Health Care Use and Expenditure Data for Elderly Medicare 

Beneficiaries: A Comparison of Two Surveys 

Lisa B. Mirel1 and Steven R. Machlin2 

1

 Centers for Medicare & Medicaid Services, Baltimore, MD, USA

2Agency for H ealthcare Research and Quality, Rockville,MD USA 

Introduction 

The population aged 65 and over is predicted to morethan double in 2050 compared to 2010. The U.S. Bureau of 

the Census estimated there were about 40 million people age 65 and over in 2010 and they estimate that total will be 

closer to 90 million in 2050, with a larger share of that age group represented by those individuals who are 85 and 

over (Figure 1). 

Figure 1. Population 65 and over by age groups: 1990-2050 

Understanding the health care needs for this growing population is critical for policy makers. Two nationally 

representative surveys, the Medicare Current Beneficiary Survey (MCBS) and the Medical Expenditure Panel 

Survey (MEPS), capture this age group and their health care needs, utilization and expenditures. Both surveys have 

been used to gain an und erstanding of the Medicare p opulation, particularly for adults age 65 and over. One example 

where both surveys have been used is the inter-agency chart book of “Older Americans 2012: Key Indicators of 

Well Being.” In the chart book, MCBS data were used to examine the percentage of Medicare beneficiary age 65 

and over in selected residential settingsby age group.Similarly, MEPS data were used to examine out-of-pocket 

health care expenditures as a percentage of income among people age 65 and over. 

The goals of this paper are to: 1) compare and contrast the surveys’ methodologies and types of estimates that can be 

made, and 2) compare use and expenditure estimates for select types of health care based on analytic subsamples 

that are as similar as possible (i.e., non-institutionalized Medicare beneficiaries age 65 and older enrolled in 

traditional fee-for-service plans). The e xplanations and results are intended to provide insights that will help analysts 

determine the most appr opriate uses of data from either or both of these sources. 

Background 

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The MCBS is a nationally representative survey of Medicare beneficiaries. The survey includes beneficiaries who 

are both aged and disabled. There are about 12,000 survey respondents a year, of which about 9,000 are ages 65 and 

over. For a more detailed description of the survey see Adler (1994). The MEPS is a nationally representative survey 

of households. There are about 14,000 households that respond each year. The data can be analyzed at either the 

household or person level. All ages are included in MEPS which is comprised of about 35,000 people each year, of 

which about 4,400 are ages 65 and over. For a more detailed description of the survey design see Ezzati-Rice et al. 

(2008). 

The two surveys have many similarities. Both surveys: 

1. are continuous multipurpose surveys, 

2. rely on a stratified multi-stage probability sample design, 

3. are longitudinal panel surveys with multiple rounds of data collection, 

4. collect event specific utilization data (e.g. inpatient stays, dental visits, etc.), 

5. collect expenditure and source of payment data for health care utilization, 

6. incorporate claims or medical record data through linkage to survey reported data. 

7. have annual files that are created based on overlapping panels, and 

8. are used to monitor health care use and expenditure trends, 

The design based linkage of the survey reported data to other sources is a common feature of both surveys. Both of 

the surveys collect utilization and expenditure data as part of the in-person interview. In MCBS, administrative 

Medicare claims data are integrated with the interview data for utilization and expenditures. In MEPS, the utilization 

estimates are anchored in the household reported events. However, the household expenditure data are supplemented 

with data collected from a sample of medical providers who provided care for the reported events. 

There are also several differences between the two surveys. The main differences are with the sampling frame, the 

target population, and the survey respondents. In MCBS the frame is the Medicare enrollment data while the frame 

for MEPS is comprised of responding households to the previous year’s National Health Interview Survey. The 

target population in MCBS is all Medicare beneficiaries (both aged and disabled). This includes both 

institutionalized and noninstitutionalized beneficiaries. In MEPS the target population includes all ages, but only the

civilian noninstitutionalized population is eligible for the survey. In terms of respondents to the survey, in MCBS the 

survey participant typically responds for himself/herself when they are able. If they are not able a proxy is used. For 

the institutionalized participants all surveys are conducted by proxy. In MEPS there is typically one household 

respondent for all eligible members of the household. 

Two other notable differences relate to health insurance coverage and medical condition data. For details of health 

insurance coverage, Centers for Medicare & Medicaid Services administrative data augment survey reported data. In 

the research datasets a flag is used to identify if the variable is from survey report only, administrative records only, 

or both survey and administrative data. This differs from MEPS where health insurance coverage is based purely on 

self-report. 

In terms of medical condition data, a unique feature of MEPS is that questions are asked to ascertain any medical 

conditions associated with reported health care events (i.e., reported prescription drug purchases, office-based 

medical visits, hospital inpatient stays, hospital outpatient visits, etc.). In contrast, health conditions are not asked for 

each specific health care event reported in MCBS. 

Data and Methods 

In our first set of analyses we created comparable analytic samples. To do this, we analyzed 2012 data for both 

surveys since that was the most recent year available for MCBS at the time of this paper. To compare the two 

surveys, we limited the study population to people age 65 and over who were noninstitutionalized and were enrolled 

in traditional Medicare fee-for-service (i.e., not Medicare Advantage) for the entire year (see Figure 2). 

