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How Much Is Enough? Out-of-Pocket Spending Among Medicare Beneficiaries: A Chartbook

Table 1:  Average and Percentile Estimates of Medicare Beneficiaries’ Total Out-of-Pocket Spending on Services and Premiums, by Demographics, 2010
Beneficiaries Out-of-pocket spending
Number % of Total Average 25th percentile Median 75th percentile 90th percentile
TOTAL 37,582,769 100% $4,734 $1,711 $3,312 $5,244 $8,235
Sex
Men 16,874,786 45 4,363 1,581 3,012 4,933 7,660
Women 20,707,984 55 5,036 1,819 3,550 5,459 8,636
Race/ethnicity
White 29,646,586 79 5,179 2,026 3,642 5,528 8,683
Black   3,555,108 9 3,151   575 1,862 3,801 6,530
Hispanic   2,513,783 7 2,826   518 1,733 3,635 5,480
Age
Under 65   6,410,667 17 3,007   437 1,826 3,898 6,463
65-74 16,125,438 43 4,020 1,753 3,179 4,955 7,427
75-84   9,991,714 27 5,245 2,274 3,868 5,687 8,536
85+   5,054,949 13 8,191 2,439 4,388 7,255 16,830
Health status
Excellent   5,712,735 15 4,058 1,857 3,188 4,889 6,897
Very good 10,386,666 28 4,114 1,903 3,402 4,974 7,400
Good 11,072,707 29 4,717 1,840 3,468 5,332 7,952
Fair   6,879,881 18 5,680 1,173 3,047 5,785 10,652
Poor   3,282,052 9 5,799   929 2,963 5,902 11,822
Income
Under $10,000   4,576,593 12 2,817   186    870 3,416 6,771
$10,000-20,000   9,318,874 25 4,467 1,050 2,581 4,705 7,441
$20,000-30,000   6,240,589 17 5,406 2,246 3,723 5,524 8,513
$30,000-40,000   4,957,866 13 5,273 2,275 3,799 5,368 8,922
$40,000-50,000   3,269,558 9 4,762 2,310 3,722 5,496 7,805
More than $50,000   9,219,289 25 5,199 2,384 3,934 5,807 8,768
Type of residence
Community 35,439,416 94 3,918 1,680 3,220 4,987 7,264
Facility 2,125,088 6  18,351 3,790 10,247 25,975 46,594
Number of functional impairments
No ADLs/IADLs 19,236,952 51 3,755 1,803 3,232 4,847 6,891
Only IADLs   5,238,023 14 4,338 1,495 3,205 5,100 7,446
1-2 ADLs   7,760,135 21 4,432 1,618 3,342 5,393 8,171
3+ ADLs   5,195,370 14 9,199 1,398 4,192 9,021 20,611
Number of chronic conditions
None   1,762,237 5 3,229 1,255 2,127 3,610 6,004
1-2 11,491,433 31 4,251 1,526 2,959 4,706 7,414
3-4 14,635,202 39 4,852 1,899 3,530 5,288 8,259
5+   9,693,897 26 5,401 1,839 3,751 6,040 9,397
NOTE:Analysis excludes beneficiaries enrolled in Medicare Advantage plans. Functional impairments include limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).The count of chronic conditions includes heart condition, high blood pressure, diabetes, arthritis, osteoporosis/broken hip, pulmonary disease, stroke, Alzheimer’s, Parkinson’s, skin cancer, other cancer, mental disorder, and incontinence.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost & Use file.
