In addition, the monthly premium rates to be paid by beneficiaries who are
married, but file a separate return from their spouse and lived with their
spouse at some time during the taxable year are:
An estimated 4 percent of current Part B enrollees are expected to be subject
to the higher premium amounts. The proportion of beneficiaries paying
income-related premiums of $106, $124.70, $143.40, or $162.10 are estimated to
be 1.3 percent, 1.2 percent, 0.5 percent, and 0.8 percent, respectively.
Medicare Premiums and Beneficiary Out-of-Pocket Costs in 2007
The Medicare Part B premiums and deductible apply to all Part B
beneficiaries, but other factors provide additional financial support for
beneficiaries. One important factor in reducing beneficiary total
out-of-pocket medical costs is Medicarefs new prescription drug benefit, which
provides an average of around $1,200 in savings.
Beneficiaries with incomes below 135 percent of poverty and limited resources
are eligible for subsidies that pay for some or all of their Medicare
premiums. As a result, about one in four Medicare beneficiaries can
get extra assistance that enables them to pay little or no premium for Part B,
and even more beneficiaries are eligible for assistance with their Part D
premiums. Beneficiaries with limited incomes may also receive assistance
with their Part B and Part D copayments. Most beneficiaries living on incomes
that come only from their monthly Social Security check are eligible for this
extra help in reducing their out-of-pocket costs. Consequently, beneficiaries
living only on a Social Security check usually pay a significantly smaller
portion of their income toward Medicare coverage than Medicare premiums and
average spending would suggest. In addition, for the vast majority of
beneficiaries, the amount of the Social Security cost of living increase will be
much greater than the additional premium they will pay. Based on the
Trustees Report baseline, the average Social Security benefit check has been
projected to increase by an estimated $22.
In addition, more beneficiaries than ever have Medicare Advantage plans
available where they live. These plans will generally offer
additional coverage at a lower cost to beneficiaries than the standard Medicare
drug benefit in 2007, as well as additional benefits and reduced copayments for
Medicare-covered services. On average, these plans save beneficiaries
around $82 a month compared to enrollment in fee-for-service Medicare for Part A
and B benefits. For 2007, the average Part D premium for Medicare Advantage
plans will be around $11 less than for stand-alone Part D plans. Many MA
plans also use a portion of the savings from Part A and B coverage to further
reduce their Part D premiums. Starting in 2006, Medicare Advantage plans
are returning an average of about $26 per beneficiary per month to the
government as a result of having costs below the statutory payment
benchmarks.
Information on these and other programs that can help beneficiaries lower
their out-of-pocket costs is available at 1-800-MEDICARE (1-800-633-4227), and
for hearing and speech impaired at TTY/TTD: 1-877-486-2048.
Reasons for Increase in Part B Premium
The new Part B premium of $93.50 is lower than the amount projected in the
2006 Medicare Trustees Report issued in May ($98.20), and the July Mid-Session
Review of the Presidentfs 2007 Budget ($98.40). The most recent data
indicate that actual incurred historical Part B spending was lower than
indicated by preliminary data and historical trends, resulting in a lower than
projected Part B premium for 2007. In particular, physician claims are
being paid more quickly than in the past, which could be attributable to more
timely submission of electronic claims and steps to promote quality performance
through competition among the Part B carriers.
The attached table summarizes the factors contributing to the 5.6 percent
premium increase, with the factors summing up to the total 5.6 percent. The
single most important factor driving the 5.6 percent Part B premium increase is
the growth in traditional fee-for-service Part B spending per capita, as opposed
to spending growth in Medicare Advantage. The phase-out of gbudget
neutralityh adjustments in Medicare Advantage payments helps account for the
limited Medicare Advantage payment increase. The largest contributors to
the 2007 premium increase by type of service are outpatient hospital services,
physician-administered drugs, and ambulatory surgical center (ASC)
services. Spending for outpatient hospital prospective payment services is
growing rapidly and is projected to increase by 11.6 percent per capita in
2007. This is mainly due to an expected 7.9 percent increase in the volume
and intensity of these services. In addition to the higher premium costs caused
by this growth, it also results in a projected 6.5 percent increase in per
capita beneficiary coinsurance payments (beneficiary coinsurance for hospital
outpatient services can be as high as 40 percent).
