2016 Medicare Beneficiaries to Pay More
By Nancy Clark, CPC, CPC-H, CPB, CPMA, CPC-I
The Centers for Medicare and Medicaid Services (CMS) recently announced increased costs for Medicare beneficiaries in 2016. The annual deductible for Part B beneficiaries will increase from $147 in 2015 to $166 for 2016. Part B monthly premiums will increase for some, but remain at $104.90 for those subject to the “hold harmless” provision. These beneficiaries include those who receive social security benefits; those who initially enroll in Medicare Part B in 2016; those considered “dual eligible beneficiaries” who have their premiums paid by Medicaid; and those whose income is below certain levels. These groups account for approximately 30 percent of the 52 million Medicare Part B beneficiaries.
Other beneficiaries will see their premiums rise to at least $121.80. Since 2007, those with greater incomes have paid higher Part B monthly premiums due to the income-related monthly adjustment amount (IRMAA). CMS indicates that less than 5 percent of beneficiaries pay these additional costs.
For the following beneficiaries, premiums will increase:
- Individuals with annual incomes between $85,000 and $107,000 and
- Married couples with annual incomes between $170,000 and $214,000
- 2015 premium was $146.90
- 2016 premium will be $170.50
- Individuals with annual incomes between $107,000 and $160,000 and
- Married couples with annual incomes between $214,000 and $320,000
- 2015 premium was $209.80
- 2016 premium will be $243.60
- Individuals with annual incomes between $160,000 and $214,000 and
- Married couples with annual incomes between $320,000 and $428,000
- 2015 premium was $272.70
- 2016 premium will be $316.70
- Individuals with annual incomes of $214,000 or more and
- Married couples with annual incomes of $428,000 or more
- 2015 premium was $335.70
- 2016 premium will be $389.80
Medicare Part A costs, which cover inpatient hospital, some home health care, and skilled nursing facility services, will also increase. For those beneficiaries who have at least 40 quarters of Medicare-covered employment, there will continue to be no Part A deductible. CMS estimates that 99 percent of beneficiaries have “premium-free Part A.” Those who are required to pay the premium will pay up to $411 per month, increased from $407 in 2015.
The Part A deductible will also increase in 2016 to $1,288, up slightly from $1,260 in 2015. Additional Part A costs include:
- Co-payment for hospital stay days 61-90: $322 per day, up from $315
- Co-payment for hospital stay days 91 and beyond: $644 per day, up from $630
- Skilled nursing facility co-payment, days 21-100: $161 per day , up from $157.50
Ensure that your beneficiaries understand their responsibility and that your office collects the appropriate amount based on the remittance advice.
For additional information, visit the CMS web site.
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