Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible Beginning January 1, 2011, 68790-68798 [2010-28248]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8042–N]
RIN 0938–AP81
Medicare Program; Medicare Part B
Monthly Actuarial Rates, Premium
Rate, and Annual Deductible
Beginning January 1, 2011
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
monthly actuarial rates for aged (age 65
and over) and disabled (under age 65)
beneficiaries enrolled in Part B of the
Medicare Supplementary Medical
Insurance (SMI) program beginning
January 1, 2011. In addition, this notice
announces the monthly premium for
aged and disabled beneficiaries as well
as the income-related monthly
adjustment amounts to be paid by
beneficiaries with modified adjusted
gross income above certain threshold
amounts. The monthly actuarial rates
for 2011 are $230.70 for aged enrollees
and $266.30 for disabled enrollees. The
standard monthly Part B premium rate
for 2011 is $115.40, which is equal to
50 percent of the monthly actuarial rate
for aged enrollees or approximately 25
percent of the expected average total
cost of Part B coverage for aged
enrollees. (The 2010 standard premium
rate was $110.50.) The Part B deductible
for 2011 is $162.00 for all Part B
beneficiaries. If a beneficiary has to pay
an income-related monthly adjustment,
they may have to pay a total monthly
premium of about 35, 50, 65, or 80
percent of the total cost of Part B
coverage.
DATES: Effective Date: January 1, 2011.
FOR FURTHER INFORMATION CONTACT: M.
Kent Clemens, (410) 786–6391.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
Part B is the voluntary portion of the
Medicare program that pays all or part
of the costs for physicians’ services,
outpatient hospital services, certain
home health services, services furnished
by rural health clinics, ambulatory
surgical centers, comprehensive
outpatient rehabilitation facilities, and
certain other medical and health
services not covered by Medicare Part
A, Hospital Insurance. Medicare Part B
is available to individuals who are
entitled to Medicare Part A, as well as
to U.S. residents who have attained age
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65 and are citizens, and aliens who were
lawfully admitted for permanent
residence and have resided in the
United States for 5 consecutive years.
Part B requires enrollment and payment
of monthly premiums, as described in
42 CFR part 407, subpart B, and part
408, respectively. The difference
between the premiums paid by all
enrollees and total incurred costs is met
by payments from the Supplementary
Medical Insurance Fund.
The Secretary of the Department of
Health and Human Services (the
Secretary) is required by section 1839 of
the Social Security Act (the Act) to
announce the Part B monthly actuarial
rates for aged and disabled beneficiaries
as well as the monthly Part B premium.
The Part B annual deductible is
included because its determination is
directly linked to the aged actuarial rate.
The monthly actuarial rates for aged
and disabled enrollees are used to
determine the correct amount of general
revenue financing per beneficiary each
month. These amounts, according to
actuarial estimates, will equal,
respectively, one-half the expected
average monthly cost of Part B for each
aged enrollee (age 65 or over) and onehalf the expected average monthly cost
of Part B for each disabled enrollee
(under age 65).
The Part B deductible to be paid by
enrollees is also announced. Prior to the
Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA) (Pub. L. 108–173), the Part
B deductible was set in statute. After
setting the 2005 deductible amount at
$110.00, section 629 of the MMA
(amending section 1833(b) of the Act)
requires that the Part B deductible be
indexed beginning in 2006. The
inflation factor to be used each year is
the annual percentage increase in the
Part B actuarial rate for enrollees age 65
and over. Specifically, the 2011 Part B
deductible is calculated by multiplying
the 2010 deductible by the ratio of the
2011 aged actuarial rate over the 2010
aged actuarial rate. The amount
determined under this formula is then
rounded to the nearest $1.
The monthly Part B premium rate to
be paid by aged and disabled enrollees
is also announced. (Although the costs
to the program per disabled enrollee are
different than for the aged, the statute
provides that they pay the same
premium amount.) Beginning with the
passage of section 203 of the Social
Security Amendments of 1972 (Pub. L.
