Font Size
 
Minimize

    • Share to Facebook
    • Twitter
    • Email
    • Print
Fast Facts About Medicare

Number of People Receiving Medicare (2012): *

Total Medicare beneficiaries

• Aged

• Disabled

50.7 million

• 42.1 million

•   8.5 million

Part A (Hospital Insurance, HI) beneficiaries

• Aged

• Disabled

50.3 million

• 41.8 million

•   8.5 million

Part B (Supplementary Medical Insurance, SMI) beneficiaries

• Aged

• Disabled

46.4 million

• 38.7 million

•   7.7 million

Part C (Medicare Advantage) beneficiaries

13.1 million

Part D (Prescription Drug Benefit) beneficiaries

37.4 million

·          Totals may not add due to rounding.

Medicare Eligibility:

  • Individuals ages 65 and over, who are eligible for Social Security payments
  • Individuals under 65 with a disability, who receive Social Security cash payments
  • People of all ages with end-stage renal disease

Average Benefit per Enrollee (2012):

Total: $12,103

  • Part A: $5,227
  • Part B: $5,097
  • Part D: $1,779

Status of Medicare Trust Funds: *

Medicare Trust Funds (billions):

HI (Part A)

SMI

(Part B) (Part D)

Total

Assets at end of 2011

$244.2

$79.7   $1.0

$324.9

Total income in 2012

Payroll taxes
Interest
Taxation of Benefits
Premiums
General Revenue/Other

$243.0

$205.7
  10.6
  18.6
   3.4
      4.6

$227.0  $66.9

----- -----
2.8   0
-- --- -----
 58.0      8.3
  166.2    58.5

$536.9

$205.7
   13.4
   18.6
   69.8
 229.3

Total expenditures in 2012

Benefits
Administrative Expenses

$266.8

$262.9
     3.9

$240.5 $66.9

$236.5 $66.5
      3.9     0.4

$574.2

$565.9
     8.3

Net change in assets

$ -23.8

  $ -13.5 $ -0

$ -37.3

Assets at end of 2012

$220.4

$ 66.2 $ 1.0

$287.6

*Totals may not add due to rounding

Medicare Part A

Medicare Part A (HI) Financing and Tax Rate:

Financing: Primarily finance by payroll taxes

  • Tax rate paid by employee: 1.45%
  • Tax rate paid by employer: 1.45%
  • Total tax rate paid by both employer-employee: 2.90%
  • Total tax rate paid by self-employed: 2.90%
  • Beginning in 2013, workers will pay an additional 0.9 percent of their earnings above $200,000 (for those who file an individual return) or $250,000 (for those who file a joint income tax return)

Medicare Part A Benefits (2013):

Hospital Benefits

- Initial deductible: $1,184

- Daily co-insurance:

  • $0 (1st ~ 60th day)
  • $296 (61st ~ 90th day)
  • $592 (91st ~ 150th day, lifetime reserve days)

Skilled Nursing Facility Benefits

- Deductible: $0

- Daily co-insurance:

  • $0 (1st ~ 20th day)
  • $148 (21st ~ 100th day)
  • - No benefits starting the 101st day

Home Health Services Benefits

- No deductible

- No co-insurance

Hospice Benefits

- Deductible: $0

- Up to $5 co-payment per prescription for outpatient drugs for pain and symptom management

Medicare Part B

Financing:

  • About 25% by monthly premiums;
  • About 75% from general federal revenues

Medicare Part B Benefits (2013):

Coverage:

Physician and outpatient care, medical supplies, home health, and preventive services

Standard Monthly premiums:

Monthly premiums have been means-tested since 2007.

If Your Yearly Income in 2011 was

You Pay

 

File Individual Tax Return

File Joint Tax Return


$85,000 or below

$170,00 or below

$104.90

$85,001 - $107,000

$170,001 - $214,000

$146.90

$107,001 - $160,000

$214,001 - $320,000

$209.80

$160,001 - $214,000

$320,001 - $428,000

$272.70

above $214,000

Above $428,000

$335.70

Initial deductible:

$147.00

Co-pay:

20% of covered expenses

Penalty for late enrollment :

10% of monthly premium for each full 12 months of late enrollment for life (Exception: late enrollment due to cancellation of an employer-sponsored group insurance)

Medicare Part D

Financing:

• About 13% by monthly premiums;

• About 73% from general federal revenues

• About 14% from state payments and interest

Medicare Part D Benefits (2012):

Coverage:

Outpatient prescription drugs

Monthly premiums:

The national base beneficiary premium is $31.17. Beginning 2011, monthly premiums are mean-tested.

