Fast Facts About Medicare
Number of People Receiving Medicare (2010):
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Total Medicare beneficiaries
• Aged
• Disabled
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47.5 million
• 39.6 million
• 7.9 million
|
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Part A (Hospital Insurance, HI) beneficiaries
• Aged
• Disabled
|
47.1 million
• 39.2 million
• 7.9 million
|
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Part B (Supplementary Medical Insurance, SMI) beneficiaries
• Aged
• Disabled
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43.8 million
• 36.7 million
• 7.1 million
|
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Part C (Medicare Advantage) beneficiaries
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11.7 million
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Part D (Prescription Drug Benefit) beneficiaries
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34.5 million
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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 (2010):
Total: $11,762
- Part A: $5,187
- Part B: $4,786
- Part D: $1,789
Status of Medicare Trust Funds:
|
Medicare Trust Funds (billions):
|
HI (Part A)
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SMI
(Part B) (Part D)
|
Total
|
|
Assets at end of 2009
|
$304.2
|
$75.5 $1.1
|
$380.8
|
|
Total income in 2010
Payroll taxes
Interest
Taxation of benefits
Premiums
General Revenue/Other
|
$215.6
$182.0
13.8
13.8
3.3
2.8
|
$208.8 $61.7
----- -----
3.1 0
-- --- -----
52.0 6.5
153.7 55.1
|
$486.0
$182.0
16.9
13.8
61.8
211.6
|
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Total expenditures in 2010
Benefits
Administrative expenses
|
$247.9
$244.5
3.5
|
$212.9 $62.0
$209.7 $61.7
3.2 0.4
|
$522.8
$515.8
7.0
|
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Net change in assets
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$ -32.3
|
$ -4.1 $ -0.4
|
$ -36.8
|
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Assets at end of 2010
|
$271.9
|
$ 71.4 $ 0.7
|
$344.0
|
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 (2011):
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Hospital Benefits
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- Initial deductible: $1,132
- Daily co-insurance:
- $0 (1st ~ 60th day)
- $283 (61st ~ 90th day)
- $566 (91st ~ 150th day, lifetime reserve days)
|
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Skilled Nursing Facility Benefits
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- Deductible: $0
- Daily co-insurance:
- $0 (1st ~ 20th day)
- $141.50 (21st ~ 100th day)
- - No benefits starting the 101st day
|
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Home Health Services Benefits
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- No deductible
- No co-insurance
|
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Hospice Benefits
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- Deductible: $0
- Up to $5 co-payment per prescription for outpatient drugs for pain and symptom management
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Medicare Part B
Financing:
- About 25% by monthly premiums;
- About 75% from general federal revenues
Medicare Part B Benefits (2011):
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Coverage
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Physician and outpatient care, medical supplies, home health, and preventive services
|
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Standard Monthly premiums
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Monthly premiums have been means-tested since 2007 .
|
If Your Yearly Income in 2009 was
|
You Pay
|
|
File Individual Tax Return
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File Joint Tax Return
|
|
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$85,000 or below
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$170,00 or below
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$115.40
|
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$85,001 - $107,000
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$170,001 - $214,000
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$161.50
|
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$107,001 - $160,000
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$214,001 - $320,000
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$230.70
|
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$160,001 - $214,000
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$320,001 - $428,000
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$299.90
|
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above $214,000
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Above $428,000
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$369.10
|
|
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Initial deductible
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$162.00
|
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Co-pay
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20% of covered expenses
|
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Penalty for late enrollment
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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)
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Medicare Part D
Financing:
• About 11% by monthly premiums;
• About 82% from general federal revenues
• About 7% from state payments and interest
Medicare Part D Benefits (2011):
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Coverage
|
Outpatient prescription drugs
|
|
Monthly premiums
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The national base beneficiary premium is $32.34. Beginning 2011, monthly premiums are mean-tested.
|
If Your Yearly Income in 2009 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
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$170,001 - $214,000
|
$12.00+Plan Premium
|
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$107,001 - $160,000
|
$214,001 - $320,000
|
$31.10+Plan Premium
|
|
$160,001 - $214,000
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$320,001 - $428,000
|
$50.10+Plan Premium
|
|
above $214,000
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Above $428,000
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$69.10+Plan Premium
|
|
|
Annual deductible
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$310*
|
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Co-insurance
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25% of drug costs between $310 and $2,849*:
|
|
Coverage gap
|
100% out-of-pocket spending for drug costs between $2,849~$4,550* . A 50% discount is available on covered brand-name prescription drugs at the time of purchase.
|
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Extra help
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Benefit for people with income less than $16,245 for an individual ($21,855 for a married couple living together)
Note: Individual state might apply different criteria for extra help
|
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Penalty for late enrollment
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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:
Benefit for dual eligibles (those who qualify for Medicare and Medicaid benefits):
9 million (16%) of Medicare beneficiaries were dual eligibles in 2008.
|
Qualified Medicare Beneficiaries
(QMBs)
|
- Entitled to Medicare Part A
- Asset test
- Not exceeding $6,680 for an individual;
- Not exceeding $10,020 for married couples
- Monthly income limit: Most states: $928 for an individual or $1,246 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 $6,680 for an individual;
- Not exceeding $10,020 for married couples
- Monthly income limit: Most states: $1,109 for an individual or $1,491 for a couple
- Coverage: Medicare Part B premiums only
|
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Qualifying Individuals
(QIs)
|
- Limited number of beneficiaries per year
- Entitled to Medicare Part A
- Asset test:
- Not exceeding $6,680 for an individual;
- Not exceeding $10,020 for married couples
- Monthly income limit: Most states: $1,246 for an individual or $1,675 for a couple
- Coverage: Medicare Part B premiums only
|
|
Medicaid Only
(Non QMB, SLMB, QDWI, 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
- 11.7 Million enrollees (24.6% of all Medicare enrollees) in 2010
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