In 2021, California reported some 6.49 million Medicare beneficiaries and therefore was the U.S. state with the highest number of beneficiaries. Medicare is a U.S. publicly funded health insurance program that covers those that are aged 65 years and older and those that have certain disabilities. This statistic depicts the leading 10 U.S. states based on their number of Medicare beneficiaries in 2021.

With 26 percent, Maine had the highest percentage of Medicare beneficiaries among its total population in 2021. This statistic depicts the top 10 U.S. states based on Medicare beneficiaries as a percentage of the total population in the calendar year 2021.

Medicare is an important public health insurance scheme for U.S. adults aged 65 years and over. As of 2024, an estimated 19.1 percent of the U.S. population was covered by Medicare, an increase from the previous year. As of 2023, California, Florida, and Texas had the largest number of adults aged 65 years and older. The Medicare program Medicare has two primary parts: Medicare Part A covers hospital care and Medicare Part B covers medical and preventative services. Both parts of Medicare are available to those aged 65 years and older under certain conditions. Medicare premiums are variable and depend on the enrollee’s income. Despite a majority of the Medicare enrollees being above the federal poverty line, there are still several programs in place to help cover the costs of healthcare for the elderly. Opinions on elderly care in the U.S. It is estimated that about 23 percent of Medicare enrollees are in fair/poor health. But there are lots of questions about who should pay for or help with elderly care long-term. In a recent survey of U.S. adults, about half of the respondents said that health insurance companies should pay for elderly care. However, a majority of adults also supported a long-term government sponsored health plan like Medicaid. The issue is still hotly debated and politicized in the United States.

Authors of Costs and Clinical Quality Among Medicare Beneficiaries - Associations with Health Center Penetration of Low-Income Residents, published in Volume 4, Issue 3 of Medicare and Medicaid Research Review, report analyses to determine if increased access to primary care by the underserved had any effect on Medicare spending and clinical quality. Using data on elderly Medicare beneficiaries across U.S. geographic healthcare markets (hospital referral regions, HRRs), data from federally funded health centers, and income data from the American Community Survey, the authors calculated Medicare spending and clinical quality, and compared those outcomes in HRRs with high versus low health center penetration. HRRs with high penetration by health centers had 9.7 percent lower Medicare spending (926 dollars per person) than HRRs with low health center penetration, and no difference in clinical quality outcomes. High health center penetration among low-income populations may accrue Medicare cost savings without compromising clinical quality.

Centers for Medicare & Medicaid Services - Nursing HomesThis feature layer, utilizing data from the Centers for Medicare & Medicaid Services (CMS), displays the locations of nursing homes in the U.S. Nursing homes provide a type of residential care. They are a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Per CMS, "Nursing homes, which include Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs), are required to be in compliance with Federal requirements to receive payment under the Medicare or Medicaid programs. The Secretary of the United States Department of Health & Human Services has delegated to the CMS and the State Medicaid Agency the authority to impose enforcement remedies against a nursing home that does not meet Federal requirements." This layer includes currently active nursing homes, including number of certified beds, address, and other information.Bridgepoint Sub-Acute and Rehab Capitol HillData downloaded: August 1, 2024Data source: Provider InformationData modification: This dataset includes only those facilities with addresses that were appropriately geocoded.For more information: Nursing homes including rehab servicesFor feedback, please contact: ArcGIScomNationalMaps@esri.comCenters for Medicare & Medicaid ServicesPer USA.gov, "The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. The CMS seeks to strengthen and modernize the Nation’s health care system, to provide access to high quality care and improved health at lower costs."

United States Health Insurance: Accident and Health: Covered Lives: Medicare Part D data was reported at 18,771,748.000 Person in 2023. This records a decrease from the previous number of 20,407,115.000 Person for 2022. United States Health Insurance: Accident and Health: Covered Lives: Medicare Part D data is updated yearly, averaging 20,407,115.000 Person from Dec 2015 (Median) to 2023, with 9 observations. The data reached an all-time high of 21,066,527.000 Person in 2018 and a record low of 18,771,748.000 Person in 2023. United States Health Insurance: Accident and Health: Covered Lives: Medicare Part D data remains active status in CEIC and is reported by National Association of Insurance Commissioners. The data is categorized under Global Database’s United States – Table US.RG021: Health Insurance: Accident and Health: Number of Covered Lives by Lines of Business.

