The 10-Year Money Trail

Every year, Medicare Part B publishes data on what it paid, to whom, and for what. We compiled a decade of this data — from 2014 to 2023 — and traced $855 billion flowing through the system. The story it tells is one of steady growth, a pandemic shock, and a system that keeps expanding regardless of what happens in the world.

Year by Year: The Full Picture

The Steady Climb: 2014–2019

Before COVID, the trend was relentlessly upward but not alarming. Payments grew from $78.2 billion to $89.5 billion — a 14.4% increase over six years, roughly tracking inflation plus the aging of the Baby Boom generation.

The provider count tells a more interesting story. From 938,141 to 1,093,367 — a 16.5% increase — outpacing payment growth. More providers entering the system meant the average payment per provider actually declined from $83,384 to $81,884. The pie was growing, but it was being split more ways.

Services grew faster than payments: from 2.27 billion to 2.59 billion, a 14.1% increase. Medicare was doing more, paying roughly the same per service, and distributing the work across more providers. A picture of controlled expansion.

The COVID Crater: 2020

The 2020 data is the clearest picture we have of what happens when the healthcare system contracts. Elective procedures vanished. Routine check-ups were postponed. Specialists saw their patient volumes crater. The average payment per provider fell to $74,199 — the lowest in our entire dataset.

But providers didn't leave the system. The count only dipped from 1,093,367 to 1,085,313 — less than 1%. The workforce stayed; the work disappeared.

The Recovery: 2021–2023

The snapback was dramatic. 2021 hit $91.5 billion — an all-time high that blew past the pre-pandemic peak by $2 billion. Patients flooded back. Deferred procedures got scheduled. COVID testing and treatment added entirely new billing categories.

Then something strange happened. 2022 dipped to $89.0 billion. Not a crash, but a pullback — possibly as COVID-specific billing wound down and the pent-up demand from 2020 was finally absorbed.

By 2023, the system hit $93.7 billion — the definitive new high. Services reached 2.65 billion, the most ever. The provider count reached 1,175,281. Medicare Part B wasn't just back — it was bigger than ever.

The Markup Story

One of the most revealing trends is the markup ratio — the gap between what providers charge and what Medicare actually pays. In 2014, providers billed 3.47x what Medicare paid. By 2019, that ratio hit 3.89x.

Then it started falling: 3.77x in 2020, 3.59x in 2021, 3.52x in 2022, and 3.45x in 2023 — actually lower than the 2014 level. This could mean Medicare is paying closer to charged amounts, or that providers are adjusting their charge strategies, or that the mix of services is shifting toward lower-markup procedures.

What $854 Billion Buys

Over ten years, Medicare Part B paid out $855 billion for 24.5 billion services delivered by over a million providers to hundreds of millions of beneficiary encounters. It's the largest single healthcare dataset in the world, and it tells us:

• The system always grows. Even a global pandemic only created a one-year dip.
• More providers, less per provider. The average provider earned less in 2023 than in 2014.
• Services grow faster than payments. Medicare is extracting more work for each dollar.
• Markup is declining. The gap between billed and paid amounts is narrowing.

Explore the Data

• Interactive Trends Dashboard — Explore all metrics year by year
• Drug Spending Analysis — Where the fastest-growing dollars are going