92–603), the premium rate, which was
determined on a fiscal year basis, was
limited to the lesser of the actuarial rate
for aged enrollees, or the current
monthly premium rate increased by the
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same percentage as the most recent
general increase in monthly Title II
social security benefits.
However, the passage of section 124
of the Tax Equity and Fiscal
Responsibility Act of 1982 (TEFRA)
(Pub. L. 97–248) suspended this
premium determination process.
Section 124 of TEFRA changed the
premium basis to 50 percent of the
monthly actuarial rate for aged enrollees
(that is, 25 percent of program costs for
aged enrollees). Section 606 of the
Social Security Amendments of 1983
(Pub. L. 98–21), section 2302 of the
Deficit Reduction Act of 1984 (DEFRA
84) (Pub. L. 98–369), section 9313 of the
Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA 85)
(Pub. L. 9–272), section 4080 of the
Omnibus Budget Reconciliation Act of
1987 (OBRA 87) (Pub. L. 100–203), and
section 6301 of the Omnibus Budget
Reconciliation Act of 1989 (OBRA 89)
(Pub. L. 101–239) extended the
provision that the premium be based on
50 percent of the monthly actuarial rate
for aged enrollees (that is, 25 percent of
program costs for aged enrollees). This
extension expired at the end of 1990.
The premium rate for 1991 through
1995 was legislated by section
1839(e)(1)(B) of the Act, as added by
section 4301 of the Omnibus Budget
Reconciliation Act of 1990 (OBRA 90)
(Pub. L. 101–508). In January 1996, the
premium determination basis would
have reverted to the method established
by the 1972 Social Security Act
Amendments. However, section 13571
of the Omnibus Budget Reconciliation
Act of 1993 (OBRA 93) (Pub. L. 103–66)
changed the premium basis to 50
percent of the monthly actuarial rate for
aged enrollees (that is, 25 percent of
program costs for aged enrollees) for
1996 through 1998.
Section 4571 of the Balanced Budget
Act of 1997 (BBA) (Pub. L. 105–33)
permanently extended the provision
that the premium be based on 50
percent of the monthly actuarial rate for
aged enrollees (that is, 25 percent of
program costs for aged enrollees).
The BBA included a further provision
affecting the calculation of the Part B
actuarial rates and premiums for 1998
through 2003. Section 4611 of the BBA
modified the home health benefit
payable under Part A for individuals
enrolled in Part B. Under this section,
beginning in 1998, expenditures for
home health services not considered
‘‘post-institutional’’ are payable under
Part B rather than Part A. However,
section 4611(e)(1) of the BBA required
that there be a transition from 1998
through 2002 for the aggregate amount
of the expenditures transferred from
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Part A to Part B. Section 4611(e)(2) of
the BBA also provided a specific yearly
proportion for the transferred funds.
The proportions were 1⁄6 for 1998, 1⁄3 for
1999, 1⁄2 for 2000, 2⁄3 for 2001, and 5⁄6
for 2002. For the purpose of determining
the correct amount of financing from
general revenues of the Federal
Government, it was necessary to include
only these transitional amounts in the
monthly actuarial rates for both aged
and disabled enrollees, rather than the
total cost of the home health services
being transferred.
Section 4611(e)(3) of the BBA also
specified, for the purpose of
determining the premium, that the
monthly actuarial rate for enrollees age
65 and over be computed as though the
transition would occur for 1998 through
2003 and that 1⁄7 of the cost be
transferred in 1998, 2⁄7 in 1999, 3⁄7 in
2000, 4⁄7 in 2001, 5⁄7 in 2002, and 6⁄7 in
2003. Therefore, the transition period
for incorporating this home health
transfer into the premium was 7 years
while the transition period for including
these services in the actuarial rate was
6 years.