Home care providers support the overall health and well-being of millions in the US annually. This number has been growing fast, expanding the scale and scope of home care providers in recent years. A rising number of adults 65 and older has been the primary driver behind this, as older adults are at a higher risk of developing a condition or experiencing an injury that limits their ability to perform tasks they once did independently. While changing demographic trends are an overarching trend impacting the health sector, the pandemic has permanently altered the industry's trajectory. Widespread outbreaks at residential facilities in the first year of the pandemic led more people to value remaining in their homes as they age; the interest in aging-in-place has only grown even as pandemic concerns have dissipated, as older adults look for options that provide safety and independence. In all, revenue has been expanding at a CAGR of 3.7% to an estimated $155.9 billion over the past five years, including expected growth of 3.2% in 2025. The mounting need for home care services and a shortage of home health aides create a mismatch between supply and demand that limits revenue growth. Shortages, preexisting the pandemic, have worsened as caregivers seek more flexible jobs with higher pay, creating increasingly high turnover that pressures providers to raise wages. Medicare and Medicaid reimbursements to home health agencies have been declining for several years, preventing home health agencies from raising salaries despite shortages. Clients eligible for home care services through insurance face long waits, leading more people to opt for self-directed care, where family members or friends work as caregivers. Too few caregivers prevent the industry from fully benefiting from rising demand and curtail profit growth. Trends driving growth in recent years will continue, providing various opportunities for home care providers. How home care providers capitalize on these trends will depend on insurer reimbursements and workforce development. Technology, ranging from wearables to telehealth, will have a more prominent role in the industry as providers look for ways to improve patient care while lessening the burden on staff. Regulatory and financial pressures will maintain consolidation activity, with private equity investment likely to expand. A significant headwind facing the industry will be the future of Medicare policies, the extent to which they cover home health and how states will react to Medicaid cuts in the Trump Administration's Big Beautiful Bill. Revenue will grow at a CAGR of 2.9% to an estimated $179.8 billion over the next five years.

Medicare Advantage Market Outlook

The global Medicare Advantage market size was valued at approximately USD 320 billion in 2023 and is projected to reach around USD 800 billion by 2032, growing at a robust CAGR of 10.8% during the forecast period. The market is primarily driven by increasing aging population, advancements in healthcare technology, and rising awareness about Medicare Advantage plans' comprehensive coverage options.

The aging global population is a significant growth factor for the Medicare Advantage market. As life expectancy increases, the proportion of elderly individuals seeking comprehensive healthcare solutions is also on the rise. This demographic shift is particularly pronounced in developed regions like North America and Europe, where the baby boomer generation is reaching retirement age. This creates a significant demand for Medicare Advantage plans, which offer a blend of health maintenance and cost-effectiveness. Additionally, the rising prevalence of chronic diseases among the elderly, such as diabetes, cardiovascular diseases, and arthritis, further fuels the need for extensive healthcare coverage provided by Medicare Advantage plans.

Technological advancements in healthcare are another vital growth factor. Telehealth, electronic health records, and advanced diagnostic tools enhance the quality of care provided to Medicare Advantage beneficiaries. These technologies streamline healthcare services, making them more accessible and efficient. For instance, telehealth allows healthcare providers to offer consultations and follow-ups remotely, which is particularly beneficial for elderly individuals who may have mobility issues. The integration of artificial intelligence and machine learning in healthcare also aids in quicker diagnosis and personalized treatment plans, thereby improving patient outcomes and satisfaction levels. As these technologies continue to evolve, they are expected to further boost the Medicare Advantage market.

