Patient responsibility in 2012 Medicare Part B(Medical Insurance) Cost

Part B Monthly Premium


You pay a Part B premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.


If Your Yearly Income in 2010 was

File Individual Tax Return                   File Joint Tax Return                           You pay

$85,000 or less                                    $170,000 or less                                 $99.90

above $85,001 up to $107,000            above $170,001 up to $214,000        $139.90

above $107,001 up to $160,000          above $214,001 up to $320,000        $199.80

above $160,001 up to $214,000          above $320,001 up to $428,000        $259.70

above $214,000                                   above $428,000                                $319.70



Part B Services

Services : Part B Deductible
You pay $140 per year.

Services : Blood
You pay : In most cases, the provider gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. However, you will pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies.

If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

You pay a copayment for additional units of blood you get as an outpatient (after the first 3), and the Part B deductible applies.

Services : Clinical Laboratory Services
You pay: $0 for Medicare-approved services.

Services : Home Health Services
You pay: $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.

Services : Medical and Other Services
You pay: 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy*, and durable medical equipment.

Services : Mental Health Services
You pay: 40% of the Medicare-approved amount for most outpatient mental health care.

Services : Other Covered Services
You pay: copayment or coinsurance amounts.

Services : Outpatient Hospital Services
You pay: a coinsurance (for doctor services) or a copayment amount for most outpatient hospital services.
The copayment for a single service can't be more than the amount of the inpatient hospital deductible.

* In 2012, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.

Note: All Medicare Advantage Plans must cover these services. Costs vary by plan and may be either higher or lower than those noted above. Review the Evidence of Coverage from your plan.

Part A and part B - 2011 premium and deductible - Medicare

MEDICARE PREMIUMS, DEDUCTIBLES FOR 2011

The Centers for Medicare and Medicaid Services (CMS) has set the Medicare premiums, deductibles and coinsurance amounts to be paid by Medicare beneficiaries in 2011.

For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,132 in 2011, an increase of $32 from this year's $1,100 deductible. The Part A deductible is the beneficiary's cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $283 per day for days 61 through 90 in 2011, and $566 per day for hospital stays beyond the 90th day in a benefit period. For 2010, the per-day payment for days 61 through 90 was $275, and $550 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $141.50 in 2011, compared to $137.50 in 2010. Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. All of these Part A program payment changes are determined in accordance with a statutory formula.

About 99 percent of Medicare beneficiaries do not pay a premium for Medicare Part A services since they have at least 40 quarters of Medicare-covered employment. However, some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 quarters of coverage obtain Part A coverage by paying a monthly premium established according to a statutory formula. This premium will be $450 for 2011, a decrease of $11 from 2010. Individuals who have between 30 and 39 “quarters of coverage” may buy into Part A at a reduced monthly premium rate of $248 in 2011.

The monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.  The standard Medicare Part B monthly premium will be $115.40 in 2011, a $4.90 increase (or 4.4-percent) over the 2010 premium.  However, the majority of Medicare beneficiaries will continue to pay the same $96.40 premium amount they have paid since 2008.

Part A premiums are decreasing because spending in 2010 was lower than expected and the Affordable Care Act implemented policies that lower Part A spending due to payment efficiencies and efforts related to waste, fraud and abuse.  Part B premiums are increasing because of growth in the use of services like outpatient hospital care, home health and physician-administered drugs.  In addition, the premium accounts for a likely Congressional action to avert a precipitous decrease in physician  payments, which the Administration supports, and has occurred every year since 2003.  The Administration is committed to permanent reform of the physician payment formula.

By law, the standard premium is set to cover one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over, plus a contingency margin. The contingency margin is an amount appropriate to (i) cover incurred-but-unpaid claims costs, (ii) provide for possible variation between actual and projected costs, and (iii) amortize any surplus assets or unfunded liabilities.  The remaining Part B costs are financed by Federal general revenues.  (In 2011, $2.5 billion in Part B expenditures will be financed by the new fees on manufacturers and importers of brand-name prescription drugs under the Affordable Care Act.  The revenue from these fees reduces the standard Part B premium by $0.90.)

Based on current estimates, Part B assets are not sufficient to cover the amount of incurred-but-unpaid expenses and to provide for a significant degree of variation between actual and projected costs.  Thus, a large positive contingency margin is needed to increase assets to a more appropriate level.

The size of the contingency margin for 2011 is affected by two additional factors.  First, the current law formula for physician fees will result in a payment reduction of 23 percent in December 2010 and, in this analysis, is projected to cause an additional reduction of about 6.5 percent starting January 2011.  (The actual reduction in physician fees under current law for January 2011 is now known to be 2.5 percent.  As is typical, the final adjustment was not available in time to include in the premium determination.)   There is a strong likelihood that these reductions will be overridden by legislation enacted after Part B premiums are established for 2011.  For each year from 2003 through November 2010, Congress has acted to prevent smaller physician fee reductions from occurring.