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Figure 2. Sample sizes for analysis comparing survey estimates: MEPS and MCBS 

MEPS 

n=37,182 

MCBS 

n=11,299 

MEPS 

Age 65 and over 

n=4,319 

MCBS 

Age 65 and over 

n=9,301 

Exclude Medicare 

Advantage 

(n = 2,235) 

Exclude Institutionalized 

& Medicare Advantage 

(n = 4,011) 

MEPS 

Analytic sample 

n=2,084 

MCBS 

Analytic sample 

n=5,290 

Source: MEPS: 2012 Full Year Consolidated Data File; MCBS: 2012 Cost and Use Data Files 

We chose three event types for comparisons: inpatient stays, prescription medications, and dental services. Inpatient 

hospital stays and prescription medicines were chosen because both surveys incorporate linked billing or 

administrative data to survey reported data for these event types. Dental services were chosen because both surveys 

rely solely on interview responses. In other words, neither of the surveys link to administrative or billing records to 

validate the reporting of dental visits. 

For our second set of analyses, unique estimates from each survey are presented. Because MEPS is a household 

survey it is possible to produce family level estimates. This is not something that can be done with the MCBS data 

because the survey is not designed to collect data from multiple people in the same household (except in the 

uncommon instance when two beneficiaries from the same household are selected by chance). MEPS data are also 

presented by age group. The MEPS collects data from all age groups which allows for estimates to be compared 

across age categories. The MCBS collects data on beneficiaries less than 65 but that population is typically disabled 

and is not representative of all persons under 65. 

Unique estimates from MCBS include data that are collected from the institutionalized population. MCBS estimates 

of sources of payment are presented comparing those living in the community to those in a long term care facility 

(i.e. institutionalized). A residence (or unit) is considered a long-term care facility if it is certified by Medicare or 

Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least 

one personal care service; or provides 24-hour, 7-day-a-week supervision by a non-family, paid caregiver. However, 

skilled nursing facilities certified by Medicare or Medicaid are not defined as long term care facilities. 

Estimates comparing functional limitations by type of community setting (traditional community and retirement 

community) are also presented using MCBS data. Persons residing in a retirement community include those who 

reported they lived in retirement community or apartment, senior citizen housing, continuing care retirement 

facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, 

and who reported they had access to one or more of the following services through their place of residence: meal 

preparation; cleaning or housekeeping services; laundry services; help with medications. Function limitations were 

defined by Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs). IADLs are 

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activities related to independent living and are valuable for evaluating persons with early-stage disease, both to 

assess the level of disease and to determine the person's ability to care for him or herself. ADLs is a term used in 

healthcare to refer to people's daily self-care activities, feeding oneself, bathing, dressing, grooming, work, 

homemaking, and leisure. A comparison of estimates between traditional community settings and retirement 

communities cannot be done with the MEPS data because the survey does not identify persons living in retirement 

communities. 

All statistical analyses were performed in SAS (version 9.3 SAS Institute Inc., Cary, N.C.), using the survey 

procedures. The analyses were weighted to account for the complex sample design and to adjust for nonresponse. 

Variances were estimated using Taylor series linearization in MEPS and balanced repeated replicate weights with 

the Fay adjustment in MCBS. Estimates are reported with their 95% confidence interval. All significance tests were 

evaluated using a two-sided p-value <0.05 as the level of statistical significance. 

Results 

For the first set of analyses comparing cost and utilization estimates with comparable analytic samples, the MCBS 

sample size was 5,290 and the MEPS sample size was 2,084 (Figure 2). 

Table 1 shows the estimates for the three events examined for MEPS and MCBS. For inpatient hospital stays, the 

differences in utilization (17.3% versus 16.2%) and mean expenses per person ($21,269 versus $18,629) were not 

statistically significant. While there was a slight difference in reported dental visit utilization (44.5% in MEPS and 

53.7% in MCBS), the mean dental expenses per person with a dental event were similar in the two surveys ($930 in 

MEPS and $1,014 in MCBS). For prescription drugs there were statistically significant differences in both 

utilization (88.7% in MEPS and 94.8% in MCBS) and mean expenses per person with a prescription drug fill 

($2,382 in MEPS and $3,184 in MCBS). 

Table1. Comparison of estimates: MEPS and MCBS 

Event type Percent with at 

least one event 

type 

95% confidence 

interval for percent 

Mean event type 

expense per person 

with at least one 

event type 

95% confidence 

interval for mean 

Inpatient hospital stay 

MEPS 17.3 (15.2-19.3) $21,269 (18,036-24,503) 

MCBS 16.2 (15.1-17.3) $18,629 (16,612-20,646) 

Dental visits

 MEPS 44.5 (41.2-47.8) $930 (760-1,100) 

MCBS 53.7 (52.1-55.4) $1,014 (938-1,090) 

Prescription drugs

 MEPS 88.7 (86.9-90.6) $2,382 (2,140-2,624) 

MCBS 94.8 (93.9-95.7) $3,184 (3,025-3,342) 

Source: MEPS: 2012 Full Year Consolidated Data File; MCBS: 2012 Cost and Use Data Files 

Tables 2a and 2b present estimates that are only available in MEPS and not in MCBS. The average total 

expenditures per family was $9,214 (Table 2a). For families where at least one member is age 65 or over, the 

average total expenditures was about $14,051 and for those without any family members age 65 or over the average 

total expenditures was $7,617. 

