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Fast Facts About Medicare

Number of People Receiving Medicare (2014): *

Total Medicare beneficiaries

• Aged

• Disabled

53.8 million

• 44.9 million

•   8.9 million

Part A (Hospital Insurance, HI) beneficiaries

• Aged

• Disabled

53.5 million

• 44.6 million

•   8.9 million

Part B (Supplementary Medical Insurance, SMI) beneficiaries

• Aged

• Disabled

49.3 million

• 41.3 million

•   8.1 million

Part C (Medicare Advantage) beneficiaries

16.2 million

Part D (Prescription Drug Benefit) beneficiaries

40.5 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 (2014):

Total: $12,179

  • Part A: $4,951
  • Part B: $5,308
  • Part D: $1,920

Status of Medicare Trust Funds: *

Medicare Trust Funds (billions):

HI (Part A)

SMI

(Part B) (Part D)

Total

Assets at end of 2013

$205.4

$74.1   $1.0

$280.5

Total income in 2014

Payroll taxes
Interest
Taxation of Benefits
Premiums
General Revenue/Other

$261.2

$227.4
     8.8
  18.1
   3.3
    3.6

 $259.8  $78.2

----- -----
2.4   0
-- --- -----
 65.6      11.4
  191.8    66.8

$599.3

$227.4
   11.2
   18.1
   80.3
 262.2

Total expenditures in 2014

Benefits
Administrative Expenses

$269.3

$264.9
     4.5

$265.9  $78.1

$261.9 $77.7
      4.0     0.4

$613.3

$604.5
     8.8

Net change in assets

$ -8.1

  $  -6.1   $  0.1

$ -14.1

Assets at end of 2014

$197.3

$ 68.1    $1.1

$266.4

*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 (2016):

Hospital Benefits

- Initial deductible: $1,288

- Daily co-insurance:

  • $0 (1st ~ 60th day)
  • $322 (61st ~ 90th day)
  • $644 (91st ~ 150th day, lifetime reserve days)

Skilled Nursing Facility Benefits

- Deductible: $0

- Daily co-insurance:

  • $0 (1st ~ 20th day)
  • $161 (21st ~ 100th day)
  • - No benefits starting the 101st day

Home Health Services Benefits

- No deductible

- 20% of Medicare –approved amount for durable medical equipment

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 (2016):

Coverage:

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

Standard Monthly premiums:

The standard Part B premium is $121.80. However, most people who receive Social Security benefits will continue to pay $104.90, the same amount they paid in 2015, because there was no cost-of-living increase for Social Security benefits for 2016. Monthly premiums have been means-tested since 2007.

If Your Yearly Income in 2014 was

You Pay

File Individual Tax Return

File Joint Tax Return

$85,000 or below

$170,00 or below

$121.80

$85,001 - $107,000

$170,001 - $214,000

$170.50

$107,001 - $160,000

$214,001 - $320,000

$243.60

$160,001 - $214,000

$320,001 - $428,000

$316.70

above $214,000

Above $428,000

$389.80

Initial deductible:

$166.00

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 15% by monthly premiums;

• About 74% from general federal revenues

• About 11% from state payments and interest

Medicare Part D Benefits (2016):

Coverage:

Outpatient prescription drugs

Monthly premiums:

The national base beneficiary premium for 2015 was $33.13. As of 2011, monthly premiums are mean-tested.

If Your Yearly Income in 2014 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

$12.70+Plan Premium

$107,001 - $160,000

$214,001 - $320,000

$32.80+Plan Premium

$160,001 - $214,000

$320,001 - $428,000

$52.80+Plan Premium

above $214,000

Above $428,000

$72.90+Plan Premium

Annual deductible

$360*

Co-insurance:

25% of drug costs between $360 and $3,310*:

Coverage gap:

58% out-of-pocket spending for generic drug costs between $3,310~$4,850*. A 55% discount is available on covered brand-name prescription drugs at the time of purchase.

Extra help:

Benefit for people with income less than $17,820 for an individual ($24,030 for a married couple living together).
Note: Individual states 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.
  • 21% of all Medicare beneficiaries had a Medigap policy in 2012.

Medicare Savings Programs:

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

·   21% of Medicare beneficiaries received Medicaid in 2011.

Qualified Medicare Beneficiaries
(QMBs)

- Entitled to Medicare Part A

- Asset test

  • Not exceeding $7,280 for an individual;
  • Not exceeding $10,930 for married couples

- Monthly income limit: Most states: $1,010 for an individual or $1,355 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 $7,280 for an individual;
  • Not exceeding $10,930 for married couples

- Monthly income limit: Most states: $1,208 for an individual or $1,622 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 $7,280 for an individual;
  • Not exceeding $10,930 for married couples

- Monthly income limit: Most states: $1,357 for an individual or $1,823 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 states 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.
  • 15.8 Million enrollees (30% of all Medicare enrollees) in 2014.

Government Relations and Policy, March 2016


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