Medicare's Role for People Under Age 65 with Disabilities
Table 1: Amount and Distribution of Medicare Per Capita Spending Overall and By Type of Service for Traditional Medicare Beneficiaries Under Age 65 and Over Age 65, 2014 | |||||
Type of service | Part of Medicare covering service | Under age 65 | Over age 651 | ||
Amount | Percent of total | Amount | Percent of total | ||
Total | $13,098 | 100.0% | $9,972 | 100.0% | |
Part D drugs | D | 3,817 | 29.1% | 1,159 | 11.6% |
Acute inpatient hospital | A | 3,141 | 24.0% | 2,722 | 27.3% |
Outpatient hospital | A | 2,203 | 16.8% | 1,448 | 14.5% |
Other inpatient hospital | A | 640 | 4.9% | 369 | 3.7% |
Evaluation & management | B | 503 | 3.8% | 459 | 4.6% |
Other Part B procedures | B | 370 | 2.8% | 524 | 5.3% |
Skilled nursing facility | A | 366 | 2.8% | 826 | 8.3% |
Physician office services | B | 365 | 2.8% | 416 | 4.2% |
Home health | A or B2 | 324 | 2.5% | 499 | 5.0% |
Part B drugs | B | 287 | 2.2% | 360 | 3.6% |
Tests | B | 271 | 2.1% | 239 | 2.4% |
Durable medical equipment | B | 225 | 1.7% | 132 | 1.3% |
Other Part B services | B | 211 | 1.6% | 164 | 1.6% |
Imaging | B | 130 | 1.0% | 171 | 1.7% |
Hospice | A | 85 | 0.6% | 333 | 3.3% |
Dialysis | B | 59 | 0.5% | 13 | 0.1% |
Anesthesia | B | 52 | 0.4% | 53 | 0.5% |
Ambulatory surgery center | B | 50 | 0.4% | 86 | 0.9% |
NOTE: Analysis excludes beneficiaries in Medicare Advantage. 165-year olds are excluded because these beneficiaries are enrolled for less than a full year. 2Home health services can be covered under Part A or Part B depending on whether or not the services follow a hospital stay. SOURCE: Kaiser Family Foundation analysis of a five percent sample of Medicare claims from the CMS Chronic Conditions Data Warehouse, 2014. |
Table 2: Amount and Distribution of Out-of-Pocket Spending Overall and By Type of Service for Traditional Medicare Beneficiaries Under Age 65 and Age 65 or Older, 2012 |
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Type | Under age 65 | Age 65 or older | ||||
Amount | Percent of total | Percent of non-premium spending |
Amount | Percent of total | Percent of non-premium spending |
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Total out-of-pocket spending | $3,706 | 100% | n/a | $6,146 | 100% | n/a |
Premium out-of-pocket spending1 | 1,383 | 37% | n/a | 2,979 | 48% | n/a |
Non-premium out-of-pocket spending | 2,324 | 63% | 100% | 3,167 | 52% | 100% |
Medical providers | 671 | 18% | 29% | 767 | 12% | 24% |
Prescription drugs | 605 | 16% | 26% | 548 | 9% | 17% |
Long-term care facility | 464 | 13% | 20% | 995 | 16% | 31% |
Dental | 203 | 5% | 9% | 359 | 6% | 11% |
Inpatient | 149 | 4% | 6% | 103 | 2% | 3% |
Outpatient | 140 | 4% | 6% | 156 | 3% | 5% |
Skilled nursing facility | 87 | 2% | 4% | 110 | 2% | 3% |
Home health | 4 | <1% | <1% | 129 | 2% | 4% |
NOTE: Analysis excludes beneficiaries in Medicare Advantage. 1Missing out of pocket premium amounts were imputed following a hotdecking approach, stratified by categories of supplemental coverage. SOURCE: Kaiser Family Foundation analysis of Medicare Current Beneficiary Survey 2012 Cost & Use file. |
Table 3: Utilization of Service by Traditional Medicare Beneficiaries Under Age 65 and Age 65 or Older, 2012 |
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Type of service | Under age 65 | Age 65 or older |
Percent using service | Percent using service | |
Prescription drugs | 88% | 90% |
Office visit | 66% | 77% |
Outpatient visit | 64% | 64% |
Dental | 35% | 49% |
Emergency department (ED) visit | 19% | 14% |
2+ ED visits | 7% | 3% |
Any inpatient stay | 18% | 18% |
2+ inpatient stay | 7% | 6% |
Home health visit | 5% | 10% |
Skilled nursing facility (SNF) stay | 2% | 6% |
2+ SNF stays | <1% | 2% |
Hospice | 1% | 3% |
NOTE: Analysis excludes beneficiaries in Medicare Advantage. SOURCE: Kaiser Family Foundation analysis of Medicare Current Beneficiary Survey 2012 Cost & Use file. |