CMS NEWS
FOR IMMEDIATE RELEASE
November 10, 2015
Contact: CMS Media Relations
2016 Medicare
Parts A & B Premiums and Deductibles Announced
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.
“Our goal is to keep Medicare Part B premiums affordable.
Thanks to the leadership of Congress and President Obama, the premiums for 52
million Americans enrolled in Medicare Part B will be either flat or
substantially less than they otherwise would have been,” said CMS Acting
Administrator Andy Slavitt. “Affordability for Medicare enrollees is a key goal
of our work building a health care system that delivers better care and spends
health care dollars more wisely.”
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.
To get more information about state-by-state savings, visit
the CMS website at
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-11-10.html.
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
|
For more information on the 2016 Medicare Parts A and B
premiums and deductibles (CMS-8059-N, CMS-8060-N, and CMS-8061-N), visit: https://www.federalregister.gov/public-inspection.
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