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Activities of daily living (ADLs) are basic activities that support survival, including eating, bathing, and toileting. See Instrumental activities of daily living (IADLs).

In the Medicare Current Beneficiary Survey, ADL disabilities are measured as difficulty performing (or inability to perform because of a health reason) one or more of the following activities: eating, getting in/out of chairs, walking, dressing, bathing, or toileting.

These benefits provide wives of dependents with half of their husband’s basic benefit and surviving widows with their husband’s full basic benefit. Divorced women can receive auxiliary spouse/widow benefits based on a marriage of at least 10 years’ duration.

This is a measure of body weight adjusted for height that correlates with body fat. A tool for indicating weight status in adults, BMI is generally computed using metric units and is defined as weight divided by height or kilograms/meters. The categories used in this report are consistent with those set by the World Health Organization. For adults 20 years of age and over, underweight is defined as having a BMI less than 18.5; healthy weight is defined as having a BMI of at least 18.5 and less than 25; overweight is defined as having a BMI equal to 25 or greater; and obese is defined as having a BMI equal to 30 or greater. To calculate your own body mass index, go to https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm . For more information about BMI, see Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. ¹

For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the conditions stated on the death certificate. In addition to the underlying cause, all other conditions reported on the death certificate are captured and coded and are referred to as multiple causes of death. Cause of death is coded according to the appropriate revision of the International Classification of Diseases (ICD). Effective with deaths occurring in 1999, the United States began using the Tenth Revision of the ICD (ICD-10).²

See Population

See Population

Crowded housing is defined as households that have more than one person per room.

The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. For census years, rates are based on unrounded census counts of the resident population as of April 1. Death rates are expressed as the number of deaths per 100,000 people. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or from specific causes of death (specific rate), or it may be related to the entire population (crude rate).

A plan that promises a specified monthly benefit at retirement. The plan may state this promised benefit as an exact dollar amount, such as $100 per month at retirement. Or, more often, it may calculate a benefit through a plan formula that considers such factors as salary and service (e.g., 1 percent of average salary for the last 5 years of employment for every year of service with an employer).

A plan that does not promise a specific benefit amount at retirement. Instead, employers and/or employees contribute money to each employee’s individual account in the plan. In many cases, employees are responsible for choosing how these contributions are invested and deciding how much to contribute from their paychecks through pretax deductions. Employers may add to employees’ accounts, in some cases, by matching a certain percentage of the employee’s contributions. The value of an employee’s account depends on how much is contributed and how well the investments perform.

In the Medicare Current Beneficiary Survey (Indicators 29 and 33), the Medical Expenditure Panel Survey (MEPS), and the data used from the MEPS predecessor surveys used in this report (Indicator 32) this category covers expenses for any type of dental care provider, including general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists, endodontists, and periodontists. In Indicator 29, dental services are included as part of the “Other” category; in Indicator 33, dental services are included as a separate category.

Ratings reflect the severity of the disability and how much the impairment impacts the ability to work.

In the Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report (Indicator 32), this category includes expenses for visits to medical providers seen in emergency rooms (except visits resulting in a hospital admission). These expenses include payments for services covered under the basic facility charge and those for separately billed physician services. In the Medicare Current Beneficiary Survey (Indicators 29 and 33) emergency room services are included as a hospital outpatient service unless they are incurred immediately prior to a hospital stay, in which case they are included as a hospital inpatient service.

This is the method of reimbursing health care providers on the basis of a fee for each health service provided to the insured person.

The age when benefits are not reduced for early retirement. Benefits are increased by about 8 percent a year until age 70 for delayed retirement. Early Retirement Age (ERA) for retired workers begins at age 62 with a 25 percent reduced level from benefits at Full Retirement Age (FRA), age 66 in 2014. Initial benefits at age 62 increase approximately 75 percent for a delay from ERA to age 70. The FRA was age 65 until 1937 and increased at 2 months per year for each birth year after 1937 until 1943. Please note that the percentages are not the probabilities of claiming at an age because different birth year cohorts are in each age group in a given year and somewhat vary in the size of the eligible population.

A group quarters is a place where people live or stay in a group living arrangement that is owned or managed by an entity or organization providing housing and/or services for the residents. This is not a typical household-type living arrangement. These services may include custodial or medical care as well as other types of assistance, and residency is commonly restricted to those receiving these services. People living in group quarters are usually not related to each other. The group quarters definitions used in the 2010 Census are available in Appendix B at: https://www.census.gov/prod/cen2010/doc/sf1.pdf.

