U.S. Department of

Health and Human Services

Donna Shalala, Secretary

Health Care Financing Administration

Nancy-Ann Min DeParle, Administrator

Michael Hash, Deputy Administrator

Office of Strategic Planning

Thomas M. Kickham, Acting Director

Tim Love, Acting Deputy Director

Systems, Technical and Analytical

Resources Group

William D. Saunders, J.D., Director

David Gibson, Deputy Director

Publication Coordinator

George D. Lintzeris

Press inquiries should be directed to the

HCFA Press Office, (202) 690-6145.

Data inquiries for Medicare and national health expenditure statistics should be directed the the Division of Health

Care Information Services, (410) 786-3689, and for

Medicaid statistics to (410) 786-0165.
Preface

This reference booklet provides 

significant summary information about 

health expenditures and Health Care 

Financing Administration (HCFA) 

programs. The information presented 

was the most current available at the 

time of publication. Significant time 

lags may occur between the end of a 

data year and aggregation of data for 

that year.

The data are organized as follows:

Page

Highlights - Growth in HCFA Programs and Health 1

Expenditures

I. Populations 5

II. Providers/Suppliers 14

III. Expenditures 21

IV. Utilization 29

V. Administrative/Operating 37

Reference 42
1

Highlights

Growth in HCFA programs and

health expenditures

Populations

• Persons enrolled for Medicare coverage increased

from 19.5 million in 1967 to a projected 39.5 million

in 1999, a 103 percent increase.

• The average monthly number of Medicaid enrollees

in 1999 (person-years) is estimated to be just under 33

million, the greater majority of whom are dependant

children (49 percent).

• At any point of time, about 12 percent of the popula-tion

is enrolled in the Medicaid program.

• Medicare enrollees with end-stage renal disease

increased from just under 67 thousand in 1980 to

nearly 250 thousand in 1998, an increase of 275

percent.

• Medicare State buy-ins have grown from about 2.8

million recipients in 1975 to over 5.1 million recipients

in 1998, an increase of over 80 percent.

• The number of dually entitled persons (that is,

persons covered by both Medicare and Medicaid)

amounted to about 6 million persons for 1998.
2

Providers/Suppliers

• The number of inpatient hospital facilities decreased

from 6,707 in December 1975 to 6,116 in December

1998. Total inpatient hospital beds have dropped

from 51.5 beds per 1,000 enrolled in 1975 to 26.3 in

1998, a decrease of nearly 49 percent.

• The total number of Medicare certified beds in short-stay

hospitals showed a steady increase from less

than 800,000 at the beginning of the program and

peaked at 1,025,000 in 1984-86. Since that time, the

number has dropped to less than 891,000.

• The number of psychiatric hospitals grew to about

400 by 1976, where it remained until the start of the

prospective payment system (PPS) in 1983. After PPS,

the number increased to over 700 in the early 1990’s

and has since dropped to about 600.

• The number of skilled nursing facilities (SNFs)

increased rapidly during the 1960s, decreased during

the first half of the 1970s, and has been increasing

ever since, reaching 15,032 by the beginning of 1999,

an increase of 1.6 percent since 1998.

• After peaking in December 1970, the number of

home health agencies (HHAs) remained stable

during most of the decade. The number of HHAs

accelerated with the passage of the Omnibus Budget

Reconciliation Act of 1980, which permitted the

certification of proprietary HHAs in States not having

licensure laws. By December 1986, there were

almost 6,000 participating facilities. The Balanced

Budget Amendment of 1997 has impacted signifi-cantly
3

on the number of participating HHAs. Between

1998 and 1999, the number of HHAs has decreased

from 10,807 to 9,330, a decrease of 13.7 percent.

Expenditures

• National health expenditures were $1.149 trillion in

1998, 13.5 percent of the gross domestic product. By

1998, total HCFA program outlays were $294.1

billion, 17.8 percent of the Federal budget.

• Medicare skilled nursing facility benefit payments

have increased from $12.3 billion in 1997 to $13.4

billion in 1998, an increase of 8.9 percent.

• Medicare home health agency benefit payments have

decreased from $17.8 billion in FY 1997 to $14.8 billion

in FY 1998, a decrease of 16.6 percent.

• National health expenditures per person were $202

in 1965 and consistently grew steadily to reach $4,094

by 1998.

Utilization of Medicare and Medicaid services

• Between 1990 and 1998, the number of short-stay

hospital discharges increased from 10.5 million to

11.8 million, an increase of nearly 12.4 percent.

• The short-stay hospital average length of stay

decreased significantly from 9.0 days in 1990 to 6.2

days in 1998, a decrease of nearly 31 percent. Like-wise,

the average length of stay for excluded units

decreased significantly from 19.5 days in 1990 to
4

12.9 days in 1998, a decrease of almost 34 percent.

• Nearly 30 million persons received services under

Medicare during 1997. Comparably, almost 35 million

persons used Medicaid services in 1997.

• Almost 6.9 million persons received reimbursable fee-forservice inpatient hospital services under Medicare

in 1997. The ratio of Medicare aged users of any type

of covered service has grown from 367 per 1,000

enrolled in 1967 to 917 per 1,000 enrolled in 1997.

• Nearly 30 million persons received reimbursable fee-forservice physic ian services under Medicare during

1997. Over 21 million persons received reimbursable

physician services under Medicaid during 1997.

• Over 20 million persons received reimbursable fee-for-service

outpatient hospital services under Medicare

during 1997. During 1997, almost 14 million persons

received Medicaid reimbursable outpatient hospital

services.

• Over 1.5 million persons received care in SNFs

covered by Medicare during 1997. Over 1.6 million

persons received care in nursing facilities, which

include SNFs and all other intermediate care facilities

other than mentally retarded, covered by Medicaid

during 1997.

• Almost 21 million persons received prescribed drugs

under Medicaid during 1997.
5

Populations

Information about persons covered

by Medicare or Medicaid

For Medicare, statistics are based on persons enrolled for coverage.

Historically, for Medicaid, recipient counts were

used as a surrogate of persons eligible for coverage, as well as for persons

utilizing services. Current data systems now allow the reporting of total

enrollees. Statistics are available by major program categories, by

demographic and geographic variables, and as proportions of the U.S.

population. Utilization data organized by persons served may be found in the

Utilization section.
6

Table 1

Medicare enrollment/trends

Total Aged Disabled

persons persons persons

July In millions

1966 19.1 19.1 - -

1970 20.5 20.5 - -

1975 24.9 22.7 2.2

1980 28.4 25.5 3.0

1985 31.1 28.1 2.9

1990 34.3 31.0 3.3

1995 37.6 33.2 4.4

1997 38.4 33.6 4.8

1998 38.8 33.8 5.0

1999 39.5 34.1 5.3 1

2000 39.9 34.4 5.5 1

2001 40.3 34.6 5.7 1

 Data for 1966-1998 are as of July. Data for 1999-2001 represent ever enrolled estimates. 1

NOTE: Numbers may not add to totals because of rounding.

