Font Size
    • Share to Facebook
    • Twitter
    • Email
    • Print

Fast Facts About Medicare

Number of People Receiving Medicare (2015): *

Total Medicare beneficiaries

• Aged

• Disabled

 55.3 million

• 46.3 million

•   9.0 million

Part A (Hospital Insurance, HI) beneficiaries

• Aged

• Disabled

 54.9 million

• 46.0 million

•   9.0 million

Part B (Supplementary Medical Insurance, SMI) beneficiaries

• Aged

• Disabled

 50.7 million

• 42.5 million

•   8.2 million

Part C (Medicare Advantage) beneficiaries

  17.5 million

Part D (Prescription Drug Benefit) beneficiaries

 41.8 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 (2015):

Total: $12,559

  • Part A: $4,978
  • Part B: $5,441
  • Part D: $2,141

Status of Medicare Trust Funds (2015): *

Medicare Trust Funds (billions):

HI (Part A)

SMI

(Part B) (Part D)

Total

Assets at end of 2014

$197.3

$68.1   $1.1

$266.4

Total income in 2015

Payroll taxes
Interest
Taxation of Benefits
Premiums
General Revenue/Other

$275.4

$241.1
     8.2
  20.2
   3.2
    2.6

 $279.0  $90.0

----- -----
2.3   0
-- --- -----
 69.4      12.8
  207.3    77.3

$644.4

$241.1
   10.5
   20.2
   85.4
 287.2

Total expenditures in 2015

Benefits
Administrative Expenses

$278.9

$273.4
     5.5

$279.0  $89.8

$275.8 $89.5
      3.1     0.3

$647.6

$638.7
     8.9

Net change in assets

$ -3.5

  $  -0.1   $  0.3

$ -3.2

Assets at end of 2014

$193.8

$ 68.2    $1.3

$263.2

*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 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 (2017):

Hospital Benefits

- Initial deductible: $1,316

- Daily co-insurance:

  • $0 (1st ~ 60th day)
  • $329 (61st ~ 90th day)
  • $658 (91st ~ 150th day, lifetime reserve days)

Skilled Nursing Facility Benefits

- Deductible: $0

- Daily co-insurance:

  • $0 (1st ~ 20th day)
  • $164.50 (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 (2017):

Coverage:

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

Standard Monthly premiums:

The standard Part B premium is $134.00. However, most people who receive Social Security benefits will pay less ($109 on average) because Part B premiums increased more than the cost-of-living increase for 2017 Social Security benefits. Monthly premiums have been means-tested since 2007.

If Your Yearly Income in 2015 was

You Pay

File Individual Tax Return

File Joint Tax Return

$85,000 or below

$170,00 or below

$134.00

$85,001 - $107,000

$170,001 - $214,000

$187.50

$107,001 - $160,000

$214,001 - $320,000

$267.90

$160,001 - $214,000

$320,001 - $428,000

$348.30

above $214,000

Above $428,000

$428.60

Initial deductible:

$183.00

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 14% by monthly premiums;

• About 76% from general federal revenues

• About 10% from state payments and interest

Medicare Part D Benefits (2017):

Coverage:

Outpatient prescription drugs

Monthly premiums:

The national base beneficiary premium for 2016 is $34.10. As of 2011, monthly premiums are mean-tested.

If Your Yearly Income in 2015 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

$13.30+Plan Premium

$107,001 - $160,000

$214,001 - $320,000

$34.20+Plan Premium

$160,001 - $214,000

$320,001 - $428,000

$55.20+Plan Premium

above $214,000

Above $428,000

$76.20+Plan Premium

Annual deductible

$400*

Co-insurance:

25% of drug costs between $400 and $3,700*:

Coverage gap:

51% out-of-pocket spending for generic drug costs between $3,700~$4,950*. A 60% 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) and up to $13,640 in resources ($27,250 for a married couple).
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.
  • 23% of all Medicare beneficiaries have a Medigap policy.

Medicare Savings Programs:

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

·   20% of Medicare beneficiaries received Medicaid in 2012.

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.
  • 17.6 Million enrollees (31% of all Medicare enrollees) in 2016.

Government Relations and Policy, February 2017



Please support our public policy and research

 



   

Subscribe e-Alerts

Sign up to receive National Committee updates on Social Security and Medicare.

Read Our Blog

Senate GOP's "Mean" Healthcare Bill Must be Defeated

Getting a look at the Senate Republican healthcare bill after weeks of secrecy is like peeking under a rock. There’s a lot under there that you don’t really want to see – and would like to believe doesn’t really exist. Unfortunately, the Senate version of the American Health Care Act is very real – and dangerously close to becoming law.

Read More




 

            

 

Copyright © 2017 by NCPSSM
Login  |