However, the 2007 premium increase is held down by a provision in current law
that, if unchanged, will require a reduction in fees paid by Medicare to
physicians of about 5 percent. Congress has acted to prevent such
physician fee reductions from occurring in each of the last four years.
Even with the fee reduction, however, the volume and intensity of physiciansf
services is projected to increase by 4.9 percent in 2007, resulting in projected
continuing pressure toward rising costs.
As CMS has said repeatedly, the rapid growth in utilization of services and
the wide variation across providers and geographic areas in the use of these
services shows that Medicare needs to move away from a system that pays simply
for more services, regardless of the quality of those services or their impact
on beneficiary health. Medicare payments should provide better
financial support to doctors and other health professionals in their efforts to
achieve better health outcomes for Medicare beneficiaries at a lower cost. CMS
is working closely with medical professionals and Congress to increase the
effectiveness of how Medicare compensates physicians and other health care
providers. CMS is also conducting demonstrations and pilot programs that pay
providers more for better quality, better patient satisfaction, and lower
overall health care costs.
As noted above, the scheduled statutory reduction for 2007 of about 5 percent
in the physician fee schedule rates means that the Part B premium increase is
significantly lower than would be the case if the statutory reduction was
eliminated. If physician payment rates were held constant (a change in the
conversion factor of 0 percent rather than -5 percent), with no other changes to
help reduce Medicare spending, Medicare Part B spending would be approximately
$2.8 billion higher in 2007. Such a change would have required an increase
in the 2007 premium of roughly another $1.50. No such change is currently
included in the premium for 2007 because the sustainable growth rate formula in
statute has not been changed.
In addition, the 2007 Part B premiums include adjustments to Part B
contingency reserves to increase the level of Federal assets held in the Part B
account of the trust fund to an appropriate level. These 2007 premium
adjustments are similar to the 2006 levels. (The Part B account of the trust
fund is an accounting system that, by law, must have Federal general revenues
and premium payments credited to it in order to pay for Part B services.)
The adjustments are needed because the financial assets counted in the
Supplemental Medical Insurance (SMI) trust fund are currently well below the
levels considered actuarially appropriate for contingency reserve purposes. This
situation has arisen primarily due to faster than expected spending growth along
with the enactment of the Consolidated Appropriations Resolution in February
2003, the MMA in December 2003, and the Deficit Reduction Act (DRA) in February
2006. Each of these three legislative packages increased Part B spending,
for example by modifying physician payment rates to avoid reductions, after the
Part B premiums had been set for 2003, 2004, and 2006, respectively.
Additional Details on Other Announced Premiums and Deductibles
Part B Deductible background: The Part B deductible was increased
to $110 in 2005 and was subsequently indexed to the increase in the average cost
of Part B services for aged beneficiaries, as part of the Medicare Modernization
Act. The reason for the increase in the average cost of Part B services
was described above. In 2007, the Part B deductible will be $131, compared
to $124 in 2006, a 5.6 percent increase.
Part A Deductible background: Medicare Part A pays for inpatient
hospital, skilled nursing facility, hospice, and certain home health care. The
$992 deductible, paid by the beneficiary when admitted as a hospital inpatient,
is an increase of $40 from $952 in 2006. The Part A deductible is the
beneficiaryfs only cost for up to 60 days of Medicare-covered inpatient hospital
care in a benefit period. Beneficiaries must pay an additional $248 per
day for days 61 through 90 in 2007, and $496 per day for hospital stays beyond
the 90th day for lifetime reserve days. This compares with $238
and $476 in 2006. The daily coinsurance for the 21st through
100th day in a skilled nursing facility will be $124 in 2007, up from
$119 in 2006.
Part A Premium background: About 99 percent of Medicare
beneficiaries do not pay a premium for Part A services, since they have at least
40 quarters for Medicare-covered employment. However, seniors who have
fewer than 30 quarters of covered employment, and certain people under age 65
with disabilities may obtain Part A coverage by paying a monthly premium set
according to a statutory formula. This premium will be $410 per month for
2007, an increase of $17 from 2006. In addition, seniors with 30 to 39
quarters of covered employment, and certain disabled persons with 30 or more
quarters of covered employment, will pay a premium of $226 in 2007, compared to
$216 in 2006.
The Notices can be found at: http://www.cms.hhs.gov/quarterlyproviderupdates/downloads/July06whatsnew.pdf
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