When looking at average total expenditures by age, we note that those age 65 and over have the highest mean total 

expenditures ($9,324) compared to younger age groups like ages 45-64, $6,043 (Table 2b). 

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Table2a. Estimate in MEPS not in MCBS: Average total expenditures per family by family composition 

Family composition n Mean 95% Confidence Interval 

Overall 14,763 $9,214 (8,697-9,731) 

At least one family member age 65+ 3,343 $14,051 (13,147-14,955) 

No family member age 65+ 11,420 $7,617 (7,046-8,187) 

Source: MEPS: 2012 Full Year Consolidated Data File 

Table2b. Estimate in MEPS not in MCBS: Average total expenditures by age 

Age group (years) n Mean 95% Confidence Interval 

Overall 37,182 $4,309 (4,079-4,539) 

0-17 10,420 $1,812 (1,548-2,077) 

18-44 13,506 $2,653 (2,405-2,900) 

45-64 8,937 $6,043 (5,479-6,607) 

65+ 4,319 $9,324 (8,717-9,931) 

Source: MEPS: 2012 Full Year Consolidated Data File 

Tables 3a and 3b present estimates that are only available in MCBS because MEPS does not include 

institutionalized persons. Medicare pays the majority (59.1%) of overall health care services (which includes 

expenses for skilled nursing facilities and expenses for institutionalized persons) but does not pay any for long term 

care facility services (Table 3a). Medicaid and out-of-pocket are the largest sources of payment for long term care 

facility services (44.3% and 45.0%, respectively). 

When looking at the percentage of Medicare beneficiaries with functional limitations we note that 55.4% of those 

living in the community do not have any limitations compared to 33.7% with no limitations living in a retirement 

community (Table 3b). About 17.5% of Medicare beneficiaries living in a retirement community have three of more 

ADLs compared to about 9.7% living in a traditional community. 

Table3a. Estimate in MCBS not in MEPS: Sources of payment for health care services for Medicare 

beneficiaries age 65+, overall and by long term care facility 

Source of payment % Overall health care services 

(95% CI) 

% Long term care facility* 

(95% CI) 

Medicare 59.1 (57.6-60.6) 0 

Medicaid 6.8 (5.9-7.7) 44.3 (39.9-48.7) 

Out-of-pocket 17.7 (16.8-18.6) 45.0 (41.0-49.1) 

Other 16.4 (15.1-17.7) 9.7 (7.3-12.1) 

*Note: does not include skilled nursing facility (SNF) 

Source: MCBS: 2012 Cost and Use Data Files 

Table3b. Estimate in MCBS not in MEPS: Percentage of Medicare beneficiaries age 65+, with functional 

limitations by type of community residence 

Functional Limitation % Traditional Community (95% CI) % Retirement Community (95% CI) 

None 55.4 (54.3-56.4) 33.7 (28.2-39.2) 

IADL only 12.3 (11.7-13.0) 13.7 (10.1-17.3) 

1-2 ADL limitation 22.6 (21.6-23.5) 35.1 (30.2-40.0) 

3 or more ADL limitations 9.7 (9.1-10.3) 17.5 (13.7-21.4) 

Source: MCBS: 2012 Access to Care Data Files 

Summary 

The MCBS and MEPS are rich data sources for researchers and policymakers for analyses related to health care 

utilization and expenditures of the growing elderly population. In this paper, we showed that the two surveys 

produce estimates of health care utilization and expenditures that, for the most part, are fairly similar for comparable 

analytic samples. Differences in estimates for prescription medicines were most notable. These differences warrant 

further investigation and may be attributable to factors such as differences in the types of drugs reported, the degree 

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of outliers in the data and the imputation methodologies used. Another objective of the paper was to promote 

understanding of the similarities and differences in methodologies and type of information collected in these 

surveys. Depending on the analytic objective, one source may be more appropriate than the other. For example, 

MEPS is designed to enable estimation at the family level as well as for younger and non-disabled persons who are 

not Medicare beneficiaries. Conversely, data on sources of payment for Medicare beneficiaries residing in long term 

care facilities and characteristics of Medicare beneficiaries by type of community residence (e.g. retirement 

community) are available in MCBS but not MEPS. 

References 

Adler, GS. A Profile of the Medicare Current Beneficiary Survey. Health Care Financing Review. 1994; 15(4), 153‐

163. 

Ezzati-Rice, TM, Rohde, F, Greenblatt, J, Sample Design of the Medical Expenditure Panel Survey 

 Household Component, 1998–2007. Methodology Report No. 22. March 2008. Agency for 

Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/ 

data_files/publications/mr22/mr22.pdf 

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