Section 811 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (Pub. L. 108–
173, also known as the Medicare
Modernization Act, or MMA), which
amended section 1839 of the Act,
requires that, starting on January 1,
2007, the Part B premium a beneficiary
pays each month be based on their
annual income. Specifically, if a
beneficiary’s ‘‘modified adjusted gross
income’’ is greater than the legislated
threshold amounts (for 2011, $85,000
for a beneficiary filing an individual
income tax return, and $170,000 for a
beneficiary filing a joint tax return) the
beneficiary is responsible for a larger
portion of the estimated total cost of
Part B benefit coverage. In addition to
the standard 25 percent premium, these
beneficiaries will now have to pay an
income-related monthly adjustment
amount. The MMA made no change to
the actuarial rate calculation, and the
standard premium, which will continue
to be paid by beneficiaries whose
modified adjusted gross income is
below the applicable thresholds, still
represents 25 percent of the estimated
total cost to the program of Part B
coverage for an aged enrollee. However,
depending on income and tax filing
status, a beneficiary can now be
responsible for 35, 50, 65, or 80 percent
of the estimated total cost of Part B
coverage, rather than 25 percent. The
end result of the higher premium is that
the Part B premium subsidy is reduced
and less general revenue financing is
required for beneficiaries with higher
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income because they are paying a larger
share of the total cost with their
premium. That is, the premium subsidy
continues to be approximately 75
percent for beneficiaries with income
below the applicable income thresholds,
but will be reduced for beneficiaries
with income above these thresholds.
The MMA specified that there be a 5year transition to full implementation of
this provision. However, section 5111 of
the Deficit Reduction Act of 2005 (Pub.
L. 109–171) (DRA) modified the
transition to a 3-year period.
Section 4732(c) of the BBA added
section 1933(c) of the Act, which
required the Secretary to allocate money
from the Part B trust fund to the State
Medicaid programs for the purpose of
providing Medicare Part B premium
assistance from 1998 through 2002 for
the low-income Medicaid beneficiaries
who qualify under section 1933 of the
Act. This allocation, while not a benefit
expenditure, was an expenditure of the
trust fund and was included in
calculating the Part B actuarial rates
through 2002. For 2003 through 2007,
the expenditure was made from the trust
fund because the allocation was
temporarily extended. However,
because the extension occurred after the
financing was determined, the
allocation was not included in the
calculation of the financing rates.
A further provision affecting the
calculation of the Part B premium is
section 1839(f) of the Act, as amended
by section 211 of the Medicare
Catastrophic Coverage Act of 1988
(MCCA 88) (Pub. L. 100–360). (The
Medicare Catastrophic Coverage Repeal
Act of 1989 (Pub. L. 101–234) did not
repeal the revisions to section 1839(f)
made by MCCA 88.) Section 1839(f) of
the Act, referred to as the ‘‘holdharmless’’ provision, provides that if an
individual is entitled to benefits under
section 202 or 223 of the Act (the OldAge and Survivors Insurance Benefit
and the Disability Insurance Benefit,
respectively) and has the Part B
premiums deducted from these benefit
payments, the premium increase will be
reduced, if necessary, to avoid causing
a decrease in the individual’s net
monthly payment. This decrease in
payment occurs if the increase in the
individual’s social security benefit due
to the cost-of-living adjustment under
section 215(i) of the Act is less than the
increase in the premium. Specifically,
the reduction in the premium amount
applies if the individual is entitled to
benefits under section 202 or 223 of the
Act for November and December of a
particular year and the individual’s Part
B premiums for December and the
following January are deducted from the
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respective month’s section 202 or 223
benefits. The ‘‘hold-harmless’’ provision
does not apply to beneficiaries who are
required to pay an income-related
monthly adjustment amount.
A check for benefits under section 202
or 223 of the Act is received in the
month following the month for which
the benefits are due. The Part B
premium that is deducted from a
particular check is the Part B payment
for the month in which the check is
received. Therefore, a benefit check for
November is not received until
December, but has December’s Part B
premium deducted from it.