SOURCES: Health Care Financing Administration, Office of Information Services.

Table 2

Medicare enrollment/coverage

HI and/or HI and 

SMI HI SMI SMI HI only SMI only

In millions

All persons 38.8 38.4 36.8 36.4 2.0 0.4

Aged persons 33.8 33.4 32.3 31.9 1.5 0.4

Disabled persons 5.0 5.0 4.5 4.5 0.5 ( ) 1

Number less than 500. 1 

NOTE: Data as of July 1, 1998.

SOURCE: Health Care Financing Administration, Office of Information Services: Data from the Division of

Information Distribution.
7

Table 3

Medicare enrollment/demographics

Total Male Female

In thousands

All persons 38,787 16,670 22,116

Aged 33,732 13,779 19,953

65-74 years 17,735 7,979 9,756

75-84 years 11,823 4,625 7,197

85 years and over 4,174 1,175 2,999

Disabled 5,055 2,891 2,164

Under 45 years 1,631 970 661

45-54 years 1,470 843 627

55-64 years 1,954 1,079 875

White 32,857 14,098 18,759

Black 3,540 1,498 2,042

All Other 2,179 991 1,188

Native American 55 27 28

Asian/Pacific 396 176 221

Hispanic 835 398 436

Other 893 390 502

Unknown Race 210 83 127

NOTES: Data as of December 31, 1998. Numbers may not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Office of Information Services.

Table 4

Medicare enrollment/end stage renal disease trends

HI and/or SMI HI SMI

 in thousands

Year

1980 66.7 66.3 64.9

1990 172.0 170.6 163.7

1993 225.9 224.3 214.7

1994 234.8 233.1 224.7

1995 257.0 255.0 245.1

1996 224.6 224.5 214.0

1997 233.7 233.7 221.4

1998 249.8 249.8 236.0

NOTE: Data as of July 1.

SOURCE: Health Care Financing Administration, Office of Information Services.
8

Table 5

Medicare enrollment/end stage renal disease demographics

Number of

enrollees

(in thousands)

All persons 249.8

Age

Under 25 years 7.8

25-44 years 48.4

45-64 years 93.7

65 years and over 99.9

Sex

Male 133.8

Female 116.0

Race

White 129.7

Other 101.6

Unknown 18.6

NOTE: Data as of July 1, 1998.

SOURCE: Health Care Financing Administration, Office of Information Services.

Table 6

Medicare/managed care

Number Enrollees

of Plans (in thousands)

Total prepaid 393 6,863

Medicare + Choice Programs 303 6,193

TEFRA Cost 38 359

Demonstrations 37 186

HCPPs Part B 15 126

Percent of total Medicare beneficiaries 17.7

 Health care prepayment plans/group practice prepayment plans. 1

NOTES: Data as of June 1999. Medicare beneficiary enrollment as of July 1, 1998. Numbers may not add to

totals because of rounding.

SOURCE: Health Care Financing Administration, Center for Health Plans and Providers.
9

Table 7

Medicare enrollment/HCFA region

Resident Medicare percent of 1

population enrollees population

2

Enrollees as

In thousands

All regions 270,299 37,998 14.1

Boston 13,429 2,094 15.6

New York 26,290 3,855 14.7

Philadelphia 27,005 4,100 15.2

Atlanta 50,411 7,784 15.4

Chicago 48,919 6,954 14.2

Dallas 31,751 3,951 12.4

Kansas City 12,593 1,968 15.6

Denver 8,808 1,068 12.1

San Francisco 40,276 4,816 12.0

Seattle 10,814 1,396 12.9

 Estimated July 1, 1998 resident population. 1

 Medicare enrollment data are as of July 1, 1998. 2

NOTES: Resident population is a provisional estimate. The 1998 resident population data for Outlying

Areas, Puerto Rico, and the Virgin Islands are not available.

SOURCES: Health Care Financing Administration, Office of Information Services U.S. Bureau of the

Census, Population Division, Population Estimates Branch.

Table 8

Aged population/projected

1998 2000 2025 2050 2075 2100

In millions

65 years and over 34.9 35.3 60.6 75.2 85.8 93.1

75 years and over 16.1 16.7 24.9 39.7 46.9 52.5

85 years and over 4.2 4.3 6.3 14.6 17.0 20.5

SOURCE: Social Security Administration, Office of Programs
10

Table 9

Life expectancy at age 65/trends

Male Female

Year In years

1965 12.9 16.3

1980 14.0 18.4

1985 14.4 18.6

1990 15.0 19.0

1995 15.3 19.0

1998 15.7 19.2

1999 1 15.7 19.3

2000 1 15.8 19.3

2005 1 16.1 19.4

2010 1 16.3 19.5

2015 1 16.5 19.7

2020 1 16.7 19.9

2025 1 16.9 20.1

2030 1 17.1 20.4

 Estimated. 1

SOURCE: Social Security Administration, Office of Programs.

Table 10

Life Expectancy at Birth and at Age 65 by Race/trends

Calendar Year All Races White Black

At Birth

1950 68.2 69.1 60.7

1980 73.7 74.4 68.1

1985 74.7 75.3 69.3

1990 75.4 76.1 69.1

1995 75.8 76.5 69.6

1997 76.5 77.1 71.1

At Age 65

1950 13.9 NA 13.9

1980 16.4 16.5 15.1

1985 16.7 16.8 15.2

1990 17.2 17.3 15.4

1995 17.4 17.6 15.6

1997 17.7 17.8 16.1

SOURCE: Public Health Service, Health United States, 1999.
11

Table 11a

Medicaid recipients/trends

Fiscal year

1975 1980 1985 1990 1995 1996

In millions

Total 22.0 21.6 21.8 25.3 36.3 36.1

Age 65 years and over 3.6 3.4 3.1 3.2 4.2 4.3

Blind/Disabled 2.5 2.9 3.0 3.7 6.0 6.2

Dependent children

 under 21 years of age 9.6 9.3 9.8 11.2 17.6 16.7

Adults in families with

 dependent children 4.5 4.9 5.5 6.0 7.8 7.1

Other Title XIX/unk. 1.8 1.5 1.2 1.0 0.6 1.7

NOTES: Prior to 1991, recipient categories do not add to total because recipients could be reported in 

more than one category. Data for fiscal years 1975-1996 are historical data as reported by States.

SOURCES: Health Care Financing Administration, Office of Information Services and the Office of

Strategic Planning.

