2016 Medicare Beneficiaries to Pay More

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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Nancy Clark

Nancy Clark

Nancy Clark, CPC, COC, CPB, CPMA, CPC-I, has over 20 years of experience in medical coding and billing, healthcare consulting, accounting, and business administration. She applies her skills to assist physician and hospital clients with revenue cycle management. Clark focuses on coding and documentation reviews, assistance with payer audits, and providing education for physicians and their staff. She is also an AAPC certified instructor, a contributing author to health care publications, and a presenter at seminars. Clark is a member of the Novitas Medicare Provider Outreach and Education Advisory Group and co-founder of the New Jersey Coders' Day Medical Coding and Billing Conference. She is proud to support the AAPC for recognizing the value of medical coding professionals and enjoys working with its members.
Nancy Clark

About Has 12 Posts

Nancy Clark, CPC, COC, CPB, CPMA, CPC-I, has over 20 years of experience in medical coding and billing, healthcare consulting, accounting, and business administration. She applies her skills to assist physician and hospital clients with revenue cycle management. Clark focuses on coding and documentation reviews, assistance with payer audits, and providing education for physicians and their staff. She is also an AAPC certified instructor, a contributing author to health care publications, and a presenter at seminars. Clark is a member of the Novitas Medicare Provider Outreach and Education Advisory Group and co-founder of the New Jersey Coders' Day Medical Coding and Billing Conference. She is proud to support the AAPC for recognizing the value of medical coding professionals and enjoys working with its members.

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