Release November 10, 2015 By CMS
Today, the Centers for Medicare & Medicaid Services (CMS)
announced the 2016 premiums and deductibles for the Medicare inpatient hospital
(Part A) and physician and outpatient hospital services (Part B) programs.
Part B Premiums/Deductibles
As the Social Security Administration previously announced, there
will no Social Security cost of living increase for 2016. As a result, by law,
most people with Medicare Part B will be "held harmless" from any
increase in premiums in 2016 and will pay the same monthly premium as last year,
which is $104.90.
Beneficiaries not subject to the "hold harmless"
provision will pay $121.80, as calculated reflecting the provisions of the
Bipartisan Budget Act signed into law by President Obama last week. Medicare
Part B beneficiaries not subject to the "hold-harmless" provision are
those not collecting Social Security benefits, those who will enroll in Part B
for the first time in 2016, dual eligible beneficiaries who have their premiums
paid by Medicaid, and beneficiaries who pay an additional income-related
premium. These groups account for about 30 percent of the 52 million Americans
expected to be enrolled in Medicare Part B in 2016.
Because of slow growth in medical costs and inflation, Medicare
Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The
"hold harmless" provision would have required the approximately 30
percent of beneficiaries not held harmless in 2016 to pay an estimated base
monthly Part B premium of $159.30 in part to make up for lost contingency reserves,
according to the 2015 Trustees Report. However, the Bipartisan Budget Act of
2015 mitigated the Part B premium increase for these beneficiaries and states,
which have programs that pay some or all of the premiums and cost-sharing for
certain people who have Medicare and limited incomes. The CMS Office of the
Actuary estimates that states will save $1.8 billion as a result of this
premium mitigation.
CMS also announced that the annual deductible for all Part B
beneficiaries will be $166.00 in 2016. Premiums for Medicare Advantage and
Medicare Prescription Drug plans already finalized are unaffected by this
announcement.
Since 2007, beneficiaries with higher incomes have paid higher
Part B monthly premiums. These income-related monthly adjustment amount (IRMAA)
affect fewer than 5 percent of people with Medicare. Under the Part B section
of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an
additional amount. The IRMAA, additional amounts, and total Part B premiums for
high income beneficiaries for 2016 are shown in the following table:
|
Beneficiaries who file an
individual tax return with income:
|
Beneficiaries who file a joint
tax return with income:
|
Income-related monthly adjustment amount
|
Total monthly premium amount
|
|
Less than or equal to $85,000
|
Less than or equal to $170,000
|
$0.00
|
$121.80
|
|
Greater than $85,000 and less
than or equal to $107,000
|
Greater than $170,000 and less
than or equal to $214,000
|
48.70
|
170.50
|
|
Greater than $107,000 and less than
or equal to $160,000
|
Greater than $214,000 and less
than or equal to $320,000
|
121.80
|
243.60
|
|
Greater than $160,000 and less
than or equal to $214,000
|
Greater than $320,000 and less
than or equal to $428,000
|
194.90
|
316.70
|
|
Greater than $214,000
|
Greater than $428,000
|
268.00
|
389.80
|
Premiums for beneficiaries who are married and lived with their
spouse at any time during the taxable year, but file a separate return, are as
follows:
|
Beneficiaries who are married and
lived with their spouse at any time during the year, but file a separate tax
return from their spouse:
|
Income-related monthly adjustment amount
|
Total monthly premium amount
|
|
Less than or equal to $85,000
|
$0.00
|
$121.80
|
|
Greater than $85,000 and less
than or equal to $129,000
|
194.90
|
316.70
|
|
Greater than $129,000
|
268.00
|
389.80
|
Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing
facility, and some home health care services. About 99 percent of Medicare
beneficiaries do not pay a Part A premium since they have at least 40 quarters
of Medicare-covered employment.
The Medicare Part A annual deductible that beneficiaries pay when
admitted to the hospital will be $1,288.00 in 2016, a small increase from
$1,260.00 in 2015. The Part A deductible covers beneficiaries' share of costs
for the first 60 days of Medicare-covered inpatient hospital care in a benefit
period. The daily coinsurance amounts will be $322 for the 61st
through 90th day of hospitalization in a benefit period and $644 for
lifetime reserve days. For beneficiaries in skilled nursing facilities, the
daily coinsurance for days 21 through 100 in a benefit period will be $161.00
in 2016 ($157.50 in 2015).
Enrollees age 65 and over who have fewer than 40 quarters of
coverage and certain persons with disabilities pay a monthly premium in order
to receive coverage under Part A. Individuals with 30-39 quarters of coverage
may buy into Part A at a reduced monthly premium rate, which will be $226.00 in
2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage
pay the full premium, which will be $411.00 a month, a $4.00 increase from
2015.
Deductibles and Coinsurance for 2016
|
Part A Deductible and Coinsurance Amounts for
Calendar Years 2015 and 2016 Type of Cost Sharing
|
|
|
2015
|
2016
|
|
Inpatient hospital deductible
|
$1,260
|
$1,288
|
|
Daily coinsurance for 61st-90th
Day
|
315
|
322
|
|
Daily coinsurance for lifetime
reserve days
|
630
|
644
|
|
SNF coinsurance
|
157.50
|
161.00
|