Table 11b

Medicaid recipients/State buy-ins for Medicare

1975 1980 1997 1998 1 2

Type of Beneficiary In thousands 1

All buy-ins 2,846 2,954 5,089 5,109

 Aged 2,483 2,449 3,445 3,459

 Disabled 363 504 1,644 1,650

 Percent of SMI enrollees

All buy-ins 12.0 10.9 14.1 14.1

Aged 11.4 10.0 10.8 10.7

Disabled 18.7 18.9 39.0 36.9

 Beneficiaries in person-years for whom the State paid the SMI premium during the year. Percent calculated 1

using July enrollment. 

 Estimated. 2

NOTE: Numbers may not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Office of Information Services.
12

Table 12

Medicaid enrollees/demographics

Fiscal year 1998

Medicaid enrollees Percent distribution

In millions

Total recipients 41.4 100.0

Age 41.4 100.0

 Under 21 22.3 51.8

 21-64 years 12.8 31.5

 65 years and over 4.7 13.6

 Unknown 1.5 3.0

Sex 41.4 100.0

 Male 16.1 37.5

 Female 23.8 59.4

 Unknown 1.5 3.1

Race 41.4 100.0

 White 17.8 46.1

 Black 10.7 24.4

 American Indian/Alaska Native 0.5 1.2

 Asian/Pacific Islander 1.0 2.0

 Hispanic 6.9 14.8

 Unknown 4.4 11.6

NOTE: Represents unduplicated number of enrollees during the fiscal year. Numbers may not add to totals

because of rounding. The percent distribution is based on rounded numbers. Totals do not necessarily equal

the sum of rounded components.

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.
13

Table 13

Medicaid average enrollment/HCFA region

Resident Medicaid percent of 1

enrollment population

Average Enrollment as

2

population

In thousands

All regions 270,299 31,683 11.7

Boston 13,429 1,657 12.3

New York 26,290 3,532 13.4

Philadelphia 27,005 2,898 10.7

Atlanta 50,411 6,568 13.0

Chicago 48,919 4,935 10.1

Dallas 31,751 3,407 10.7

Kansas City 12,593 1,206 9.6

Denver 8,808 591 6.7

San Francisco 40,276 5,649 14.0

Seattle 10,814 1,239 11.5

Estimated July 1, 1998 population. 1 

 Medicaid enrollment data are for fiscal year 1998 and represent the estimated average monthly enrollment 2

for the year.

NOTES: Numbers may not add to totals because of rounding. Resident population is a provisional estimate.

Excludes data for Puerto Rico, Virgin Islands and Outlying Areas.

SOURCES: Health Care Financing Administration, Center for Medicaid and State Operations. U.S.

Department of Commerce, Bureau of the Census.

Table 14

Medicaid enrollees/trends

1997 1998 1999 2000

Avg. Avg. Avg Avg.

In millions

Total 33.0 32.5 32.9 33.4

Age 65 years and over 4.1 3.7 3.8 3.8

Blind/Disabled 6.1 6.4 6.5 6.7

Dependent children

 under 21 years of age 16.4 16.0 16.1 16.4

Adults in families with

 dependent children 6.4 6.4 6.4 6.5

NOTE: Data for fiscal years 1997 and 1998 are historical data as reported by the States. Projections for fiscal

years 1999 and 2000 were prepared by the Office of the Actuary from the President’s FY 2000 Budget.
14

Providers/Suppliers

Information about institutions,

agencies, or professionals who

provide health care services and

individuals or organizations who

furnish health care equipment or

supplies

These data are distributed by major provider/supplier categories, by

geographic region, and by type of program participation. Utilization data

organized by type of provider/supplier may be found in the Utilization section.
15

Table 15

Inpatient hospitals/trends

1975 1980 1997 1998

Total hospitals 6,707 6,777 6,293 6,116

 Beds in thousands 1,132 1,150 1,037 1,012

 Beds per 1,000 enrollees 51.5 46.7 27.0 26.3 1

Short-stay 6,084 6,104 5,165 5,038

 Beds in thousands 884 991 910 891

 Beds per 1,000 enrollees 40.2 40.2 23.9 23.2 1

Psychiatric 358 408 654 602

 Beds in thousands 207 131 83 78

 Beds per 1,000 enrollees 9.4 5.3 2.2 2.0 1

Other long-stay 265 265 474 476

 Beds in thousands 42 28 45 44

 Beds per 1,000 enrollees 1.9 1.1 1.2 1.1 1

 Based on number of aged HI enrollees. 1

NOTES: Facility data as of July 1, except 1998 data which are as of December 1998. Facilities certified for

Medicare are deemed to meet Medicaid standards.

SOURCES: Health Care Financing Administration, Office of Information Services and the Office of

Strategic Planning.

Table 16

Medicare assigned claims/HCFA region

Net assignment rates

1980 1997 1998

All regions 51.5 96.7 97.3

Boston 67.4 98.6 98.3

New York 51.8 96.9 97.7

Philadelphia 61.6 97.1 97.8

Atlanta 52.3 97.1 97.3

Chicago 47.6 96.9 97.3

Dallas 50.3 96.5 97.2

Kansas City 40.4 95.7 96.7

Denver 39.5 94.7 96.0

San Francisco 53.2 97.4 98.4

Seattle 31.3 90.7 88.6

NOTE: Calendar year data.

SOURCE: Health Care Financing Administration, Office of Financial Management.
16

Table 17

Medicare Hospital Status

Total hospitals 6,166

Hospitals under PPS 4,975 1

 Hospitals receiving special consideration 1,372

 Regional referral centers 231

 Sole community hospitals 785

 Medicare dependent hospitals 356

Non-PPS hospitals 1,191

 Categorically exempt: 1,126

 Psychiatric 601

 Rehabilitation 198

 Christian science 20

 Childrens 71

 Critical Access 17

 Alcohol/Drug 9

 Other long-term 210

 Short-stay hospitals in waiver State (Maryland) 50

 Cancer hospitals 9

Total excluded units 2,411

 Psychiatric 1,510

 Rehabilitation 901

 Total number of hospitals subject to PPS regardless of actual submitted inpatient hospital claims during the 1

fiscal year.

NOTE: Data as of January.

SOURCES: Health Care Financing Administration, Office of Information Services; Center for Health Plans

and Providers; and the Office of Clinical Standards and Quality.
17

Table 18

Long-term facilities/HCFA region

Title XVIII and Nursing

XVIII/XIX SNFs Facilities IMRs 1 2

All regions 15,032 2,289 7,250 3

Boston 1,115 241 183

New York 1,010 11 887

Philadelphia 1,418 143 458

Atlanta 2,597 189 739

Chicago 3,205 578 2,123

Dallas 1,804 596 1,490

Kansas City 1,209 472 189

Denver 599 71 95

San Francisco 1,562 118 1,002

Seattle 504 42 84

 Skilled nursing facilities. 1

 Institutions for mentally retarded. 2

 All regions totals includes U.S. Possessions and Territories 3

NOTE: Data as of December 1998.

