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Medicare Premium, Coinsurance, and Deductible Update for 2016

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The Centers for Medicare and Medicaid Services (CMS) just released the new Medicare premium, coinsurance, and deductible rates for 2016.

For inpatient hospital services furnished in calendar year 2016, the deductible amount is $1,288 (an increase of $28 from 2015). The deductible covers all of a beneficiary�s costs during days 1-60 of a Medicare covered inpatient hospital stay.  The daily coinsurance rates for inpatient hospital stays beyond day 60 through day 90 of a hospital stay will be $322.  If a beneficiary utilizes hospital lifetime reserve days during 2016, the coinsurance amount per day will be $644.

For skilled nursing facility services furnished in calendar year 2016, the daily coinsurance rate for Medicare days 21 through 100 will be $161.00. This is an increase of $3.50 from 2015.

The Part B deductible will increase to $166.00 in 2016, from $147.00 in 2015.

For beneficiaries subject to the �hold harmless� provisions, the Part B medical insurance will stay at the 2015 rate of $104.90. 

Some beneficiaries will be subject to an increase in Part B premium, and will pay $121.80.  Those individuals are:

  • Those not collecting Social Security benefits
  • Those enrolling in Part B for the first time in 2016
  • Dual eligible beneficiaries who have their premiums paid by Medicaid
  • Beneficiaries who pay an additional income-related premium

According to CMS this accounts for about 30% of all Medicare beneficiaries.

The following link summarizes the Part B premiums for those who are subject to the income-related additional premium amount:

BENEFICIARIES WHO FILE AN INDIVIDUAL TAX RETURN WITH INCOME

BENEFICIARIES WHO FILE A JOINT TAX RETURN WITH INCOME

INCOME- RELATED MONTHLY ADJUSTMENT AMOUNT

TOTAL MONTHLY PREMIUM AMOUNT

Less than or equal to $85,000 Less than or equal to $170,000 $  0.00 $121.80
Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000 $ 48.70 $170.50
Greater than $107,000 and less than or equal to $160,000 Greater than $214,000 and less than or equal to $320,000 $121.80 $243.60
Greater than $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000 $194.90 $316.70
Greater than $214,000 Greater than $428,000 $268.00 $389.80

 

BENEFICIARIES WHO ARE MARRIED, BUT FILE A SEPARATE TAX RETURN FROM THEIR SPOUSE

INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT

TOTAL MONTHLY PREMIUM AMOUNT

Less than or equal to $85,000

$  0.00

$121.80
Greater than $85,000 and less than or equal to $129,000

$194.90

$316.70
Greater than $129,000

$268.00

$389.80

Some individuals who have fewer than 40 quarters of Medicare-covered employment choose to purchase Medicare Part A benefits by paying a monthly premium. The Part A premiums for those with fewer than 30 quarters of coverage will be $411 per month, an increase of $4 from 2015. For individuals with 30 to 39 quarters of coverage, the reduced premium will be $226, which is an increase of $2 from 2015.

For further information or if you have any questions regarding this bulletin, please feel free to contact a member of our Health Care Management Group at 847.282.6300.

Information contained herein is accurate at the time of publication.  We recommend that you consult with your Marcum advisor before implementing any action.

 
 
 
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