Generally, if a beneficiary qualifies for
hold-harmless protection, the reduced
premium for the individual for that
January and for each of the succeeding
11 months is the greater of the
following—
• The monthly premium for January
reduced as necessary to make the
December monthly benefits, after the
deduction of the Part B premium for
January, at least equal to the preceding
November’s monthly benefits, after the
deduction of the Part B premium for
December; or
• The monthly premium for that
individual for that December.
In determining the premium
limitations under section 1839(f) of the
Act, the monthly benefits to which an
individual is entitled under section 202
or 223 of the Act do not include
retroactive adjustments or payments and
deductions on account of work. Also,
once the monthly premium amount is
established under section 1839(f) of the
Act, it will not be changed during the
year even if there are retroactive
adjustments or payments and
deductions on account of work that
apply to the individual’s monthly
benefits.
Individuals who have enrolled in Part
B late or who have re-enrolled after the
termination of a coverage period are
subject to an increased premium under
section 1839(b) of the Act. The increase
is a percentage of the premium and is
based on the new premium rate before
any reductions under section 1839(f) of
the Act are made.
II. Provisions of the Notice
A. Notice of Medicare Part B Monthly
Actuarial Rates, Monthly Premium
Rates, and Annual Deductible
The Medicare Part B monthly
actuarial rates applicable for 2011 are
$230.70 for enrollees age 65 and over
and $266.30 for disabled enrollees
under age 65. Section II.B. of this notice
below, presents the actuarial
assumptions and bases from which
these rates are derived. The Part B
standard monthly premium rate for
2011 is $115.40. The Part B annual
deductible for 2011 is $162.00. Listed
below are the 2011 Part B monthly
premium rates to be paid by
beneficiaries who file an individual tax
return (including those who are single,
head of household, qualifying
widow(er) with dependent child, or
married filing separately who lived
apart from their spouse for the entire
taxable year), or a joint tax return.
Beneficiaries who file an individual tax return with
income:
Beneficiaries who file a joint tax return with income:
Less than or equal to $85,000 .....................................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$160,000.
Greater than $160,000 and less than or equal to
$214,000.
Greater than $214,000 .................................................
Income-related
monthly
adjustment
amount
Total monthly
premium
amount
$0.00
46.10
$115.40
161.50
115.30
230.70
184.50
299.90
253.70
369.10
Less than or equal to $170,000 ...................................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$320,000.
Greater than $320,000 and less than or equal to
$428,000.
Greater than $428,000 .................................................
In addition, the monthly premium
rates to be paid by beneficiaries who are
married and lived with their spouse at
any time during the taxable year, but file
a separate tax return from their spouse,
are listed below.
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax
return from their spouse:
Income-related
monthly
adjustment
amount
Total monthly
premium
amount
$0.00
184.50
253.70
$115.40
299.90
369.10
Less than or equal to $85,000 ................................................................................................................................
Greater than $85,000 and less than or equal to $129,000 .....................................................................................
Greater than $129,000 ............................................................................................................................................
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The Part B annual deductible for 2011
is $162.00 for all beneficiaries.
B. Statement of Actuarial Assumptions
and Bases Employed in Determining the
Monthly Actuarial Rates and the
Monthly Premium Rate for Part B
Beginning January 2011
1. Actuarial Status of the Part B Account
in the Supplementary Medical
Insurance Trust Fund
Under the statute, the starting point
for determining the standard monthly
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premium is the amount that would be
necessary to finance Part B on an
incurred basis. This is the amount of
income that would be sufficient to pay
for services furnished during that year
(including associated administrative
costs) even though payment for some of
these services will not be made until
after the close of the year. The portion
of income required to cover benefits not
paid until after the close of the year is
added to the trust fund and used when
needed.
