About half (49.7%) of all health care expenditures in the United States in 2022 were for people in the top 5% of the expenditure distribution, according to an analysis of the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey Household Component (MEPS-HC). The top 1% of people ranked by their health care expenditures accounted for 21.7% of total health care expenditures. The bottom 50% accounted for only 2.8 % of total health care expenses.
The most commonly treated conditions among people with the top 5% of expenses in 2022 were hypertension (42.9%), followed by hyperlipidemia (35.6%), and musculoskeletal pain and back problems (30.6%). Other commonly treated conditions for people with the top 5% of expenses included diabetes mellitus, injuries, anxiety, cancer, and arthritis. The highest expenditure groups were more likely to include people with multiple chronic conditions or costly treatments (e.g., surgeries, hospitalizations) associated with these conditions, the study stated.
The MEPS-HC data includes expenditures made by all payer sources for medical care. The payers included private insurance, Medicare, Medicaid, out-of-pocket expenses, and other sources. The analysis reports commonly treated conditions among those in the highest expenditure groups, and it reports the shares of expenses by age group, race/ethnicity, type of medical service, and source of payment. The data pertain to the civilian noninstitutionalized population.
Overall, the average per-person expenditure was $6,765. Across the expenditure percentiles, the average per-person expenditure ranged from $147,071 for those in the 1% highest expenditure group to $374 for those in the bottom 50% lowest expenditure group. Overall, about 13.6% of costs were paid out-of-pocket, 43.1% were paid by a private insurance plan, 26.3% were paid by Medicare, 12.4% were paid by Medicaid/Children’s Health Insurance Program (CHIP), and 4.6% were paid by other payers.
- For the 1% of the population with the highest expenses, the annual per-person cost was $80,990 or higher. The average annual per-person cost was $147,071. The authors did not report the percentage breakdown by payer.
- For the top 5% of the population with the highest expenses, the annual per-person cost was $30,206 or more. The average annual per-person cost was $67,321. About 8.0% was paid out-of-pocket, 44.4% by private insurance, 30.8% by Medicare, 11.9% by Medicaid/CHIP, and 4.8% by other payers.
- For the top 10% of the population with the highest expenses, the annual per-person cost was $16,202 or more. The average annual per-person cost was $44,595. About 9.3% was paid out-of-pocket, 43.1% by private insurance, 30.7% by Medicare, 12.1% by Medicaid/CHIP, and 4.8% by other payers.
- In the bottom 50%, the annual per-person cost was less than $1,361. The average annual per-person cost was $374. About 26.2% was paid out-of-pocket, 47.3% by private insurance, 6.1% by Medicare, 17.6% by Medicaid/CHIP, and 2.9% by other payers.
The findings were reported in Concentration of Healthcare Expenditures and Selected Characteristics of People with High Expenses, United States Civilian Noninstitutionalized Population, 2018-2022 by Adriana Hernandez-Viver, MS, and Emily M. Mitchell, Ph.D., in a statistical brief for the federal Agency for Healthcare Research and Quality. The goal was to examine the concentration of health care expenses in 2022. They compared the 2022 statistics to two time periods: the early COVID-19 years of 2020 and 2021, and the pre-COVID-19 years of 2018 and 2019.
For more information, contact: Office of Communications, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, Maryland 20857; Email: media@ahrq.hhs.gov; Website: https://www.ahrq.gov/
August 2025 00US25EUA0023