The Survey of Consumer Finances (SCF) estimates wealth for the “Primary Economic Unit”, which is similar to the Census Bureau’s Household. The “Primary Economic Unit” is the economically dominant single person or couple (whether married or living together as partners) and all other persons in the household who are financially interdependent with the economically dominant person or couple. If a couple is economically dominant in the PEU, the head is the male in a mixed sex couple or the older person in a same-sex couple. If a single person is economically dominant, that person is designated as the family head in this report.

In the Consumer Expenditure Survey (Indicator 13), health care expenditures include out-of-pocket expenditures for health insurance, medical services, prescription drugs, and medical supplies. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), health care expenditures include all expenditures for inpatient hospital, medical, nursing home, outpatient (including emergency room visits), dental, prescription drugs, home health care, and hospice services, including both out-of-pocket expenditures and expenditures covered by insurance. Personal spending for health insurance premiums is excluded. In the Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report (Indicator 32), health care expenditures refer to payments for health care services provided during the year. (Data from the 1987 survey have been adjusted to permit comparability across years; see Zuvekas and Cohen [2002]. ³) Out-of-pocket health care expenditures are the sum of payments paid to health care providers by the person, or the person’s family, for health care services provided during the year. Health care services include inpatient hospital, hospital emergency room, and outpatient department care; dental services; office-based medical provider services; prescription drugs; home health care; and other medical equipment and services. Personal spending for health insurance premium(s) is excluded.

A prepaid health plan delivering comprehensive care to members through designated providers, having a fixed monthly payment for health care services, and requiring members to be in a plan for a specified period of time (usually one year).

A dietary assessment tool with 13 components designed to measure quality in terms of how well a set of foods aligns with the key recommendations of the 2015–2020 Dietary Guidelines for Americans. Intakes equal to or better than the standards set for each component are assigned a maximum score. Maximum HEI-2015 component scores range from 5 to 10 points. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each component are summed to create a total maximum HEI-2015 score of 100 points. Nine of the 13 components assess adequacy components. The remaining four components assess dietary components that should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes that meet or exceed the standards. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. A higher total score indicates a diet that aligns better with the Dietary Guidelines. HEI-2015 total and component scores in this report reflect usual dietary intakes among older adults in the United States.

See specific data source descriptions.

Home health care is care provided to individuals and families in their places of residence for promoting, maintaining, or restoring health or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims data (Indicators 28, 29, and 33), home health care refers to skilled nursing care, physical therapy, speech language pathology services, occupational therapy, and home health aide services provided to homebound patients. In the Medical Expenditure Panel Survey (Indicator 32), home health care services are classified into the “Other health care” category and are considered any paid formal care provided by home health agencies and independent home health providers. Services can include visits by professionals, including nurses, doctors, social workers, and therapists, as well as home health aides, homemaker services, companion services, and home-based hospice care. Home care provided free of charge (informal care by family members) is not included.

Hospice care is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones by a hospice program or agency. Hospice services are available in home and inpatient settings. In the Medicare Current Beneficiary Survey (MCBS) (Indicators 29 and 30) hospice care includes only those services provided as part of a Medicare benefit. In Indicator 29, hospice services are part of the “Other” category. In Indicator 33, hospice services are a separate category. In the Medical Expenditure Panel Survey (MEPS) (Indicator 32), hospice care provided in the home (regardless of the source of payment) is included in the “Other health care” category, while hospice care provided in an institutional setting (e.g., nursing home) is excluded from the MEPS universe.

Hospital care in the Medical Expenditure Panel Survey (Indicator 32) includes hospital inpatient care and care provided in hospital outpatient departments and emergency rooms. Care can be provided by physicians or other health practitioners. Payments for hospital care include payments billed directly by the hospital and those billed separately by providers for services provided in the hospital.

In the Medicare Current Beneficiary Survey (Indicators 29 and 33) hospital inpatient services include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, as well as emergency room expenses incurred immediately prior to inpatient stays. Expenses for hospital stays with the same admission and discharge dates are included if the Medicare bill classified the stay as an “inpatient” stay. Payments for separate billed physician inpatient services are excluded. In the Medical Expenditure Panel Survey (Indicator 32) these services include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician inpatient services, and emergency room expenses incurred immediately prior to inpatient stays. Expenses for reported hospital stays with the same admission and discharge dates are also included.

