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///Medicare Fast Facts
Medicare Fast Facts2018-09-04T16:28:09+00:00

Number of People Receiving Medicare (2016): *

Total Medicare beneficiaries

• Aged

• Disabled

 56.8 million

• 47.8 million

•   9.0 million

Part A (Hospital Insurance, HI) beneficiaries

• Aged

• Disabled

 56.5 million

• 47.5 million

•   9.0 million

Part B (Supplementary Medical Insurance, SMI) beneficiaries

• Aged

• Disabled

 52.1 million

• 43.9 million

•   8.2 million

Part C (Medicare Advantage) beneficiaries

  17.6 million

Part D (Prescription Drug Benefit) beneficiaries

 43.2 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 (2016):

Total: $12,829

  • Part A: $4,968
  • Part B: $5,558
  • Part D: $2,304

Status of Medicare Trust Funds (2016): *

Medicare Trust Funds (billions):

HI (Part A)

SMI

(Part B) (Part D)

Total

Assets at end of 2015

$193.8

$68.1   $1.3

$263.2

Total income in 2016

Payroll taxes
Interest
Taxation of Benefits
Premiums
General Revenue/Other

$290.8

$253.5
7.7
23.0
3.3
3.3

 $313.2  $106.2

—– —–
2.1   0
— — —–
72.1   13.8
239.0    92.4

$710.2

$253.5
9.8
23.0
89.1
334.7

Total expenditures in 2016

Benefits
Administrative Expenses

$285.4

$280.5 
     4.9

$293.4  $100.0

$289.5 $99.5
      3.9     0.5

$678.7

$669.5 
     9.2

Net change in assets

$ 5.4

  $19.8   $6.3

$31.5

Assets at end of 2016

$199.1

$ 88.0    $7.6

$294.7

*Totals may not add due to rounding

Medicare Part A

Medicare Part A (HI) Financing and Tax Rate:

Financing: Primarily financed 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 (2018):

Hospital Benefits

– Initial deductible: $1,340

– Daily co-insurance:

  • $0 (1st ~ 60th day)
  • $335 (61st ~ 90th day)
  • $670 (91st ~ 150th day, lifetime reserve days)

Skilled Nursing Facility Benefits

– Deductible: $0

– Daily co-insurance:

  • $0 (1st ~ 20th day)
  • $167.50 (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 (2018):

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 ($130 on average) because Part B premiums increased more than the cost-of-living increase for 2018 Social Security benefits. Monthly premiums have been means-tested since 2007.

If Your Yearly Income in 2016 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 – $133,500

$214,001 – $267,000

$267.90

$133,501 – $160,000

$267,001 – $320,000

$348.30

above $160,000

Above $320,000

$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 13% by monthly premiums;

• About 78% from general federal revenues

• About 9% from state payments and interest

Medicare Part D Benefits (2018):

Coverage:

Outpatient prescription drugs

Monthly premiums:

The national base beneficiary premium for 2018 is $35.02. As of 2011, monthly premiums are mean-tested.

If Your Yearly Income in 2016 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

$13.00+Plan Premium

$107,001 – $160,000

$214,001 – $320,000

$33.60+Plan Premium

$160,001 – $214,000

$320,001 – $428,000

$54.20+Plan Premium

above $214,000

Above $428,000

$74.80+Plan Premium

Annual deductible

$405*

Co-insurance:

25% of drug costs between $405 and $3,750*:

Coverage gap:

44% out-of-pocket spending for generic drug costs between $3,750~$5,000*. A 65% discount is available on covered brand-name prescription drugs at the time of purchase.

Extra help:

Benefit for people with income less than $18,210 for an individual ($24,690 for a married couple living together) and up to $14,100 in resources ($28,150 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.
  • 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 2017.

Qualified Medicare Beneficiaries
(QMBs)

– Entitled to Medicare Part A

– Asset test

  • Not exceeding $7,560 for an individual;
  • Not exceeding $11,340 for married couples

– Monthly income limit: Most states: $1,032 for an individual or $1,392 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 $7,560 for an individual;
  • Not exceeding $11,340 for married couples

– Monthly income limit: Most states: $1,234 for an individual or $1,666 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 $7,560 for an individual;
  • Not exceeding $11,340 for married couples

– Monthly income limit: Most states: $1,386 for an individual or $1,872 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.
  • 18.4 Million enrollees (32% of all Medicare enrollees) in 2016.

Government Relations and Policy, April 2018