SOURCE: Health Care Financing Administration, Center for Health Plans and providers.

Table 19

Other Medicare providers and suppliers/trends

1975 1980 1997 1998

Home health agencies 2,242 2,924 10,807 9,330

Clinical Lab Improvement

Act Facilities - - 164,054 166, 817

End stage renal disease facilities - 999 3,367 3,531

Outpatient physical therapy 117 419 2,758 2,890

Portable X-ray 132 216 656 657

Rural health clinics - 391 3,673 3,551

Comprehensive outpatient

rehabilitation facilities - - 531 590

Ambulatory surgical centers - - 2,480 2,644

Hospices - - 2,344 2,317

NOTES: Facility data for selected years 1975-1980 are as of July 1. Facility data for 1997 and 1998 are as of

December.

SOURCE: Health Care Financing Administration, Center for Health Plans and Providers.
18

Table 20

Selected facilities/type of control

Short-stay nursing health

hospitals facilities agencies

Skilled Home

Total facilities 5,038 15,032 9,330

Percent of total

Non-profit 58.3 28.6 31.3

Proprietary 13.2 65.9 54.4

Government 28.4 5.4 14.3

NOTES: Data as of December 1998. Facilities certified for Medicare are deemed to meet Medicaid standards.

Percent distribution may not add to 100 percent due to rounding.

SOURCES: Health Care Financing Administration, Office of Strategic Planning and the Office of

Information Services.

Table 21

Periodic interim payment (PIP) facilities/trends

1980 1985 1996 1997 1998

Hospitals

Number of PIP 2,276 3,242 1,134 1,029 1,024

Percent of total

 participating 33.8 48.3 18.0 16.4 16.7

Skilled nursing facilities

Number of PIP 203 224 1,354 1,388 1,396

Percent of total

participating 3.9 3.4 9.6 9.3 9.3

Home health agencies

Number of PIP 481 931 1,515 1,366 1,284

Percent of total

participating 16.0 16.0 15.6 12.6 13.8

NOTES: Data from 1985 to date are as of September; 1980 data are as of December. These are facilities

receiving periodic interim payments (PIP) under Medicare. Effective for claims received on or after July 1,

1987, the Omnibus Budget Reconciliation Act of 1986 eliminates PIP for many PPS hospitals when the

servicing intermediary meets specified processing time standards.

SOURCE: Health Care Financing Administration, Office of Financial Management.
19

Table 22

Physicians active in patient care/selected years

 1998 1999

Number Percent Number Percent

Active in Patient Care 767,058 100.0 830,371 100.0

Medical Specialties 157,279 20.5 162,040 19.5

Surgical Specialties 157,679 20.6 159,787 19.2

Other Specialties 82,150 10.7 84,398 10.2

Family and General Pract . 98,903 12.9 100,317 12.1

Emergency Medicine 21,497 2.8 22,772 2.7

Pediatrics 29,098 3.8 29,947 3.6

Non-physician specialties 220,452 28.7 271,110 32.6

NOTES: Includes physicians, doctors of osteopathy, and limited licensed practitioners. Totals do not

necessarily equal the sum of rounded components.

SOURCES: Health Care Financing Administration. Office of Information Services and the Office of

Strategic Planning.

Table 23

Physicians/HCFA region

Physicians Physicians

active in per 100,000

patient care population

All regions 830,371 307 1

Boston 55,558 414

New York 107,965 411

Philadelphia 101,043 364

Atlanta 128,122 254

Chicago 142,521 296

Dallas 83,575 263

Kansas City 36,155 287

Denver 26,558 302

San Francisco 117,695 292

Seattle 31,181 288

Non-Federal physicians only. Includes physicians, doctors of osteopathy, and limited licensed practitioners. 1 

Excludes physicians in foreign countries.

NOTES: Physicians as of September 1999. Civilian population as of July 1, 1998.

SOURCES: Health Care Financing Unique Physician Identification Number Directory.
20

Table 24

Inpatient hospitals/HCFA region

Short-stay per 1,000 Long-stay per 1,000

hospitals enrollees facilities enrollees

Beds Beds

All regions 5,038 23.2 1,078 3.2

Boston 201 16.7 80 5.3

New York 359 24.9 78 4.9

Philadelphia 404 21.1 126 4.3

Atlanta 978 23.7 196 2.6

Chicago 890 26.1 160 2.5

Dallas 740 25.0 216 3.9

Kansas City 441 28.2 55 2.5

Denver 284 23.4 39 3.5

San Francisco 531 20.5 108 1.7

Seattle 210 17.8 20 2.0

NOTES: Data as of December 1998. Rates based on number of hospital insurance enrollees as of July 1,

1998.

SOURCE: Health Care Financing Administration, Office of Information Services.
21

Expenditures

Information about spending for health

care services by Medicare, Medicaid,

and in the Nation as a whole

Health care spending at the aggregate levels is distributed by source of funds,

types of service, geographic area, and broad beneficiary or eligibility

categories. Direct out-of-pocket, other private, and non-HCFA-related

expenditures are also covered in this section. Expenditures on a per-unit-ofservice level are covered in the Utilization section.
22

Table 25

HCFA and total Federal disbursements

Fiscal year

1998 

$ in billions

Gross domestic product (current dollars) $8,404.3

 Total Federal budget 1652.6 1

 Percent of gross domestic product 19.7

Department of Health and Human Services 350.6 2

 Percent of Federal budget 21.2

 HCFA budget

 Medicare benefit payments 210.1

 Medicaid medical assistance payments 96.4

 HCFA program management 1.7

 Medicaid State and local administration 4.8

 Other Medicare administrative expenses 1.0

 Peer review organizations 0.2

 Health care fraud and abuse control 0.6

 Total outlays (unadjusted) 314.9

 Offsetting and proprietary receipts -20.7

 Total net of offsetting and proprietary receipts 294.1

 Percent of Federal budget 17.8

 Net of offsetting receipts. 1

NOTE: Numbers may not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Office of Financial Management.

Table 26

Program expenditures/trends

Total In billions Medicaid 

Medicare 1

2

Fiscal year

1980 $60.8 $35.0 $25.8

1990 182.2 109.7 72.5

1998 391.7 213.6 178.1

1999 402.7 212.0 190.7 3

 Medicare amounts are gross outlays for benefits and administration. 1

Medicaid amounts include both the Federal and State share of benefit payments, including vaccines for 2 

children, and administrative costs.

 Reflects data from the September 1999 Monthly Treasury Statement. The FY 1999 Medicaid amount is 3

estimated.