These services in the Medicare Current Beneficiary Survey (Indicators 29 and 33) include visits to both physicians and other medical providers seen in hospital outpatient departments or emergency rooms (provided the emergency room visit does not result in an inpatient hospital admission), as well as diagnostic laboratory and radiology services. Payments for these services include those covered under the basic facility charge. Expenses for in-patient hospital stays with the same admission and discharge dates and classified on the Medicare bill as “outpatient” are also included. Separately billed physician services are excluded.

Hospital stays in the Medicare claims data (Indicator 28) refers to admission to and discharge from a short-stay acute care hospital.

In the American Housing Survey, housing cost burden is defined as expenditures on housing and utilities in excess of 30 percent of household reported income.

In the Consumer Expenditure Survey’s Interview Survey, housing expenditures include payments for mortgage interest; property taxes; maintenance, repairs, insurance, and other expenses; rent; rent as pay (reduced or free rent for a unit as a form of pay); maintenance, insurance, and other expenses for renters; and utilities.

In the Medicare Current Beneficiary Survey, income is for the sample person or the sample person and spouse if the sample person was married at the time of the survey. All sources of income from jobs, pensions, Social Security benefits, Railroad Retirement and other retirement income, Supplemental Security Income, interest, dividends, and other income sources are included.

Household income from the Medical Expenditure Panel Survey (MEPS) and the MEPS predecessor surveys used in this report was created by summing personal income from each household member to create family income. Family income was then divided by the number of people that lived in the household during the year to create per capita household income. Potential income sources asked about in the survey interviews include annual earnings from wages, salaries, or withdrawals; Social Security and Veterans Administration payments; Supplemental Security Income and cash welfare payments from public assistance; Temporary Assistance for Needy Families, formerly known as Aid to Families with Dependent Children; gains or losses from estates, trusts, partnerships, C corporations, rent, and royalties; and a small amount of other income. See Poverty Indicator 32: Out-of-Pocket Health Care Expenditures.

See Hospital inpatient services.

See Population

For the 2010 Census, the U.S. Census Bureau defined institutions as adult correctional facilities, juvenile facilities, skilled-nursing facilities, and other institutional facilities such as mental (psychiatric) hospitals and in-patient hospice facilities. See Population

Indicators of functional well-being that measure the ability to perform more complex tasks than the related activities of daily living. See also Activities of daily living (ADLs).

In the Medicare Current Beneficiary Survey. IADLs are measured as difficulty performing (or inability to perform because of a health reason) one or more of the following activities: heavy housework, light housework, preparing meals, using a telephone, managing money, or shopping. Only the questions on telephone use, shopping, and managing money are asked of long-term care facility residents.

In the Medicare Current Beneficiary Survey (MCBS; Indicators 21 and 35), a residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; 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. In the MCBS (Indicators 29 and 33), a long-term care facility excludes “short-term institutions” (e.g., sub-acute care) stays. See Short-term institution (Indicators 29 and 33), and Skilled nursing home (Indicator 28).

An X-ray image of the breast used to detect irregularities in breast tissue.

An average of n numbers computed by adding the numbers and dividing by n.

A measure of central tendency, the point on the scale that divides a group into two parts.

This nationwide health insurance program is operated and administered by the states with Federal financial participation. Within certain broad, federally determined guidelines, states decide who is eligible; the amount, duration, and scope of services covered; rates of payment for providers; and methods of administering the program. Medicaid pays for health care services, community-based supports, and nursing home care for certain low-income people. Medicaid does not cover all low-income people in every state. The program was authorized in 1965 by Title XIX of the Social Security Act.

This nationwide program provides health insurance to people age 65 and over, people entitled to Social Security disability payments for 2 years or more, and people with end-stage renal disease, regardless of income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security Act, and became effective on July 1, 1966. Medicare covers acute care services and post-acute care settings such as rehabilitation and long-term care hospitals, and generally does not cover nursing home care. Prescription drug coverage began in 2006.

See Medicare Part C.