Rising awareness and favorable government policies also contribute significantly to the market's growth. Governments across various regions are implementing policies to promote the adoption of Medicare Advantage plans due to their cost-effectiveness and comprehensive coverage. In the United States, for example, the Medicare Advantage program is heavily promoted by the Centers for Medicare & Medicaid Services (CMS) due to its potential to reduce overall healthcare costs while providing better care coordination. Moreover, awareness campaigns and educational programs aimed at informing citizens about the benefits of Medicare Advantage plans are leading to higher enrollment rates. This trend is expected to continue as more people become aware of the advantages these plans offer over traditional Medicare.

Plan Type Analysis

The Medicare Advantage market can be segmented based on plan type into Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNPs), and others. Health Maintenance Organization (HMO) plans are popular due to their cost-effectiveness and structured care pathways. HMOs usually require beneficiaries to use a network of doctors and hospitals and often require referrals for specialists. This structured approach helps in managing healthcare costs efficiently while ensuring coordinated care. The predictability of out-of-pocket costs is another significant advantage that makes HMOs an attractive option for many beneficiaries.

Health Maintenance Organizations (HMOs) play a pivotal role in the Medicare Advantage landscape. These plans are designed to offer structured and coordinated care through a network of healthcare providers. By emphasizing preventive care and efficient management of healthcare services, HMOs help in reducing unnecessary medical expenses while ensuring high-quality care for beneficiaries. The requirement for referrals and network-based care pathways often leads to better coordination among healthcare providers, which is crucial for managing chronic conditions prevalent among the elderly. As a result, HMOs are particularly appealing to those who prioritize cost-effectiveness and structured healthcare management.

Preferred Provider Organization (PPO) plans offer more flexibility compared to HMOs. PPOs allow beneficiaries to see any doctor or specialist without

Analysis reported in Post-Discharge Follow-Up Visits and Hospital Utilization by Medicare Patients, 2007-2010, published in Volume 4, Issue 2 of Medicare and Medicaid Research Review, shows an increase in the likelihood of receiving a community-based follow-up visit within 30 days of discharge and a slight decrease in the number of days before such visits took place for Medicare patients with an initial admission for heart failure (HF), acute myocardial infarction (AMI), or community-acquired pneumonia (CAP). The largest increase was in 2009 when CMS began publicly reporting hospital-level readmission rates for these conditions. Patients who were Black, Hispanic, or enrolled in Medicaid or Medicare Advantage were less likely to have timely post-discharge follow-up visits.

This data set accompanies the Profile of the California Medicare Population chartbook, published by the Office of Medicare Innovation and Integration in February 2022, and available at (https://www.dhcs.ca.gov/services/Documents/OMII-Medicare-Databook-February-18-2022.pdf). The three data files in this data set were analyzed from federal administrative data (the Medicare Master Beneficiary Summary File) for beneficiary characteristics as of March 2021. These datasets include: Medicare enrollment, Medicare Advantage enrollment (and its converse fee-for-service Medicare enrollment), dual Medi-Cal eligibility and enrollment (and its converse Medicare-only enrollment), by county. Medicare Savings Program enrollees were considered Medicare-only and not dually enrolled in Medi-Cal. All Medicare Part C beneficiaries, including PACE, Cal MediConnect and Special Needs Plans, were considered to have Medicare Advantage.

DHCS partnered with The SCAN Foundation and ATI Advisory in 2021 and 2022 to develop a series of chartbooks that provide information about Medicare beneficiaries in California. This work is supported by a grant from The SCAN Foundation to advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.

Content

The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation.

This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point.

Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php. Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

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Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

The point shapefile shows geocoded locations of hospices across the U.S. as of 12/31/2007. Out of 3,255 hospices for which data is available from HRSA (Health Resources and Services Administration), only 2,703 (nearly 83%) could be geocoded.

