Sixty-five million adults are covered by Medicare, including 57 million adults ages 65 and older and nearly 8 million adults under age 65 with disabilities. While the vast majority (91%) of Medicare beneficiaries give their Medicare coverage an overall positive rating, health care cost-related problems are not uncommon. Medicare beneficiaries contribute to the cost of their health care coverage through monthly premium payments, deductibles, and other cost-sharing requirements. Additionally, people on Medicare may face additional premiums for Medicare Part D prescription drug coverage, Medicare Advantage coverage, and supplemental insurance. Further, there is no limit on out-of-pocket spending for beneficiaries in traditional Medicare, and beneficiaries often incur out-of-pocket costs for services not covered under traditional Medicare, such as dental, hearing, and vision services.
In this analysis, we assess the financial burden of health care spending among households where all members are covered by Medicare (referred to as Medicare households) compared to households where no members are covered by Medicare (referred to as non-Medicare households), based on data from the 2021 Consumer Expenditure Survey. (See Methods for details on the analysis.)
The health care spending burden was twice as large among Medicare households than non-Medicare households in 2021
Average health-related expenses accounted for 15% of Medicare households’ total spending compared to 7% for non-Medicare households.
Medicare households spent more on health care than non-Medicare households, both as an annual dollar amount and as a share of total household spending. Medicare households spent an average of $6,557 on health care, accounting for 15% of their total household spending ($44,686), while non-Medicare households spent $4,598 on their health care, accounting for 7% of their total household spending ($67,769) (Figure 1). Health care expenses include health insurance premiums, medical services (e.g., hospital and physician services), prescription drugs, and medical supplies (e.g., crutches, eyeglasses, hearing aids).
The larger burden of health care spending among Medicare households than non-Medicare households is a function of both lower average total household spending for Medicare households than non-Medicare households and higher health care use, which results in higher health care spending by Medicare households.
Across all spending categories, housing accounted for the largest share of total household spending for both Medicare and non-Medicare households, with the share larger for Medicare households (37%) than non-Medicare households (33%). Transportation accounted for a smaller share of Medicare households’ total spending (13%) compared to non-Medicare household spending (17%), but both Medicare and non-Medicare households spent similar shares on food (15% for both). Average spending on other expenses (e.g., education, clothing) comprised a smaller share of Medicare households’ total spending (21%) than non-Medicare households’ total spending (28%).
One in 3 Medicare households spent 20% or more of their total household spending on health-related expenses in 2021, compared to 1 in 14 non-Medicare households
Consistent with the higher health care spending burden among Medicare households compared to non-Medicare households, one in three (32%) Medicare households spent 20% or more of their total household spending on health-related expenses compared to one in 14 (7%) non-Medicare households. Three out of four Medicare households (75%) spent 10% percent or more of their total household spending on health, compared to one out of four non-Medicare households (26%) (Figure 3).
The health care spending burden was twice as large for Medicare households than for non-Medicare households in 2021, measured by average health care spending as a share of total household spending, and one in three Medicare households spend at least 20% of their household budgets on health care. Health spending data for 2021 for both Medicare and non-Medicare households might be lower than what would otherwise have been expected absent the COVID-19 pandemic, since utilization and spending fell sharply in 2020 due to the pandemic and continued at lower-than-expected levels in 2021. Additionally, the analysis underestimates the health care spending burden for households that incur long-term care facility costs because the Consumer Expenditure Survey does not include people who reside in facilities. This exclusion is more likely to affect the spending burden estimates for Medicare households than non-Medicare households since spending on long-term care facilities is a significant share of average out-of-pocket health care costs for people with Medicare.
With health care use increasing with age and income falling as people retire, it’s not unexpected that health care is a bigger cost burden for Medicare households. But this cost burden has implications for policy debates, including the level of cost-sharing and premiums in Medicare. Policies aimed at improving financial protections for Medicare beneficiaries have been proposed in recent years. The recently-enacted Inflation Reduction Act of 2022 includes several provisions that will lower prescription drug costs for people with Medicare, including a cap on Medicare beneficiaries’ out-of-pocket spending under the Medicare Part D benefit; a limit on insulin cost sharing to $35 a month in Medicare Part B and Part D; and expanded eligibility for full Part D Low-Income Subsidies. Policy makers have also considered other proposals that would improve the affordability of health care for Medicare beneficiaries, such as expanding income eligibility thresholds for the Medicare Savings Programs to enable more people to qualify for these financial supports, and adding an out-of-pocket cap on cost sharing for benefits covered under traditional Medicare. Adopting such changes, however, would require additional federal spending.
This work was supported in part by the AARP Public Policy Institute. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Nancy Ochieng and Juliette Cubanski are with KFF. Anthony Damico is an independent consultant.
|This analysis uses data from the Bureau of Labor Statistics Consumer Expenditure Survey (CE) for year 2021. The CE provides data on expenditures, income, and demographic characteristics of consumers in the United States.
The CE is a survey of households (“consumer units”), excluding people residing in institutions such as long-term care facilities. A consumer unit consists of any of the following: (1) all members of a particular household who are related by blood, marriage, adoption, or other legal arrangements; (2) a person living alone or sharing a household with others or living as a roomer in a private home or lodging house or in permanent living quarters in a hotel or motel, but who is financially independent; or (3) two or more persons living together who use their incomes to make joint expenditure decisions. Financial independence is determined by spending behavior with regard to the three major expense categories: housing, food, and other living expenses.
Total expenditures include the following components of household expenditures: food; housing; transportation; health care; entertainment; personal care products and services; reading; education; tobacco products and smoking supplies; cash contributions: life, endowment, annuities, and other personal insurance; contributions to retirement pensions and Social Security. Note that total expenditures for each consumer unit does not include tax expenditures, such as income tax.
Total health care expenditures include spending on four subcomponents of health care: health insurance premiums, medical services, prescription drugs, and medical supplies.
The estimates presented in this analysis are averages for demographic groups of consumer units, not per capita estimates, and thus are not comparable to estimates based on other surveys that report per capita estimates, such as out-of-pocket health care spending reported in the Medicare Current Beneficiary Survey. Expenditures by individuals would differ from the average even if the characteristics of the group are similar to those of the individual. Another source of differences between averages reported here and elsewhere is that the spending data are based on survey self-reports and therefore are subject to nonsampling error, including the inability or unwillingness of respondents to provide accurate data.
Unless otherwise noted, all differences discussed in the text are significant at the 95% confidence level.