 In recognition of this strong possibility of higher Part B expenditures resulting from similar legislation to override the decreases in physician fees in December 2010 and January 2011, it is appropriate to maintain a significantly larger Part B contingency reserve than would otherwise be necessary.  The asset level projected for the end of 2010 would otherwise not be adequate to accommodate this contingency.

 

Medicare Part D premium and dedcutible for 2011

MEDICARE PREMIUMS, DEDUCTIBLES FOR 2011

Enrollees in Medicare Part D prescription drug plans pay premiums that vary from plan to plan depending on each plan’s efficiency and scope of benefits.  Beginning in 2011, the Affordable Care Act requires Part D enrollees whose incomes exceed the same thresholds that apply to higher income Part B enrollees to pay a monthly adjustment amount.  These enrollees will pay the regular plan premium to their Part D plan and will pay the income-related adjustment to Medicare. The 2011 Part D income-related monthly adjustment amounts to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return 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
Less than or equal to $85,000	Less than or equal to $170,000	$0.00
Greater than $85,000 and less than or equal to $107,000	Greater than $170,000 and less than or equal to $214,000	$12.00
Greater than $107,000 and less than or equal to $160,000	Greater than $214,000 and less than or equal to $320,000	$31.10
Greater than  $160,000 and less than or equal to $214,000	Greater than $320,000 and less than or equal to $428,000	$50.10
Greater than $214,000	Greater than $428,000	$69.10

In addition, the income-related monthly adjustment amounts to be paid by Part D beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at any time during the taxable year 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
Less than or equal to $85,000	$0.00
Greater than $85,000 and less than or equal to $129,000	$50.10
Greater than $129,000	$69.10

As noted above, states have programs that pay some or all of beneficiaries' Part A and Part B premiums and coinsurance for certain people who have Medicare and a limited income. Similarly, Part D beneficiaries with limited income and assets are eligible for Federal subsidies to reduce their premiums and coinsurance.

Medicare premiums and coinsurance rates for 2010

Medicare premiums and coinsurance rates for 2010

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2010:

Medicare Premiums for 2010:

Part A: (Hospital Insurance) Premium

    *       Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
    *       The Part A premium is $254.00 per month for people having 30-39 quarters of Medicare-covered employment.
    *       The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

Most beneficiaries will continue to pay the same $96.40 premium amount in 2010.  Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2010.  For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2010?"

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium.  The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.  For additional details, see our FAQ titled: "2010 Part B Premium Amounts for Persons with Higher Income Levels".

Medicare Deductible and Coinsurance Amounts for 2010:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2010 = $1,100) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

    *       A total of $1,100 for a hospital stay of 1-60 days.
    *       $275 per day for days 61-90 of a hospital stay.
    *       $550 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
  
    *      All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

    *       $137.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

    *       $155.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $155.00 deductible.)


Related Links :

• Medicare reimbursement rates increase

• Medicare reimbursement rates for GI

• What is hospital medicare reimbursement

• How much i need to pay for medicare

How much i need to pay for Medicare premium

THE VALUE OF MEDICARE PART B

Health care information is often complex and knowing what choice to make when you become eligible for Medicare can be difficult. This article will discuss the advantages and disadvantages of enrolling in Medicare Part B.

You should enroll in Medicare Parts A and B as soon as you are eligible; this will help you avoid late penalties which may apply should you later decide to enroll.  If you have 40 qualified work quarters during which Medicare Health Insurance Tax (HIT) was paid, there are no premiums for Medicare Part A. You will automatically be enrolled in Medicare Parts A and B when you enroll in Medicare, but you may elect to decline Part B. In making an informed choice, you should know the advantages and disadvantages of enrolling or not enrolling in Medicare Part B.

Medicare Part A covers hospital services and Part B covers outpatient and professional services such as doctor visits, X-ray and lab services, ambulance services, physical and speech therapy, durable medical equipment (i.e., oxygen, wheelchairs, and walkers) and some preventive care, which are coordinated with most of the Administered health plans.

2010 Medicare Part B Premium Structure

Effective January 1, 2007, Part B premiums are income-based, subject to your prior two years of income tax filings with the Internal Revenue Service (IRS). You can choose whether or not to enroll in Part B; however, if you do enroll in Part B and in one of the Medicare plans — Anthem Blue Cross Plan III, Kaiser Senior Advantage, Secure Horizons, SCAN, or CIGNA Health Care for Seniors — your Part B premium standard rate will be reimbursed by the County (subject to annual review by the Board of Supervisors).

The following chart applies to members with Medicare Part A and Part B and enrolled in a Medicare plan:

County Reimbursement Schedule for 2010 Medicare Part B Premiums (standard rate)
Income	2010 Medicare Part B Premium Monthly Rates*	2010 County Medicare Part B Premium Reimbursement Program Monthly Amount**
$0 – $85,000	$96.40 (standard rate)	$96.40 singles and $192.80 for two parties
$85,001 – $170,000	$110.50	$110.50 singles and $221 for two parties

The maximum Part B reimbursement for 2010 is $110.50 (standard rate).