Also known as Hospital Insurance, Medicare Part A covers inpatient care in hospitals, critical access hospitals, skilled nursing facilities, and other postacute care settings, such as rehabilitation and long-term care hospitals. It also covers hospice and some home health care.

Also known as Medical Insurance, Medicare Part B covers doctor’s services, outpatient hospital care, and durable medical equipment. It also covers some other medical services that Medicare Part A does not cover, such as physical and occupational therapy and some home health care. Medicare Part B also pays for some supplies when they are medically necessary.

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans instead of through the original Medicare plan (Parts A and B). These plans were known as Medicare+Choice or Part C plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the types of plans allowed to contract with Medicare were expanded, and the Medicare Choice program became known as Medicare Advantage. In addition to offering comparable coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage.

This program subsidizes the costs of prescription drugs for Medicare beneficiaries. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and went into effect on January 1, 2006. Beneficiaries can obtain the Medicare drug benefit through two types of private plans: beneficiaries can join a Prescription Drug Plan for drug coverage only or they can join a Medicare Advantage plan that covers both medical services and prescription drugs. Alternatively, beneficiaries may receive drug coverage through a former employer, in which case the former employer may qualify for a retiree drug subsidy payment from Medicare.

See Supplemental health insurance.

Noninstitutional group quarters: For the 2010 Census, the U.S. Census Bureau defined noninstitutional group quarters as facilities that house those who are primarily eligible, able, or likely to participate in the labor force while residents. The noninstitutionalized population lives in noninstitutional group quarters such as college/university student housing, military quarters, and other noninstitutional group quarters such as emergency and transitional shelters for people experiencing homelessness and group homes. For more information on noninstitutional group quarters, please see Appendix B at https://www.census.gov/prod/cen2010/doc/sf1.pdf .

See Body mass index (BMI)

In the Medical Expenditure Panel Survey (Indicator 32), this category includes expenses for visits to physicians and other health practitioners seen in office-based settings or clinics. “Other health practitioner” includes audiologists, optometrists, chiropractors, podiatrists, mental health professionals, therapists, nurses, and physician’s assistants, as well as providers of diagnostic laboratory and radiology services. Services provided in a hospital-based setting, including outpatient department services, are excluded.

In the Medicare Current Beneficiary Survey (Indicator 33), this category includes short-term institution, hospice, and dental services. In the Medical Expenditure Panel Survey (Indicator 32), other health care includes home health services (formal care provided by home health agencies and independent home health providers) and other medical equipment and services. The latter includes expenses for eyeglasses, contact lenses, ambulance services, orthopedic items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, alterations/modifications, and other miscellaneous items or services that were obtained, purchased, or rented during the year.

These are health care expenditures that are not covered by insurance.

See Hospital outpatient services.

See Body mass index (BMI)

In the Medicare Current Beneficiary Survey (Indicator 33), this category includes visits to a medical doctor, osteopathic doctor, and health practitioner as well as diagnostic laboratory and radiology services. Health practitioners include audiologists, optometrists, chiropractors, podiatrists, mental health professionals, therapists, nurses, paramedics, and physician’s assistants. Services provided in a hospital-based setting, including outpatient department services, are included.

In the Medicare Current Beneficiary Survey (Indicator 29), this term refers to “physician/medical services” combined with “hospital outpatient services”.

In Medicare claims data (Indicator 28), physician visits and consultations include visits and consultations with primary care physicians, specialists, and chiropractors in their offices, hospitals (inpatient and outpatient), emergency rooms, patient homes, and nursing homes.

Data on populations in the United States are often collected and published according to several different definitions. Various statistical systems then use the appropriate population for calculating rates.

The official measure of poverty is computed each year by the U.S. Census Bureau and is defined as having income less than 100 percent of the poverty threshold (i.e., $12,043 for one person age 65 and over in 2018). ⁴ Poverty thresholds are the dollar amounts used to determine poverty status. Each family (including single-person households) is assigned a poverty threshold based on the family’s size and the ages of the family members. All family members have the same poverty status. Several indicators included in this report include a poverty status measure. Poverty status (less than 100 percent of the poverty threshold) was computed for Indicators 7, 8, 27, 31, and 32 using the official Census Bureau definition for the corresponding year. In addition, the following income-to-poverty categories are used in this report:

In the Medicare Current Beneficiary Survey (Indicators 29, 30, 33) and in the Medical Expenditure Panel Survey (Indicator 32), prescription drugs are all prescription medications (including refills), except those provided by the doctor or practitioner as samples and those provided in an inpatient setting.