More than one in four hospitalizations for those with both Medicare and full Medicaid coverage was potentially avoidable, according to findings reported in Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations, published in Volume 4, Issue 1 of the Medicare and Medicaid Research Review. Using data from 2007 to 2009, the study examined potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events. Beneficiaries in institutions were much more likely to have these events - 16 percent of beneficiaries in the study population were in an institution, yet comprised 45 percent of all potentially avoidable hospitalizations. The range in rates per 1,000 person years across the states was considerable from a low of 59 (Utah) to a high of 197 (Mississippi), a more than a threefold difference. Five conditions were responsible for nearly 80 percent of potentially avoidable hospitalizations. From 2007 to 2009, the national and state rates were fairly consistent.

United States HIC: 18 to 24 Yrs: PG: Govt: Medicare data was reported at 219.000 Person th in 2017. This records a decrease from the previous number of 331.000 Person th for 2016. United States HIC: 18 to 24 Yrs: PG: Govt: Medicare data is updated yearly, averaging 201.909 Person th from Mar 1999 (Median) to 2017, with 19 observations. The data reached an all-time high of 371.217 Person th in 2012 and a record low of 149.147 Person th in 1999. United States HIC: 18 to 24 Yrs: PG: Govt: Medicare data remains active status in CEIC and is reported by US Census Bureau. The data is categorized under Global Database’s United States – Table US.G083: Health Insurance Coverage.

The National Medical Expenditure Survey (NMES) series provides information on health expenditures by or on behalf of families and individuals, the financing of these expenditures, and each person's use of services. The Institutional Population Component (IPC) is a survey of nursing and personal care homes and facilities for the mentally retarded and residents admitted to those facilities. Information was collected on facilities and their residents at several points during 1987. Use and expenditure estimates for institutionalized persons can be combined with those from the Household Component for composite estimates covering most of the civilian population. Information on facilities and residents was collected from facility administrators and caregivers, with additional information collected from next-of-kin or other knowledgeable respondents. These data were supplemented by Medicare claims information for covered sample persons. Research File 36 provides information from the Medicare Automated Data Retrieval System (MADRS) for a subset of persons from File 1 of NATIONAL MEDICAL EXPENDITURE SURVEY, 1987: INSTITUTIONAL POPULATION COMPONENT, FACILITY USE AND EXPENDITURE DATA FOR NURSING AND PERSONAL CARE HOME RESIDENTS PUBLIC USE TAPE 17 and a subset of persons from File 1 of NATIONAL MEDICAL EXPENDITURE SURVEY, 1987: INSTITUTIONAL POPULATION COMPONENT, FACILITY USE AND EXPENDITURE DATA FOR RESIDENTS OF FACILITIES FOR PERSONS WITH MENTAL RETARDATION RESEARCH FILE 22R. Six data files are provided for Research File 36R, all of which contain demographic data such as age, sex, and race. Other variables common to all parts are facility type, person number, sample person identifier, reimbursement amount by Medicare, and total charges reported by provider. Parts 1-6 cover, respectively, Part B Payment Records, Part B Outpatient Bill Records, Part B Home Health Bill Records, Part A Inpatient/Skilled Nursing Facilities Bill Records, Part A Home Health Bill Records, and Part A Hospice Bill Records.

Context

The CMS National Plan and Provider Enumeration System (NPPES) was developed as part of the Administrative Simplification provisions in the original HIPAA act. The primary purpose of NPPES was to develop a unique identifier for each physician that billed medicare and medicaid. This identifier is now known as the National Provider Identifier Standard (NPI) which is a required 10 digit number that is unique to an individual provider at the national level.

Once an NPI record is assigned to a healthcare provider, parts of the NPI record that have public relevance, including the provider’s name, speciality, and practice address are published in a searchable website as well as downloadable file of zipped data containing all of the FOIA disclosable health care provider data in NPPES and a separate PDF file of code values which documents and lists the descriptions for all of the codes found in the data file.

Content

The dataset contains the latest NPI downloadable file in an easy to query BigQuery table, npi_raw. In addition, there is a second table, npi_optimized which harnesses the power of Big Query’s next-generation columnar storage format to provide an analytical view of the NPI data containing description fields for the codes based on the mappings in Data Dissemination Public File - Code Values documentation as well as external lookups to the healthcare provider taxonomy codes . While this generates hundreds of columns, BigQuery makes it possible to process all this data effectively and have a convenient single lookup table for all provider information.