SOURCE: Health Care Financing Administration, Office of Financial Management.
23

Table 27

Benefit outlays by program

1967 1968 1998 1999 1

Annually Amounts in billions

HCFA program outlays $5.1 $8.4 $379 $389

 Federal outlays NA 6.7 306 311

 Medicare 3.2 5.1 210 208

 HI 2.5 3.7 134 129

 SMI 0.7 1.4 76 79

 Medicaid 1.9 3.3 169 181 2,3

 Federal share NA 1.6 96 103

Monthly In millions In billions

HCFA program outlays $423 $702 $31 $32

 Federal outlays NA 561 26 26

 Medicare 264 427 17 17

 HI 209 311 11 11

 SMI 55 116 6 7

 Medicaid 158 275 13 15 2,3

 Federal share NA 133 8 9

Hourly In thousands In millions

HCFA program outlays $579 $962 $42 $44

 Federal outlays NA 768 34 36

 Medicare 362 585 24 24

 HI 286 426 16 15

 SMI 76 159 8 9

 Medicaid 217 377 18 21 2,3

 Federal share NA 183 11 12

By Minute In thousands

HCFA program outlays $10 $16 $701 $740

 Federal outlays NA 13 568 592

 Medicare 6 10 394 408

 HI 5 7 259 250

 SMI 1 3 135 158

 Medicaid 4 6 307 344 2,3

 Federal share NA 3 174 196

Estimated. These amounts reflect both Federal and State Medicaid benefit outlays. State Medicaid 1 2

administrative costs are excluded. Expenditures for the vaccine for children’s program are included. 

Excludes Title XXI outlays for the Children’s Health Insurance Program. 3 

NOTES: Fiscal year data. Numbers may not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Office of Financial Management.
24

Table 28

Program benefit payments/HCFA region

Medicaid

Medicare Federal funding Federal share

Total payments Net expenditures

computable for reported 

 1

In millions

All regions $210,102 $169,014 $95,593

Boston 17,518 11,505 6,013

New York 25,058 32,991 16,542

Philadelphia 23,337 16,067 8,812

Atlanta 43,451 27,249 17,419

Chicago 35,364 27,257 15,005

Dallas 24,090 16,708 11,051

Kansas City 9,394 6,569 4,025

Denver 4,904 3,556 2,216

San Francisco 27,341 21,312 11,197

Seattle 5,475 5,799 3,313

 Excludes HCFA adjustments. 1

NOTES: Data as of fiscal year 1998 and are considered preliminary. Source Form HCFA-64 -- Line 11, Net

Expenditures Reported. Medical assistance only. Territories are at capped levels.

SOURCES: Health Care Financing Administration, Office of Information Services; Office of Financial

Management; and the Center for Medicaid and State Operations.

Table 29

Medicare/trust fund projections

Fiscal year

1997 1998 1999

In billions

HI benefit payments $136.0 $134.3 $129.1 1

Aged 120.0 118.5 113.0

Disabled 16.0 15.8 16.1

SMI benefit payments 71.1 75.8 79.2

Aged 60.3 64.5 68.2

Disabled 10.8 11.3 11.0

SOURCE: Health Care Financing Administration, Office of Financial Management.
25

Table 30

Medicare/type of benefit

Fiscal year 1998

benefit payments Percent 

in millions distribution 1

Total HI $134,320 $100.0 2

Inpatient hospital 86,563 64.4

Skilled nursing facility 13,381 10.0

Home health agency 14,490 10.8

Hospice 2,080 1.6

Managed care 17,807 13.2

Total SMI 75,782 100.0

Physician/other suppliers 40,062 52.9

Outpatient/Other Providers 14,853 19.6

Home health agency 273 0.4

Laboratory 6,462 8.5

Managed Care 14,132 18.6

Includes the effect of regulatory items and recent legislation but not proposed law. Excludes peer review 1 2 

organization expenditures.

NOTES: Based on midsession review. Distribution of home health benefits between Trust Funds reflects

original reporting by Treasury. Benefits by type of service are estimated and subject to change. Numbers may

not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Budget and Analysis Group.

Table 31

National health care/trends

Calendar year

1965 1980 1997 1998

National total in billions $41.1 $247.3 $1,088.2 $1,149.1

Percent of GDP $5.7 $8.9 $13.4 $13.5

Per capita amount $202 $1,052 $3,912 $4,094

Source of funds Percent of total

Private 75.0 57.6 53.8 54.5

Public 25.0 42.4 46.2 45.5

Federal 11.7 29.1 33.4 32.8

State/local 13.3 13.3 12.8 12.7

NOTES: These data reflect Bureau of Economic Analysis Gross Domestic Product as of October 1999, and

the Social Security Administration’s revisions to the population as of July 1999. Numbers may not add to

totals because of rounding.

SOURCE: Health Care Financing Administration, Office of the Actuary.
26

Table 32

Medicaid/type of service

Fiscal year

1996 1997 1998

In billions

Total vendor payments $121.7 $124.4 $142.3

Percent of total

Inpatient services 22.4 20.2 17.3

General hospitals 20.7 18.6 15.3

Mental hospitals 1.7 1.6 2.0

Nursing facility services 24.3 24.5 22.7 1

Intermediate care facility (MR) services 7.9 7.9 6.7 2

Physician services 5.9 5.7 4.3

Dental services 0.8 0.8 0.6

Other practitioner services 0.9 0.8 0.4

Outpatient hospital services 5.3 5.0 4.1

Clinic services 3.5 3.4 2.8

Laboratory and radiological services 1.0 0.8 0.7

Home health services 8.9 9.8 1.9

Prescribed drugs 8.8 9.6 9.6

Family planning services 0.4 0.3 0.3

Early and periodic screening 1.2 1.3 1.0

Rural health clinic services 0.2 0.2 ---

Other care 8.4 9.6 27.6

Nursing facilities include: SNFs and all other categories for Intermediate Care Facilities (ICF), other than “

1 

MR”. "MR” indicates mentally retarded. 2

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.

Table 33

Medicare savings attributable to secondary payor

provisions/type of provision

Workers Working

Comp. Aged ESRD Auto Disability Total

1996 $104.7 $1,357.6 $167.6 $385.0 $924.9 $2,939.9

1997 111.5 1322.9 146.7 372.9 876.3 2888.0

1998 108.3 1667.3 143.1 247.1 1049.3 3391.6

NOTES: Fiscal year data. In millions of dollars. FY 1998 total includes liability amount of $176.5 million.

Total includes other amounts not broken out in detail.

SOURCE: Health Care Financing Administration, Office of Financial Management.
27

Table 34

Medicaid/payments by eligibility status

Fiscal year 1998 Percent 

vendor payments distribution 1

In millions

Total $142,318 100.0

Age 65 years and over 40,602 28.5

Blind/disabled 60,375 42.4

Dependent children

 under 21 years of age 20,459 14.4

Adults in families with

 dependent children 14,833 10.4

Other Title XIX 6,049 4.3

Preliminary. 1 

NOTE: Numbers may not add to totals due to the exclusion of unknowns and because of rounding.

