2016 Medicare Parts A & B Premiums and Deductibles Announced

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 61^st through 90^th 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

Don't Lose Your Subsidy in 2016

If you received premium subsidy in 2014, please be aware that you need to file IRS form 8962 with
your 2014 taxes.  If you did not file form 8962 you need to file this form by August 31, 2015 or you may lose your premium subsidy in 2016.

Here is the link to form 8962

OTC Nexium Prompts Drug Formulary Changes

NEXIUM® 24HR (esomeprazole 20 mg) became available as an over-the-counter (OTC) 14-day treatment for frequent heartburn in May 2014. As a result, most drug formulary (list of covered drugs) are changing.  The following drugs will be moving (or have moved) to a higher formulary Tier.

• Nexium 
• Esomeprazole 
• Lansoprazole 

King v. Burwell U.S. Supreme Court Ruling: Payment of Premium Subsidies Upheld

Good News! This morning the Supreme Court made an important decision about the Health Insurance Marketplace. Their ruling means that consumers will continue to receive quality affordable health care coverage no matter where they live.

For consumers getting their coverage through the Health Insurance Marketplace, this means that nothing has changed. You will still continue to receive your subsidy. 

If you have any questions please don't hesitate to contact Tiffany or Bud.

You can watch the president’s address here and read the Supreme Court’s ruling here.

Additional information about what the Supreme Court decision means for you can be found online at: HealthCare.gov/Decision. 

Information from:Centers for Medicare & Medicaid Services (CMS)

ACA Requiring Insurance Companies to Collect Social Security Numbers

Beginning this year, health insurers have to send the Internal Revenue Service (IRS) information about health plan members and their insurance coverage, including their Social Security number (or other tax identification number). It’s one of the requirements of the Affordable Care Act (ACA).

The ACA requires that everyone have qualifying insurance, qualify for an exemption, or potentially pay a tax penalty. The IRS will cross-check the information in tax returns against the information health insurers are required to submit for every person they cover. This IRS review will confirm that individuals have the required coverage and don’t have to pay a tax penalty.

Many insurance companies have been phasing out the use of SSNs for member identification. However, with the ACA requirements, health insurers will now be sending letters or otherwise reaching out to plan members asking for that information if they don’t already have it.

Does Your Business Qualify for the Health Care Tax Credit?

As an small employer you may qualify for a health care tax credit.

To qualify for the tax credit, all of the following must apply:

• You have fewer than 25 full-time equivalent (FTE) employees
• Your average employee salary is about $50,000 per year or less
• You pay at least 50% of your full-time employees' premium costs
• You offer coverage to your full-time employees through the SHOP Marketplace

The tax credit is worth up to 50% of your contribution toward your employees' premium costs (up to 35% for tax-exempt employers).

Important Links:

• Calculate your FTE's
• Estimate your tax credit

For more information you can visit Healthcare.gov SHOP overview.

Tiffany Geiger, President

A New Special Enrollment Opportunity

The Centers for Medicare and Medicaid Services (CMS) announced a new Individual Health Insurance Marketplace Special Enrollment Opportunity beginning on March 15 through April 30. This Special Enrollment Opportunity is for individuals and families who did not have health coverage in 2014 and are subject to the fee or "shared responsibility payment" when they file their 2014 taxes. 

Who is Eligible

To be eligible you must meet ALL of the following:

• You must live live in a state that has enrollment through Healthcare.gov. (Ohio is one of these states.)
• Are not currently enrolled in health coverage through Healthcare.gov for 2015 
• Attest that you paid the fee for not having health coverage in 2014 
• Attest that you first became aware of, or understood the implications of, the penalty or shared responsibility payment, after Feb. 15, 2015, when Open Enrollment ended.

What This Means

• You  will have the opportunity to purchase an On-Exchange Individual Health Plan from March 15 through April 30. 
• Enrollments made by the 15th of the month will have coverage effective on the 1st day of the following month. 
• Enrollments made after the 15th of the month will have coverage effective on the 1st day of the second month.

State-based Exchanges (SBE) have the flexibility to determine whether they will establish a similar special enrollment period. Check specific SBE websites for additional information. 

Tiffany Geiger, President 

Important Update Regarding the Anthem Cyber Attack

Notice from Anthem on February 6, 2015

Members who may have been impacted by the cyber attack against us should be aware of scam email campaigns targeting current and former members.  These scams, designed to capture personal information (known as “phishing”) are designed to appear as if they are from a health plan and the emails include a “click here” link for credit monitoring. These emails are NOT from us.

