Prevalence and Spending on Diabetes for Medicare’s Feefor- Service Population: US Trends, 2010


Chronic Dis Int. 2014;1(2): 2.

Prevalence and Spending on Diabetes for Medicare’s Feefor- Service Population: US Trends, 2010

Holly Korda1* and Erkan Erdem2

1Health Systems Research Associates, USA

2KPMG LLP, Economic and Valuation Services, USA

*Corresponding author: Holly Korda, Health Systems Research Associates, 15 Birch Lane Portland, ME 04064, USA

Received: November 05, 2014; Accepted: November 05, 2014; Published: November 06, 2014


Diabetes Mellitus is one of the most common and costly chronic diseases. The Centers for Disease Control and Prevention reports that in 2010, 25.8 million people, or 8.3% of the population of the United States, had diabetes, including 10.9 million adults age 65 and above [1]. Type 2 diabetes comprises an estimated 90-95% of cases, with Type 1 diabetes and gestational diabetes accounting for the remaining cases [2-5]. Diabetes is a leading cause of death and is often associated with costly and disabling conditions including obesity, hypertension, nerve damage, kidney failure, lower limb amputations, adult onset blindness, heart disease and stroke. Individuals with diabetes use more health care services, medications and other supplies, and have shown medical costs per case that increase with age [6].

In the U.S., individuals age 65 and over account for an estimated 59% of national spending on diabetes care, most of which is paid by the Medicare program [7], the publicly-funded health insurance program funded by the Centers for Medicare & Medicaid Services (CMS). Medicare covers the majority of adults age 65 and above in the US. While some individuals may enroll in private health plans that contract with Medicare, the standard benefit is Medicare Fee-for-Service (FFS) coverage. The Medicare FFS program offers coverage in several parts. Medicare Part A (hospital insurance) covers care in hospitals, skilled nursing facilities and other institutions. Medicare Part B (medical insurance) covers physicians’ services, outpatient services, diagnosis, examinations, care, equipment and supplies relating to diabetes, and some preventive and self-management services. Medicare Part D (prescription drug insurance) provides prescription drug coverage and covers supplies for injecting or inhaling insulin, and is provided through private insurance companies that contract with CMS.

Because diabetes presents an enormous health and economic burden on the aging Medicare population and its publicly-funded program, it is of critical importance to better understand prevalence and spending for diabetes within the aging population and the Medicare program in particular. Specifically, we were interested to understand:


We were able to examine these and related trends in diabetes care for FFS beneficiaries with a focus on individuals age 65 and above (older adult population) to better understand prevalence and spending patterns. We also included in our analyses beneficiaries below age 65, because the Medicare program does provide coverage to a small number of disabled beneficiaries in this age category. Our analyses used actual Medicare FFS claims information from a newly available set of Public Use Files (PUFs) from CMS which also contained 2010 information about Medicare beneficiaries’ chronic conditions. These PUFs and analyses are described in a recent journal article [8]. Our approach contributes to previous studies of spending and resource use on diabetes care that have relied on large self-reported survey data, or data from private Medicare Part D health plans. These latter data sources do not represent actual hospital, medical and pharmaceutical spending as do the administrative claims we use for the trend analyses summarized in this editorial report.

The PUFs include the following chronic conditions: Alzheimer’s Disease and Related Disorders or Senile Dementia; Cancer including one or more of the following types: breast, colorectal, prostate, or lung; Congestive Heart Failure; Chronic Kidney Disease; Chronic Obstructive Pulmonary Disease; Depression; Diabetes; Ischemic Heart Disease; Osteoporosis; Rheumatoid Arthritis/Osteoarthritis; and Stroke\Transient Ischemic Attack.

Summary Findings

We share some of our key findings below. For detailed tables and reporting readers are referred to our recently published work, cited previously [8].

Discussion: A Starting Point for Policy and Program Planning

This report provides a brief summary of trends in prevalence and spending for Medicare beneficiaries with diabetes age 65 and above in the FFS population. Our findings are consistent with trends identified in surveys and research that shows diabetes as a common, costly chronic condition, especially among older adults. Findings also showincreases in prevalence of chronic conditions with advancing age.

People with diabetes accounted for approximately one in four Medicare FFS beneficiaries in 2010, with a higher share among Part A beneficiaries. Most beneficiaries with diabetes had other chronic conditions, which averaged 2.8 (with diabetes). Spending was modest for beneficiaries who had only diabetes, but increased substantially for the majority who had diabetes with other chronic conditions. For example, we found that hospital care costs increased about 3 fold ($1,502 vs. $537) if a diabetic beneficiary also had ischemic heart disease, which is the most common chronic condition with diabetes.

The presence of comorbidities such as those in this study can complicate diabetes management, including patients’ abilities to selfmanage their care, and increase overall costs of care. Conditions such as depression and arthritis can impair patients’ functioning, lifestyle changes and impose barriers to proper care management.

As with any data set, there are limitations to the CMS PUFs data we have used for these analyses. The data do not include information about beneficiaries’ race and ethnicity, for example, actors known to be closely tied to prevalence of diabetes. The data also include information on only eleven chronic conditions, when many others may be related to or tied to a diagnosis of diabetes.

Still, the trends we present here do provide a starting point for further, ongoing investigation important to program policy and management of health and health care for older adults with diabetes and chronic conditions in the Medicare program. In particular, the prevalence of diabetes with co-occurring chronic conditions has significant implications for prevention and self-management efforts focused at constraining increases in diabetes and related expenditures for older adults in the Medicare FFS population.


  1. Maier HM, Ilich JZ, Kim JS, Spicer MT. Nutrition supplementation for diabetic wound healing: a systematic review of current literature. Skinmed. 2013; 11: 217-224.
  2. American Diabetes Association. Economic costs of diabetes in the US. In 2007. Diabetes Care. 2008; 31: 596-615.
  3. American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013; 36: 1033-1046.
  4. Centers for Disease Control and Prevention. Diabetes: successes and opportunities for population-based prevention and control at a glance. 2011.
  5. Narayan KM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes burden: U.S., 2005-2050. Diabetes Care. 2006; 29: 2114-2116.
  6. Dall TM, Zhang Y, Chen YJ, Quick WW, Yang WG, Fogli J. The economic burden of diabetes. Health Aff (Millwood). 2010; 29: 297-303.
  7. Kaiser Family Foundation. Medicare at a Glance. 2012.
  8. Erdem E, Korda H. Medicare fee-for-service spending for diabetes: examining aging and comorbidities. Diabetes & Metabolism. 2014.

Download PDF

Citation: Korda H and Erdem E. Prevalence and Spending on Diabetes for Medicare’s Fee-for-Service Population: US Trends, 2010. Chronic Dis Int. 2014;1(2): 2. ISSN 2379-7983

Journal Scope
Online First
Current Issue
Editorial Board
Instruction for Authors
Submit Your Article
Contact Us