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.

Table 35

Medicare/durable medical equipment 1

Category Allowed Charges

1997 1998

 In thousands

Total $4,975,664 $4,633,543

Surgical dressings 60,670 54,349

Supplies/accessories 52,516 64,635

Capped rental 1,027,536 1,102,261

Customized items 48,053 43,519

Oxygen 2,044,556 1,621,345

Prosthetics/orthotics 926,149 937,451

Inexpensive/routine 584,123 633,906

Items with frequent maintenance 133,844 168,102

Other 98,217 7,975

Data are for calendar year. 1 

The allowed charge is the Medicare approved payment reported on a line item on the physician/supplier 2 

claim.

SOURCE: Health Care Financing Administration, Office of Information Services.
28

Table 36

National health care/type of expenditure

National Per

total in capita

billions amount Total Medicare Medicaid

Percent Paid

Total $1,149 $4,094 33.6 18.8 14.8

Health services

 and supplies 1,113.7 3968 34.7 19.4 15.3

Personal health care 1,019.3 3632 36.2 20.6 15.6

Hospital care 382.8 1364 48.3 32.4 15.9

Physician services 229.5 818 28.0 21.5 6.5

Nursing home care 87.8 313 62.6 11.9 50.7

Other personal care 319.2 1137 21.9 8.4 13.5

Admin. and pub.

 health activities 94.4 337 29.7 10.6 19.1

Research and

 construction 35.3 126 -- -- --

NOTE: Data are as of calendar year 1998.

SOURCE: Health Care Financing Administration, Office of the Actuary.

Table 37

Personal health care/payment source

Calendar year

1970 1980 1997 1998

In billions

Total $63.8 $217.0 $968.6 $1,019.3

Percent

Total 100.0 100.0 100.0 100.0

Private funds 64.7 59.9 55.5 56.4

Private health insurance 23.2 28.6 32.3 33.1

Out-of-pocket 39.0 27.8 19.5 19.6

Other private 2.6 3.6 3.7 3.7

Public funds 35.3 40.1 44.5 43.6

Federal 23.0 29.2 34.4 33.7

State and local 12.2 10.9 10.1 9.9

NOTES: Excludes administrative expenses, research, construction, and other types of spending that are not

directed at patient care.

SOURCE: Health Care Financing Administration, Office of the Actuary.
29

Utilization

Information about the use of health

care services

Utilization information is organized by persons receiving services and

alternately by services rendered. Measures of health care usage include:

persons served, units of service (e.g., discharges, days of care, etc.), and

dimensions of the services rendered (e.g., average length of stay, charge per

person or per unit of service). These utilization measures are aggregated by

program coverage categories, provider characteristics, type of service, and

demographic and geographic variables.
30

Table 38

Medicare/short-stay hospital utilization

1985 1990 1997 1998

Discharges

 Total in millions 10.5 10.5 11.9 11.8

 Rate per 1,000 enrollees 347 313 317 309 2

Days of care

 Total in millions 92 94 76 73

 Rate per 1,000 enrollees 3,016 2,805 2,014 1,907 2

Average length of stay

 All short-stay 8.7 9.0 6.4 6.2

 Excluded units 18.8 19.5 13.4 12.9 3

Total charges per day $597 $1,060 $2,167 $2,330

 Data for fiscal year 1998 should be treated as preliminary. 1

The population base is HI enrollment excluding HI enrollees residing in foreign countries. 2 

 Includes alcohol/drug, psychiatric, and rehabilitation units through 1990, and psychiatric and rehabilitations 3

1997 through 1998.

SOURCE: Health Care Financing Administration, Office of Information Services.

Table 39

Medicare long-term care/trends

Skilled nursing facilities Home health agencies

Persons Served Persons Served

served in per 1,000 served in per 1,000

thousands enrollees thousands enrollees

Calendar year

1982 252 9 1,172 40

1985 315 10 1,576 51

1990 638 19 1,978 58

1992 779 22 2,504 71

1993 908 25 2,867 80

1994 1,068 29 3,176 86

1995 1,240 33 3,457 93

1996 1,384 37 3,627 95

1997 1,503 46 3,505 106 1 1

Managed care enrollees excluded in determining rate. 1 

SOURCE: Health Care Financing Administration, Office of Information Services.
31

Table 40

Medicare average length of stay/trends

Fiscal year

1984 1990 1995 1996 1997 1998 1 

All short-stay hospitals 9.1 9.0 7.1 6.6 6.4 6.2

PPS hospitals 8.0 8.9 7.1 6.6 6.4 6.2

Excluded units 18.0 19.5 14.8 14.0 13.4 12.9

Data as of 12/98 for fiscal year 1998 should be treated as preliminary. 1

NOTES: Fiscal year data. Average length of stay is shown in days. For all short-stay and PPS hospitals ,

1984 data are based on a 20-percent sample of Medicare HI enrollees. Data for 1990 through 1998 are based

on 100-percent MEDPAR. Data may differ from other sources or from the same source with a different

update cycle.

SOURCE: Health Care Financing Administration, Office of Information Services.

Table 41

Medicare persons served/trends

Calendar year

1975 1980 1985 1996 1997

Aged persons served

 per 1,000 enrollees

HI and/or SMI 528 638 722 816 917

HI 221 240 219 216 254

SMI 536 652 739 848 959

Disabled persons served

 per 1,000 enrollees

HI and/or SMI 450 594 669 749 826

HI 219 246 228 208 218

SMI 471 634 715 828 925

NOTES: Prior to 1997, data were obtained from the Annual Person Summary Record. Beginning in 1997,

utilization rates are based on persons receiving fee-for-service care and total persons not enrolled in prepaid

health plans. For the period 1975-1996, users of hospice services were excluded.

SOURCE: Health Care Financing Administration, Office of Information Services and the Office of Strategic

Planning.
32

Table 42

Medicare fee-for-service persons served/projections

Fiscal year

1998 1999 2000 2001 2002

In millions

HI

 Aged

 Enrollees 27.9 27.3 26.6 26.0 25.6

 Persons served 6.7 6.4 6.4 6.5 6.6

 Disabled

 Enrollees 4.8 4.9 5.1 5.2 5.4

 Persons served 0.9 0.8 0.8 0.8 0.9

SMI

 Aged

 Enrollees 26.5 26.0 25.3 24.7 24.2

 Persons served 23.5 23.3 22.8 22.4 22.1

Disabled

 Enrollees 4.0 4.0 4.0 4.1 4.2

 Persons served 3.3 3.4 3.4 3.5 3.6

NOTES: Enrollment represents actuarial estimates of average monthly fee-for-service enrollment during the

fiscal year. Persons served represents actuarial estimates of beneficiaries projected to meet the Part A or 

Part B deductible amount during the fiscal year.

