Number of People Receiving Medicare (2019): *
| Total Medicare beneficiaries
• Aged • Disabled |
61.2 million
• 52.6 million • 8.7 million |
| Part A (Hospital Insurance, HI) beneficiaries
• Aged • Disabled |
60.9 million
• 52.2 million • 8.7 million |
| Part B (Supplementary Medical Insurance, SMI) beneficiaries
• Aged • Disabled |
56.1 million
• 48.2 million • 7.9 million |
| Part C (Medicare Advantage) beneficiaries | 22.2 million |
| Part D (Prescription Drug Benefit) beneficiaries | 47.2 million |
- Totals may not add due to rounding.
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 (2019):
Total: $14,151
- Part A: $5,365
- Part B: $6,617
- Part D: $2,168
Status of Medicare Trust Funds (2019): *
| Medicare Trust Funds (billions): | HI (Part A) | SMI
(Part B) (Part D) |
Total |
| Assets at end of 2018 | $200.4 | $96.3 $8.0 | $304.7 |
| Total income in 2019
Payroll taxes |
$322.5
$285.1 |
$373.6 $98.7
—– —– |
$794.8
$285.1 |
| Total expenditures in 2019
Benefits |
$328.3
$322.8 |
$370.3 $97.6
$365.7 $97.1 |
$796.2
$785.6 |
| Net change in assets | -$ 5.8 | $ 3.3 $ 1.2 | $ 1.4 |
| Assets at end of 2019 | $194.6 | $ 99.6 $ 9.2 | $303.3 |
*Totals may not add due to rounding
Medicare Part A
Medicare Part A (HI) Financing and Tax Rate:
Financing: Primarily financed 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 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 (2020):
| Hospital Benefits | – Initial deductible: $1,408
– Daily co-insurance: · $0 (1st ~ 60th day) · $352 (61st ~ 90th day) · $704 (91st ~ 150th day, lifetime reserve days) |
| Skilled Nursing Facility Benefits | – Deductible: $0
– Daily co-insurance: · $0 (1st ~ 20th day) · $176 (21st ~ 100th day) · – No benefits starting the 101st day |
| Home Health Services Benefits | – No deductible
– 20% of Medicare –approved amount for durable medical equipment |
| 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 (2020):
| Coverage: | Physician and outpatient care, medical supplies, home health, and preventive services | ||||||||||||||||||||||||||||||||||||
| Standard Monthly premiums: | The standard Part B premium is $144.60. Monthly premiums have been means-tested since 2007.
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| Initial deductible: | $198.00 | ||||||||||||||||||||||||||||||||||||
| Co-pay: | 20% of covered expenses | ||||||||||||||||||||||||||||||||||||
| 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 16% by monthly premiums
- About 71% from general federal revenues
- About 13% from state payments, interest and court settlements
Medicare Part D Benefits (2020):
| Coverage: | Outpatient prescription drugs | ||||||||||||||||||||||||||||||||||||
| Monthly premiums: | The national base beneficiary premium for 2019 was $32.74. As of 2011, monthly premiums are means-tested.
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| Annual deductible | $435* | ||||||||||||||||||||||||||||||||||||
| Co-insurance: | 25% of drug costs between $435 and $4,020*: | ||||||||||||||||||||||||||||||||||||
| Coverage gap: | 25% out-of-pocket spending for generic drug costs between $4,020-$6,350*. A 75% discount is available on covered brand-name prescription drugs at the time of purchase. | ||||||||||||||||||||||||||||||||||||
| Extra help: | Benefit for people with income less than $19,140 for an individual ($25,860 for a married couple living together) and up to $14,610 in resources ($29,160 for a married couple). Note: Individual states might apply different criteria for extra help. |
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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.
- Starting June 1 2010, plans E, H, I, or J are no longer available to buy. People who already have one of these plans can continue with it. Also, Plans M and N are policies introduced in 2010.
- 29% of all Medicare beneficiaries have a Medigap policy.
Medicare Savings Programs:
Benefit for dual eligibles (those who qualify for Medicare and Medicaid benefits):
- 20% of Medicare beneficiaries received Medicaid in 2017.
| Qualified Medicare Beneficiaries (QMBs) |
– Entitled to Medicare Part A
– Asset test · Not exceeding $7,860 for an individual; · Not exceeding $11,800 for married couples – Monthly income limit: Most states: $1,084 for an individual or $1,457 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: · Not exceeding $7,860 for an individual; · Not exceeding $11,800 for married couples – Monthly income limit: Most states: $1,296 for an individual or $1,744 for a couple – Coverage: Medicare Part B premiums only |
| Qualifying Individuals (QIs) |
– Limited number of beneficiaries per year
– Entitled to Medicare Part A – Asset test: · Not exceeding $7,860 for an individual; · Not exceeding $11,800 for married couples – Monthly income limit: Most states: $1,456 for an individual or $1,960 for a couple – Coverage: Medicare Part B premiums only |
| Medicaid Only (Non QMB, SLMB, or QI) |
– 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 states 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-stage renal disease, and live in the service area of the plan.
- Formerly known as Medicare+Choice or Medicare Health Plans.
- Benefits are provided by private insurance companies.
- Premiums, cost sharing, and coverage vary by plan.
- 1 million enrollees (36% of all Medicare enrollees) in 2020.
Government Relations and Policy, August 2020