The number of cases of a disease, infected people, or people with some other attribute present during a particular interval of time. It is often expressed as a rate (e.g., the prevalence of diabetes per 1,000 people during a year).

See Supplemental health insurance.

Public assistance is money income reported in the Current Population Survey from Supplemental Security Income (payments made to low-income people who are age 65 and over, blind, or disabled) and public assistance or welfare payments, such as Temporary Assistance for Needy Families and General Assistance.

See specific data source descriptions.

A measure of some event, disease, or condition in relation to a unit of population, along with some specification of time.

The reference population is the base population from which a sample is drawn at the time of initial sampling. See Population

In the National Health Interview Survey, respondent-assessed health status is measured by asking the respondent, “Would you say [your/subject name’s] health is excellent, very good, good, fair, or poor?” The respondent answers for all household members including himself or herself.

The Retiree Drug Subsidy is designed to encourage employers to continue providing retirees with prescription drug benefits. Under the program, employers may receive a subsidy of up to 28 percent of the costs of providing the prescription drug benefit.

This category in the Medicare Current Beneficiary Survey (Indicators 29 and 33) includes skilled nursing facility stays and other short-term (e.g., sub-acute care) facility stays (e.g., a rehabilitation facility stay). Payments for these services include Medicare and other payment sources. See Skilled nursing facility (Indicator 28), Nursing facility (Indicator 35), and Long-term care facility (Indicators 21, 29, 33, and 36).

As defined by Medicare (Indicator 28), a skilled nursing facility provides short-term skilled nursing care on an inpatient basis, following hospitalization. These facilities provide the most intensive care available outside of inpatient acute hospital care. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), “skilled nursing facilities” are classified as a type of “short-term institution.” See also Short-term institution (Indicators 29 and 33), and Long-term care facility (Indicators 21, 29, 33, and 35).

In the Medicare claims data (Indicator 28), skilled nursing facility stays refer to admission to and discharge from a skilled nursing facility, regardless of the length of stay. See also Skilled nursing facility (Indicator 28).

A population in which the age and sex composition is known precisely, as a result of a census. A standard population is used as a comparison group in the procedure for standardizing mortality rates.

Designed to fill gaps in the original Medicare plan coverage by paying some of the amounts that Medicare does not pay for covered services and may pay for certain services not covered by Medicare. Private Medigap is supplemental insurance that individuals purchase themselves or through organizations such as AARP or other professional organizations. Employer- or union-sponsored supplemental insurance policies are provided through a Medicare enrollee’s former employer or union. For dual-eligible beneficiaries, Medicaid acts as a supplemental insurer to Medicare. Some Medicare beneficiaries enroll in Health Maintenance Organizations (HMOs) and other managed care plans that provide many of the benefits of supplemental insurance, such as low copayments and coverage of services that Medicare does not cover.

Since 2011, the Census Bureau has published poverty estimates using the Supplemental Poverty Measure (SPM). The SPM creates a more complex statistical picture incorporating additional items such as tax payments, work expenses, and medical out-of-pocket expenditures in its family resource estimates. The resource estimates also take into account the value of noncash benefits including nutritional, energy, and housing assistance. Thresholds used in the new measure are derived from Consumer Expenditure Survey expenditure data on basic necessities (food, shelter, clothing, and utilities) and are adjusted for geographic differences in the cost of housing.

The Department of Defense’s regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors.

TRICARE’s Medicare wraparound coverage (similar to traditional Medigap coverage) for Medicare-eligible uniformed services beneficiaries and their eligible family members and survivors.

People who served on active duty in the Army, Navy, Air Force, Marines, Coast Guard, uniformed Public Health Service, or uniformed National Oceanic and Atmospheric Administration; Reserve Force and National Guard called to Federal active duty; and those disabled while on active duty training. Excluded are those dishonorably discharged and those whose only active duty was for training or State National Guard service.

Health care services provided by the Veterans Health Administration (Indicator 34) includes preventive care, ambulatory diagnosis and treatment, inpatient diagnosis and treatment, and medications and supplies. This includes home- and community-based services (e.g., home health care) and long-term care institutional services (for those eligible to receive these services).