Fork this kernel to get started.

Acknowledgements

https://bigquery.cloud.google.com/dataset/bigquery-public-data:nppes?_ga=2.117120578.-577194880.1523455401

https://console.cloud.google.com/marketplace/details/hhs/nppes?filter=category:science-research

Dataset Source: Center for Medicare and Medicaid Services. This dataset is publicly available for anyone to use under the following terms provided by the Dataset Source - http://www.data.gov/privacy-policy#data_policy — and is provided "AS IS" without any warranty, express or implied, from Google. Google disclaims all liability for any damages, direct or indirect, resulting from the use of the dataset.

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Inspiration

What are the top ten most common types of physicians in Mountain View?

What are the names and phone numbers of dentists in California who studied public health?

The number of older individuals – those aged 65 and older – enrolled in the Medicaid health insurance program was projected to be *** million in 2020. Enrollment is expected to increase year-on-year and is forecast to reach ***** million by 2027.

Which enrollment group is the largest? The percentage of people covered by Medicaid has notably increased since 2000, and enrollment has accelerated in recent years due to the program’s expansion under the Affordable Care Act. The elderly represent the smallest enrollment group, and this looks set to continue in the coming years. The number of disabled enrollees is projected to grow to nearly ****** million, while children are expected to remain the largest enrollment group.

Combining Medicaid and Medicare Aged individuals can qualify for Medicaid based on their low-income or via another eligibility pathway, such as receiving Supplemental Security Income. Some seniors may also qualify for both Medicaid and Medicare, and these dual-eligible beneficiaries receive a comprehensive range of medical support. Medicare is a health insurance program primarily aimed at individuals aged 65 and older – this group accounted for around ** percent of all Medicare enrollees in 2019.

United States HIC: All Ages: PG: Govt: Medicare data was reported at 53,372.000 Person th in 2016. This records an increase from the previous number of 51,864.800 Person th for 2015. United States HIC: All Ages: PG: Govt: Medicare data is updated yearly, averaging 42,208.760 Person th from Mar 1999 (Median) to 2016, with 18 observations. The data reached an all-time high of 53,372.000 Person th in 2016 and a record low of 36,990.392 Person th in 1999. United States HIC: All Ages: PG: Govt: Medicare data remains active status in CEIC and is reported by US Census Bureau. The data is categorized under Global Database’s USA – Table US.G082: Health Insurance Coverage.

This dataset contains aggregate Medicaid payments, and counts for eligible recipients and recipients served by month and county in Iowa, starting with month ending 1/31/2011. Eligibility groups are a category of people who meet certain common eligibility requirements. Some Medicaid eligibility groups cover additional services, such as nursing facility care and care received in the home. Others have higher income and resource limits, charge a premium, only pay the Medicare premium or cover only expenses also paid by Medicare, or require the recipient to pay a specific dollar amount of their medical expenses. Eligible Medicaid recipients may be considered medically needy if their medical costs are so high that they use up most of their income. Those considered medically needy are responsible for paying some of their medical expenses. This is called meeting a spend down. Then Medicaid would start to pay for the rest. Think of the spend down like a deductible that people pay as part of a private insurance plan.

According to findings reported in Asthma Medication Ratio Predicts Emergency Department Visits and Hospitalizations in Children with Asthma, published in Volume 3, Issue 4 of the Medicare and Medicaid Research Review, the controller-to-total asthma medication ratio, calculated using pharmacy claims data, can predict both emergency department visits and hospitalizations in children with asthma. Patients with a ratio of less than 0.5 (meaning fewer controller and more rescue medication claims) were 1.5-2.0 times more likely to have a subsequent emergent healthcare visit than children with higher ratios. Providers and payers may consider tracking the asthma medication ratio and using it to signal pediatric patients at high risk for emergent health care visits. This will allow targeted interventions to improve controller medication use in these highest risk patients. Ultimately, increasing controller medication use in these patients would lead to improved ratios and fewer emergent healthcare visits.