SOURCE: Health Care Financing Administration, Office of the Actuary.
33

Table 43

Medicare persons served/HCFA region

Aged Disabled 

persons Served persons Served 

served in per 1,000 served in per 1,000

thousands enrollees thousands enrollees 

All regions 26,130 917 3,716 826 1

Boston 1,475 930 198 820

New York 2,942 827 417 785

Philadelphia 2,861 932 371 841

Atlanta 5,480 936 915 865

Chicago 5,275 940 665 838

Dallas 2,714 905 413 832

Kansas City 1,526 943 183 860

Denver 732 940 96 799

San Francisco 2,269 895 347 776

Seattle 851 950 111 817

Includes utilization for residents of foreign countries. 1 

NOTES: Data as of calendar year 1997 for persons served under HI and/or SMI. Based on utilization for feefor-service and excludes utilization under alternative payment systems such as health maintenance

organizations. Numbers may not add to totals because of rounding.

SOURCE: Health Care Financing Administration, Office of Information Services.
34

Table 44

Medicare/end stage renal disease (ESRD)

Calendar year

1996 1997 1998

Total enrollees 224,564 233,728 249,797 1

Dialysis patients 214,103 230,190 245,710 2

Outpatient 181,533 198,968 216,310

Home 32,570 31,222 29,400

Transplants performed 12,198 12,427 13,272 3

Living donor 3,084 3,210 3,453

Cadaveric donor 8,495 8,512 8,752

Living unrelated 619 705 1,067

Average dialysis payment rate

Hospital-based facilities $130 $130 $130

Freestanding facilities $126 $126 $126

 Medicare ESRD enrollees as of July 1. 1

 Includes Medicare and non-Medicare patients receiving dialysis as of December 31. 2

Includes kidney transplants for Medicare and non-Medicare patients. 3 

SOURCES: Health Care Financing Administration, Office of Clinical Standards and Quality.
35

Table 45

Medicaid/type of service

Fiscal year 1998

Medicaid 

recipients 

In thousands

Total 40,649

Inpatient services

 General hospitals 4,273

 Mental hospitals 135

Nursing facility services 1,646 1

Intermediate care facility (MR) services 126 2

Physician services 18,555

Dental services 4,965

Other practitioner services 4,342

Outpatient hospital services 12,158

Clinic services 5,285

Laboratory and radiological services 9,381

Home health services 1,225

Prescribed drugs 19,338

Family planning services 2,011

Early and periodic screening 6,175

Personal care support services 3,108

Home and community based waiver services 467

PCCM services 4,066

Prepaid health care 20,203

Other care 6,975

 Nursing facilities include: SNFs and all categories of ICF, other than “MR.” 1

“MR” indicates mentally retarded. 2 

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.
36

Table 46

Medicaid/units of service

Fiscal year 1998

units of service 1

In thousands

General hospital 1

 Total discharges 3,971

 Recipients discharged 2,793

 Total days of care 19,091

Nursing facility 2

 Total days of care 384,549

Intermediate care facility/mentally retarded 3

Total days of care 50,636

Preliminary. 1 

 Based on reporting States and the District of Columbia (Data are not reported for Nebraska, West Virginia 2

and Puerto Rico).

 Based on reporting States and the District of Columbia (Data are not reported for Arizona, Nebraska, 3

Oklahoma, Tennessee, West Virginia, Virgin Islands and Puerto Rico).

NOTE: Nursing facilities include: SNFs and all categories of ICF, other than MR.

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.
37

Administrative/Operating

Information on activities and services

related to oversight of the day-to-day

operations of HCFA programs

Included are data on Medicare contractors, contractor activities and

performance, HCFA and State agency administrative costs, quality control,

and summaries of the operation of the Medicare trust funds.
38

Table 47

Medicare administrative expenses/trends

Administrative expenses

Amount of benefit

in millions payments

As a percent

HI Trust Fund

1967 $89 3.5

1970 149 3.1

1975 259 2.5

1980 497 2.1

1985 813 1.7

1990 774 1.2

1996 1,229 1.0

1997 1,613 1.2

1998 1,653 1.2

SMI Trust Fund

1967 135 20.3 1

1970 217 11.0

1975 405 10.8

1980 593 5.8

1985 922 4.2

1990 1,524 3.7

1996 1,771 2.6

1997 1,420 2.0

1998 1,435 1.9

Includes expenses paid in fiscal years 1966 and 1967. 1 

NOTE: Fiscal year data.

SOURCE: Health Care Financing Administration, Office of the Actuary.

Table 48

Medicare/contractors

Intermediaries Carriers

Blue Cross/Blue Shield 36 18

Other 3 8

NOTE: Data as of January 1999.

SOURCE: Health Care Financing Administration, Office of Financial Management.
39

Table 49

Medicare/appeals

Intermediary Carrier

reconsiderations reviews

Number processed 58,765 3,101,201

Percent with increased payments 32.1 68.2 1

 Excludes withdrawals and dismissals. 1

NOTE: Data for fiscal year 1998.

SOURCE: Health Care Financing Administration, Office of Financial Management.

Table 50

Medicare/claims processing bottom line unit costs

Unit cost per claim

1975 1980 1997 1998

Intermediaries $3.84 $2.96 $1.20 $0.92 1 3

Carriers 2.90 2.33 $0.96 $0.91 2

Includes direct costs and overhead costs for bill payment, reconsiderations, and hearings lines. Includes 1 2 

direct costs and overhead costs for the claims payment, reviews and hearings, and beneficiary/physician

inquiries lines. Begining in FY 1998, inquiries and PET activities are separated from other bill payment 3

cost for intermediaries.

NOTE: Fiscal year data.

SOURCE: Health Care Financing Administration, Office of Financial Management.

Table 51

Medicare/claims processing

Intermediaries Carriers

Claims processed in millions 149.0 710.8

 Total PM costs in millions $295.8 $895.1

 Total MIP costs in millions $315.5 $229.1 1

Claims processing costs in millions $197.5 $562.2

 Claims processing unit costs $ 0.82 $ 0.64 2

Range

High $1.50 $1.22

Low $0.68 $0.58

Prior to FY 1998 the Claims Processing Unit Cost for Intermediaries included Inquires and Provider 1 

Education costs. Medicare Integrity Program (MIP) costs include $50 million from the Fraud and Abuse 2

Enhancement Program.