Table 2: Medicare Beneficiaries’ Average Total Out-of-Pocket Spending on Services and Premiums, by Demographics, 2000 and 2010
  2000 2010
  Beneficiaries Out-of-pocket spending Beneficiaries Out-of-pocket spending
  Number % of Total Premiums Services Total Number % of Total Premiums Services Total
TOTAL 33,594,228 100% $1,132 $2,161 $3,293 37,582,769 100% $1,989 $2,744 $4,734
Sex
Men 14,690,408 44 1,081 1,778 2,859 16,874,786 45 1,879 2,485 4,363
Women 18,903,820 56 1,172 2,458 3,630 20,707,984 55 2,080 2,956 5,036
Race/ethnicity
White 27,055,448 81 1,255 2,333 3,588 29,646,586 79 2,196 2,983 5,179
Black  3,024,231 9  564 1,611 2,175  3,555,108 9 1,135 2,016 3,151
Hispanic  2,220,219 7  646 1,328 1,974  2,513,783 7 1,199 1,627 2,826
Age
Under 65  5,058,221 15  449 1,759 2,208  6,410,667 17  948 2,059 3,007
65-74 14,137,492 42 1,185 1,403 2,588 16,125,438 43 2,093 1,926 4,020
75-84 10,316,096 31 1,385 2,175 3,560  9,991,714 27 2,369 2,876 5,245
85+  4,082,419 12 1,155 5,249 6,405  5,054,949 13 2,229 5,962 8,191
Health status
Excellent  4,289,314 13 1,375 1,084 2,460  5,712,735 15 2,283 1,774 4,058
Very good  7,945,551 24 1,329 1,390 2,719 10,386,666 28 2,268 1,846 4,114
Good 10,538,972 31 1,185 2,049 3,234 11,072,707 29 2,078 2,638 4,717
Fair  7,188,604 21  894 3,180 4,074  6,879,881 18 1,521 4,159 5,680
Poor  3,534,777 11  720 3,309 4,029  3,282,052 9 1,295 4,505 5,799
Income
Under $10,000  8,177,862 24  516 2,081 2,597  4,576,593 12  643 2,174 2,817
$10,000-20,000  9,451,333 28 1,165 2,366 3,531  9,318,874 25 1,505 2,962 4,467
$20,000-30,000  5,918,629 18 1,343 2,020 3,363  6,240,589 17 2,347 3,060 5,406
$30,000-40,000  3,672,472 11 1,403 2,002 3,406  4,957,866 13 2,452 2,821 5,273
$40,000-50,000  2,121,199 6 1,421 2,671 4,091  3,269,558 9 2,410 2,352 4,762
More than $50,000  4,252,733 13 1,571 1,938 3,510  9,219,289 25 2,507 2,692 5,199
Type of residence
Community 31,394,889 93 1,187 1,345 2,532 35,439,416 94 2,060 1,858 3,918
Facility  2,199,339 7 353 13,806 14,159  2,125,088 6 816 17,534 18,351
Number of functional impairments
No ADLs/IADLs 16,647,765 50 1,274 1,135 2,409 19,236,952 51 2,227 1,528 3,755
Only IADLs  5,201,027 15 1,107 1,541 2,649  5,238,023 14 1,824 2,513 4,338
1-2 ADLs  6,628,009 20 1,053 2,319 3,372  7,760,135 21 1,868 2,564 4,432
3+ ADLs  5,062,063 15  796 5,857 6,653  5,195,370 14 1,461 7,737 9,199
Number of chronic conditions
None  2,425,586 7 1,076 1,093 2,169  1,762,237 5 1,876 1,353 3,229
1-2 12,615,489 38 1,122 1,935 3,056 11,491,433 31 1,926 2,325 4,251
3-4 12,461,312 37 1,149 2,336 3,485 14,635,202 39 2,081 2,771 4,852
5+  6,091,841 18 1,140 2,697 3,837  9,693,897 26 1,947 3,454 5,401
NOTE:Analysis excludes beneficiaries enrolled in Medicare Advantage plans. Premiums includes Medicare Parts A, B, and D and other types of health insurance beneficiaries may have (Medigap, employer-sponsored insurance, and other public and private sources). Functional impairments include limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).The count of chronic conditions includes heart condition, high blood pressure, diabetes, arthritis, osteoporosis/broken hip, pulmonary disease, stroke, Alzheimer’s, Parkinson’s, skin cancer, other cancer, mental disorder, and incontinence.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2000 and 2010 Cost & Use files.
Methodology

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