DO NOT click on any links in email.
DO NOT reply to the email or reach out to the senders in any way.
DO NOT supply any information on the website that may open, if you clicked on a link in email.
DO NOT open any attachments that arrive with email.

We are not calling members regarding the cyber attack and are not asking for credit card information or social security numbers over the phone.

This outreach is from scam artists who are trying to trick consumers into sharing personal data. There is no indication that the scam email campaigns are being conducted by those that committed the cyber attack, or that the information accessed in the attack is being used by the scammers.

We will contact current and former members via mail delivered by the U.S. Postal Service about the cyber attack with specific information on how to enroll in credit monitoring. Affected members will receive free credit monitoring and ID protection services.

For more guidance on recognizing scam email, please visit the FTC Website: http://www.consumer.ftc.gov/articles/0003-phishing.

We have created a dedicated website (www.AnthemFacts.com) where everyone can access information such as frequently asked questions and answers.

Letter From Anthem Regarding Their Hack

To our valued customers: Safeguarding your employee's personal, financial and medical information is one of our top priorities, and because of that, we have state-of-the-art information security systems to protect your data. However, despite our efforts, Anthem was the target of a very sophisticated external cyber attack. These attackers gained unauthorized access to Anthem's IT system and have obtained personal information from our current and former members such as their names, birthdays, member ID/Social Security numbers, street addresses, email addresses and employment information, including income data. Based on what we know now, there is no evidence that banking, credit card, medical information (such as claims, test results, or diagnostic codes) were targeted or compromised. Once the attack was discovered, Anthem immediately made every effort to close the security vulnerability, contacted the FBI and began fully cooperating with their investigation. Anthem has also retained Mandiant, one of the world's leading cybersecurity firms, to evaluate our systems and identify solutions based on the evolving landscape. Anthem's own associates' personal information - including our own - was accessed during this security breach. We join you in your concern and frustration, and we assure you that we are working around the clock to do everything we can to further secure your employees' data. Anthem will individually notify current and former members whose information has been accessed. We will provide credit monitoring and identity protection services free of charge so that those who have been affected can have peace of mind. We have created a dedicated website (www.AnthemFacts.com ) where members can access information such as frequently asked questions and answers. We have also established a dedicated toll-free number that both current and former members can call if they have questions related to this incident. That number is: 1-877-263-7995. As we learn more, we will continually update this website and share that information with you. And, we developed a memo template and FAQ to help you answer questions you may receive from your employees. We want to personally apologize to you and your employees for what has happened, as we know you expect us to protect your information. We will do everything in our power to make our systems and security processes better and more secure, and hope that we can earn back your trust.

Sincerely, Ken Goulet President, Commercial and Specialty Business Erin Hoeflinger Ohio Plan President

What You Need to Know About 2014 Taxes and Your Health Insurance

Confused filing your taxes in 2014 and showing you had health coverage?  You're not alone!  Here are the answers to the question we hear the most.

New check box on this year's tax form
When filing your 2014 federal income tax return, you'll see a new box asking if you had health care coverage last year.  If you were covered in 2014, you must check this box on the tax form so you won’t pay a penalty.

New tax forms 
1095-A   1095-B   1095-C

1095-A will be sent out in early February to everyone who enrolled through the marketplace. If you don't want to wait, you can also download a copy from your marketplace account online.

1095-B - This form shows that you have minimum essential coverage.  These forms will be sent to all fully insured members by the insurance company NEXT year.  These forms are not required until 2015 tax year.

1095-C - Applies to large employer groups. These forms are not required until 2015 tax year.

No special form needed for 2014 taxes if your coverage was NOT through the marketplace
Tax software programs may tell you that your health insurer will send them a form to submit with their taxes to show proof of coverage.  This is not true for the 2014 tax year filing.  You do not need to submit a form.  Most insurance companies are not sending members a form this time, because it's not needed until 2015. So, for next year's 2015 tax return, you will get a form showing you had coverage.

What are the penalties
Penalties for not having health care coverage during 2014 are as follows:
$95 for an adult
$47.50 per child
Maximum of $285 or 1% of a household’s income for a family
In some cases, a person may be exempt from having coverage and not have to pay a penalty. Your clients can visit this Internal Revenue Service (IRS) website  to learn more about that.

Information from:
Anthem Broker updated January 27,2015; "We’re telling members what they need to know about their taxes and health insurance"
https://www.healthcare.gov/taxes/marketplace-health-plan/ "If you had a health plan through the Health Insurance Marketplace in 2014"

Tiffany Geiger, President, Creekstone Benefits