.

Medicare research

• Medicare survey, SingleCare
• Medicare.gov
• Centers for Medicare & Medicaid Services
• Medicare statistics, medicareresources.org
• Medicare price projections, Statista
• Medicare Advantage plan dataset, Kaiser Family Foundation
• Medicare numbers by plan type, National Committee to Preserve Social Security & Medicare
• Medicare Part D spending, Kaiser Family Foundation
• Medicare price trends, Kaiser Family Foundation
• Medicare spending trends 2010–2016, The Commonwealth Fund
• Medicare fraud explanation, Medicare Interaction
• Medicare fraud numbers, cms.gov
• Common conditions statistics, cms.gov
• Medicare and COVID-19, Office of Inspector General
• Medicare costs, medicare.gov