NOTE: Data for fiscal year 1998. PM= Program Management

SOURCE: Health Care Financing Administration, Office of Financial Management.
40

Table 52

Medicare/claims received

 Claims received

Intermediary claims received in thousands 150,260

 Percent of total

 Inpatient hospital 8.9

 Outpatient hospital 44.2

 Home health agency 10.1

 Skilled nursing facility 2.6

 Other 34.2

Carrier claims received in thousands 697,515

 Percent of total

Assigned 97.3

Unassigned 2.7

NOTE: Data for calendar year 1998.

SOURCE: Health Care Financing Administration, Office of Financial Management.

Table 53

Medicare/charge reductions

Assigned Unassigned

Claims approved

 Number in millions 575.8 15.2

 Percent reduced 88.0 82.3 1 1

Total covered charges

 Amount in millions $106,947 $1,382

 Percent reduced 46.9 17.1

 Amount reduced per claim $83.71 $15.5

 Figure may be slightly overstated due to the possibility of a claim being counted more than once because 1

more than one type of reduction is applied.

NOTES: Data for calendar year 1998. As a result of report changes effective April 1, 1992, charge reductions

include: reasonable charge, medical necessity, and global fee/rebundling reductions.

SOURCE: Health Care Financing Administration, Office of Financial Management.
41

Table 54

Medicaid/administration

Fiscal year

1997 1998

In thousands

Total payments computable 

 for Federal funding $5,485,717 $8,333,696 1

Federal share of current

 expenditures:

 Family planning 15,922 15,091

 Design, development or

 installation of MMIS 55,181 99,039 2

 Skilled professional

 medical personnel 237,244 237,871

 Operation of an

 approved MMIS 593,684 668,716 2

 Other financial

 participation 2,576,948 3,484,468

 Mechanized systems not

 approved under MMIS 65,298 70,047 2

Total administration 3,544,277 4,575,232

Net adjusted Federal share $3,202,512 $4,607,978 3

 Source: Form HCFA-64.10, Expenditures for State and Local Administration for the Medical Assistance Program (net 1

expenditure reported). FY 1998 data are preliminary.

 Medicaid Management Information System. 2

 Includes Federal share of net expenditures reported plus HCFA adjustments. 3

SOURCE: Health Care Financing Administration. Center for Medicaid and State Operations and the Office of Financial

Management.
42

Reference

Selected reference material including

cost-sharing features of the Medicare

program, program financing, and

Medicaid Federal medical assistance

percentages
43

Program financing

Medicare/source of income

Hospital Insurance trust fund:

1. Payroll taxes*

2. Transfers from railroad retirement account

3. General revenue for

a. uninsured persons

b. military wage credits

4. Premiums from voluntary enrollees

5. Interest on investments

*Contribution rate 1997 1998 1999

Percent

Employees and employers, each 1.45 1.45 1.45

Self-employed 2.90 2.90 2.90

Maximum taxable amount (CY 1999) None 1

Vouluntary HI Premium 2

Monthly Premium (1999): $309

Supplementary Medical Insurance trust fund:

1. Premiums paid by or on behalf of enrollees

2. General revenue

3. Interest on investments

Part B Premium

Monthly Basic Premium (1999): $45.50

Medicaid/financing

1. Federal contributions (ranging from 50 to 77 percent for fiscal year 1999)

2. State contributions (ranging from 23 to 50 percent for fiscal year 1999)

 The Omnibus Reconciliation Act of 1993 eliminated the Annual Maximum Taxable Earnings amounts for 1

1994 and later. For these years, the contribution rate is applied to all earnings in covered employment.

 Premium paid for voluntary participation of individuals aged 65 and over not otherwise entitled to hospital 2

insurance and certain disabled individuals who have exhausted other entitlement. A reduced premium of $170

is available to individuals aged 65 and over who are not otherwise entitled to hospital insurance but who

have, or whose spouse has or had, at least 30 quarters of coverage under Title II of the Social Security Act.

SOURCE: Health Care Financing Administration, Office of the Actuary.
44

Medicare deductible and coinsurance amounts

Part A (effective date) Amount

Inpatient hospital deductible (1/1/99) $768/benefit period

Regular coinsurance $192/day for 61st thru 90th day

days (1/1/99)

Lifetime reserve days (1/1/99) $384/day (60 nonrenewable days)

SNF coinsurance days (1/1/99) $96.00/day after 20th day

Blood deductible first 3 pints/benefit period

Voluntary hospital insurance premium (1/1/99) $309/month

$170/month if have at least 30 quarters of

coverage.

Limitations:

Inpatient psychiatric hospital days 190 nonrenewable days

Part B (effective date) Amount

Deductible (1/1/91) $100 in reasonable charges/year 1

Blood deductible first 3 pints/calendar year

Coinsurance 20 percent of allowed charges 1

Premium (1/1/99) $45.50/month

Limitations:

Outpatient treatment for mental illness No limitations

Licensed physical therapist’s services in home or

 office (1/1/91)

 $600 (80% of maximum annual program payment

 of $750)

 The Part B deductible and coinsurance applies to most services. Items and/or services not subject to either 1

the deductible or coinsurance are clinical diagnostic lab tests subject to a fee schedule, home health services,

items and services furnished in connection to obtaining a second or third opinion, influenza vaccine and its

administration, and pneumococcal vaccine and its administration. In addition, federally qualified health center

services are not subject to the deductible but are subject to the coinsurance.

SOURCE: Health Care Financing Administration, Office of the Actuary.
45

Geographical jurisdictions of HCFA regional offices and

Federal medical assistance percentages (FMAP)

fiscal year 2000

I. Boston FMAP II. New York FMAP

Connecticut 50 New Jersey 50

Maine 66 New York 50

Massachusetts 50 Puerto Rico 50

New Hampshire 50 Virgin Islands 50

Rhode Island 54 Canada --

Vermont 62

IV. Atlanta

III. Philadelphia Alabama 70

Delaware 50 Florida 57

Dist. of Columbia 70 Georgia 60

Maryland 50 Kentucky 71

Pennsylvania 54 Mississippi 77

Virginia 52 North Carolina 62

West Virginia 75 South Carolina 70

Tennessee 63

V. Chicago

Illinois 50 VI. Dallas

Indiana 62 Arkansas 73

Michigan 55 Louisiana 70

Minnesota 51 New Mexico 73

Ohio 59 Oklahoma 71

Wisconsin 59 Texas 61

VII. Kansas City VIII. Denver

Iowa 63 Colorado 50

Kansas 60 Montana 72

Missouri 61 North Dakota 70

Nebraska 61 South Dakota 69

Utah 72

IX. San Francisco Wyoming 64

Arizona 66

California 52 X. Seattle

Hawaii 51 Alaska 60

Nevada 50 Idaho 70

American Samoa 50 Oregon 60

Guam 50 Washington 52

N. Mariana Islands 50

SOURCE: Health Care Financing Administration, Center for Medicaid and State Operations.