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Fast Facts About Medicare

Number of People Receiving Medicare (2013): *

Total Medicare beneficiaries

• Aged

• Disabled

52.3 million

• 43.5 million

•   8.8 million

Part A (Hospital Insurance, HI) beneficiaries

• Aged

• Disabled

51.9 million

• 43.1 million

•   8.8 million

Part B (Supplementary Medical Insurance, SMI) beneficiaries

• Aged

• Disabled

47.9 million

• 40.0 million

•   7.79illion

Part C (Medicare Advantage) beneficiaries

14.4 million

Part D (Prescription Drug Benefit) beneficiaries

39.1 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 (2013):

Total: $11,910

  • Part A: $5,045
  • Part B: $5,092
  • Part D: $1,773

Status of Medicare Trust Funds: *

Medicare Trust Funds (billions):

HI (Part A)

SMI

(Part B) (Part D)

Total

Assets at end of 2012

$220.4

$66.2   $1.0

$287.6

Total income in 2013

Payroll taxes
Interest
Taxation of Benefits
Premiums
General Revenue/Other

$251.1

$220.8
    9.3 
  14.3 
   3.4
   3.3

$255.5  $69.7

----- -----
2.4   0
-- --- -----
     63.1      9.9 
  189.5    59.8

$575.8

$220.8 
   11.7 
   14.3 
    76.4 
 252.6

Total expenditures in 2013

Benefits
Administrative Expenses

$266.2

$261.9
     4.3

$247.1 $69.7

$243.8 $69.3 
      3.3     0.4

$582.9

$565.9
     7.9

Net change in assets

$ -15.0

  $ 7.9 $ -0

$ -7.1

Assets at end of 2012

$205.4

$ 74.1 $ 1.0

$280.5

*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%
  • As of 2013, workers 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 (2015):

Hospital Benefits

- Initial deductible: $1,260

- Daily co-insurance:

  • $0 (1st ~ 60th day)
  • $315 (61st ~ 90th day)
  • $630 (91st ~ 150th day, lifetime reserve days)

Skilled Nursing Facility Benefits

- Deductible: $0

- Daily co-insurance:

  • $0 (1st ~ 20th day)
  • $157.50 (21st ~ 100th day)
  • - No benefits starting the 101st day

Medicare Part B

Financing:

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

Medicare Part B Benefits (2015):

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 (2015):

Coverage:

Outpatient prescription drugs

Monthly premiums:

The national base beneficiary premium for 2014 was $32.42. As of 2011, monthly premiums are means 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

$12.30+Plan Premium

$107,001 - $160,000

$214,001 - $320,000

$31.80+Plan Premium

$160,001 - $214,000

$320,001 - $428,000

$51.30+Plan Premium

above $214,000

Above $428,000

$70.80+Plan Premium

Annual deductible

$320*

Co-insurance:

25% of drug costs between $320 and $2,960*:

Coverage gap:

65% out-of-pocket spending for generic drug costs between $2,960~$4,700*. 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 $17,505 for an individual ($23,595 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:

  • There are 10 different standardized Medigap policies.
  • 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. 
  • 23% of all Medicare beneficiaries had benefits in 2010.

Medicare Savings Programs:

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

·   21% of Medicare beneficiaries had benefits in 2010.

Qualified Medicare Beneficiaries
(QMBs)

- Entitled to Medicare Part A

- Asset test

  • Not exceeding $7,160 for an individual;
  • Not exceeding $10,750 for married couples

- Monthly income limit: Most states: $993 for an individual or $1,331 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 $7,160 for an individual;
  • Not exceeding $10,750 for married couples

- Monthly income limit: Most states: $1,187 for an individual or $1,593 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 $7,160 for an individual;
  • Not exceeding $10,750 for married couples

- Monthly income limit: Most states: $1,333 for an individual or $1,790 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.

 Government Relations and Policy, February 2015


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