If Your Yearly Income in 2011 was

You Pay

 

File Individual Tax Return

File Joint Tax Return


$85,000 or below

$170,00 or below

Plan Premium

$85,001 - $107,000

$170,001 - $214,000

$11.60+Plan Premium

$107,001 - $160,000

$214,001 - $320,000

$29.90+Plan Premium

$160,001 - $214,000

$320,001 - $428,000

$48.30+Plan Premium

above $214,000

Above $428,000

$66.60+Plan Premium

Annual deductible

$325*

Co-insurance:

25% of drug costs between $325 and $2,970*:

Coverage gap:

79% out-of-pocket spending for generic drug costs between $2,970~$4,750*. A 52.5% discount is available on covered brand-name prescription drugs at the time of purchase.

Extra help:

Benefit for people with income less than $17,235 for an individual ($23,265 for a married couple living together).
Note: Individual state might apply different criteria for extra help.

Penalty for late enrollment:

1% of the national average premium for each month not enrolled for life (Exception for late enrollment due to having prescription drug coverage that is as good as Medicare's).

* Varies by individual plans and indexed to the annual percentage increase in Part D expenditures thereafter.

Supplemental Insurance

Medigap:

  • Each state offers up to 10 standard plans in 2011.
  • Starting June 1 2010, plans E, H, I, or J are no longer available to buy. People who already have one of these plans are able to continue with it. Also, Plans M and N are new policies introduced in 2010.
  • 23% of all Medicare beneficiaries had benefits in 2010.

Medicare Savings Programs:

Benefit for dual eligibles (those who qualify for Medicare and Medicaid benefits):

·   9 million (18%) of Medicare beneficiaries were dual eligibles in 2009.

Qualified Medicare Beneficiaries
(QMBs)

- Entitled to Medicare Part A

- Asset test

  • Not exceeding $6,940 for an individual;
  • Not exceeding $10,410 for married couples

- Monthly income limit: Most states: $978 for an individual or $1,313 for a couple

- Coverage: Medicare Part A & B premiums, deductibles and coinsurance.

Specified Low-Income Medicare Beneficiaries (SLMBs)

- Entitled to Medicare Part A

- Asset test:

  • Not exceeding $6,940 for an individual;
  • Not exceeding $10,410 for married couples

- Monthly income limit: Most states: $1,169 for an individual or $1,571 for a couple

- Coverage: Medicare Part B premiums only

Qualifying Individuals
(QIs)

- Limited number of beneficiaries per year

- Entitled to Medicare Part A

- Asset test:

  • Not exceeding $6,940 for an individual;
  • Not exceeding $10,410 for married couples

- Monthly income limit: Most states: $1,313 for an individual or $1,765 for a couple

- Coverage: Medicare Part B premiums only

Medicaid Only
(Non QMB, SLMB, or QI)

- Entitled to Medicare Part A and/or Part B and are eligible for full Medicaid benefits

- Typically, these individuals need to spend down to qualify for
Medicaid or fall into a Medicaid eligibility poverty group

- Coverage: Full Medicaid benefits, Medicare cost-sharing
liability

Note: Individual state might have less restrictive criteria for dual eligibility.

Medicare Advantage (MA):

  • Eligibility to choose a MA plan: People who are enrolled in both Medicare A and B, pay the Part B monthly premium, do not have end-state renal disease, and live in the service area of the plan.
  • Formerly know as Medicare+Choice or Medicare Health Plans.
  • Benefits are provided by private insurance companies.
  • Premiums, cost sharing, and coverage vary by plan.
  • 14.4 Million enrollees (28% of all Medicare enrollees) in 2013.

 


Please support our public education campaigns



Subscribe e-Alerts
  Email Address:  
 
  First Name:  
  Last Name:  
   
 
Submit

Read Our Blog

2014 Social Security & Medicare Trustees Report

Hold the Rhetoric, Pass the Truth on the 2014 Trustees Report “This year’s projections come as no surprise to anyone who understands how Social Security... ...

Read More

 

Medicare's Top 10
     

 

Copyright © 2014 by NCPSSM
Login  |