Healthcare Expenditure — by Payer

2023

Annual per-person expenditure across 18,640 inscope respondents. Click a payer to see the full spending distribution among those with any expenditure.

Split by

Dollar share by payer — % of total healthcare expenditure

Self / OOP Out-of-pocket payments made directly by the patient or their family — copays, deductibles, and costs for uncovered services.

Private Insurance Primarily employer-sponsored group plans (employers typically cover 70–80% of premiums), plus individually purchased marketplace plans. Run by private insurers such as Blue Cross, Aetna, and UnitedHealth.

Medicare Federal health insurance for adults 65 and older. Also covers younger people with long-term disabilities (after 24 months on SSDI), end-stage renal disease (ESRD), or ALS — which is why under-65 age groups show non-zero Medicare values. Funded by payroll taxes and premiums.

Medicaid Joint federal–state program covering low-income individuals and families. Eligibility and benefits vary by state.

VA / CHAMPVA Department of Veterans Affairs coverage for eligible veterans. CHAMPVA extends to spouses and dependents of veterans with service-related disabilities.

TRICARE Health coverage for active-duty military personnel, National Guard and Reserve members, retirees, and their families. Managed by the Department of Defense.

Other Combines four smaller payer categories: other federal programs, state and local government programs, workers' compensation, and miscellaneous other sources.

Coverage — share of respondents with any expenditure

Expenditure distribution — select a payer above

What the data shows

Private insurance is the single largest payer — but covers fewer than six in ten people

Private insurance paid 37.2% of all healthcare dollars in 2023, more than any other payer. Yet 44.1% of respondents had zero private insurance expenditure for the year, meaning nearly half of Americans relied entirely on government programs or paid out of pocket. Among those with private coverage, the average annual insurance payment was $5,453. The dominance of employer-sponsored plans — where employers typically cover 70–80% of premiums — explains much of this concentration.

Medicare: 26% of people, but they account for 58% of their own total healthcare spending

Only 26.4% of respondents had any Medicare expenditure — primarily adults 65 and older. But within that group, Medicare payments accounted for 58.1% of their total healthcare expenditure. The average Medicare payment per user was $10,064, and one in four Medicare users exceeded $10,000 in a single year. As the Baby Boom generation continues aging into Medicare eligibility, this financial concentration is not an anomaly — it is the expected arithmetic of an aging population.

Out-of-pocket costs are manageable for most — and catastrophic for a few

73% of respondents paid something out of pocket, with a median of just $444 for the year. For most people, the burden is real but not ruinous. The tail, however, is severe: 4.1% paid more than $5,000 out of pocket, 1.3% exceeded $10,000, and one person reached $104,652. Among all respondents with any healthcare expenditure, the median out-of-pocket share was 11.7% of their total cost — but the 95th percentile was 92.5%. And 625 people (3.4%) paid 100% of their costs themselves, with no insurance covering anything.

VA users are few, but their per-person spending exceeds private insurance users

Only 498 respondents (2.7%) had any VA or CHAMPVA expenditure. Among them, the average annual payment was $8,518 — higher than the $5,453 average among private insurance users. Veterans who access VA care tend to have more complex, chronic, or service-related health conditions, driving significantly higher per-person utilization. The small user base does not reflect a small need.

Medicaid's mean and median tell two different stories

Among Medicaid users, the average annual payment was $4,228 — but the median was only $699. The gap is wide. Most Medicaid beneficiaries use relatively modest amounts of care; a smaller group with complex chronic conditions pulls the mean upward sharply. This split is visible in the distribution curve: the curve rises slowly through most of its range, then climbs steeply in the final quartile. One additional signal: Medicaid users paid an average of just $540 out of pocket, compared to $1,479 for private insurance users — lower-income populations face less absolute cost-sharing, even if relative burdens remain significant.

Source: AHRQ, 2023 Medical Expenditure Panel Survey, Full-Year Consolidated File (HC-251). All statistics are unweighted. Distribution shows only respondents with expenditure > $0, sorted from smallest to largest. Y-axis clipped at P95; true maximum annotated.