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The premium rates are established
prospectively and are, therefore, subject
to projection error. Additionally,
legislation enacted after the financing
was established, but effective for the
period in which the financing is set,
may affect program costs. As a result,
the income to the program may not
equal incurred costs. Therefore, trust
fund assets must be maintained at a
level that is adequate to cover an
appropriate degree of variation between
actual and projected costs, and the
amount of incurred, but unpaid,
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expenses. Numerous factors determine
what level of assets is appropriate to
cover variation between actual and
projected costs. The three most
important of these factors are: (1) The
difference from prior years between the
actual performance of the program and
estimates made at the time financing
was established; (2) the likelihood and
potential magnitude of expenditure
changes resulting from enactment of
legislation affecting Part B costs in a
year subsequent to the establishment of
financing for that year, and (3) the
expected relationship between incurred
and cash expenditures. These factors are
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analyzed on an ongoing basis, as the
trends can vary over time.
Table 1 summarizes the estimated
actuarial status of the trust fund as of
the end of the financing period for 2009
and 2010.
TABLE 1—ESTIMATED ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SUPPLEMENTARY MEDICAL INSURANCE TRUST
FUND AS OF THE END OF THE FINANCING PERIOD
Assets
(millions)
Financing period ending
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December 31, 2009 .....................................................................................................................
December 31, 2010 .....................................................................................................................
2. Monthly Actuarial Rate for Enrollees
Age 65 and Older
The monthly actuarial rate for
enrollees age 65 and older is one-half of
the sum of monthly amounts for: (1) The
projected cost of benefits; and (2)
administrative expenses for each
enrollee age 65 and older, after
adjustments to this sum to allow for
interest earnings on assets in the trust
fund and an adequate contingency
margin. The contingency margin is an
amount appropriate to provide for
possible variation between actual and
projected costs and to amortize any
surplus assets or unfunded liabilities.
The monthly actuarial rate for
enrollees age 65 and older for 2011 is
determined by first establishing perenrollee cost by type of service from
program data through 2009 and then
projecting these costs for subsequent
years. The projection factors used for
financing periods from January 1, 2008
through December 31, 2011 are shown
in Table 2.
As indicated in Table 3, the projected
monthly rate required to pay for onehalf of the total of benefits and
administrative costs for enrollees age 65
and over for 2011 is $191.24. Based on
current estimates, the assets are not
sufficient to cover the amount of
incurred, but unpaid, expenses and to
provide for a significant degree of
variation between actual and projected
costs. Thus, a positive contingency
margin is needed to increase assets to a
more appropriate level. The monthly
actuarial rate of $230.70 provides an
adjustment of $41.22 for a contingency
margin and ¥$1.76 for interest
earnings.
The size of the contingency margin for
2011 is affected by several factors. The
first, and largest, factor involves the
current law formula for physician fees,
which will result in a reduction in
physician fees of 23 percent in
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December 2010 and is projected to
result in a reduction of about 6.5
percent in January 2011. For each year
from 2003 through November 2010,
Congress has acted to prevent physician
fee reductions from occurring. In
recognition of the strong possibility of
substantial increases in Part B
expenditures that would result from
similar legislation to override the
decreases in physician fees in 2010 and
2011, it is appropriate to maintain a
significantly larger Part B contingency
reserve than would otherwise be
necessary. The asset level projected for
the end of 2010 is not adequate to
accommodate this contingency.
The second factor also has a large
impact on the level of the contingency
reserve. As noted previously, for most
Part B beneficiaries the hold-harmless
provision prevents their benefits under
Section 202 or 223 of the Act from
decreasing as a result of an increase in
the Part B premium. The increase in the
benefits under Section 202 and 223 of
the Act was 0 percent in 2010, and
could be 0 percent for 2012. As a result,
the increase in the Part B premium for
2010 (the $14.10 increase from the 2009
standard monthly premium of $96.40 to
the 2010 standard monthly premium of
$110.50) was paid by only a small
percentage of Part B enrollees.
Similarly, the increase in the Part B
premium for 2011 will be paid by only
a small percentage of Part B enrollees.
(Approximately 27 percent of
beneficiaries are not subject to the holdharmless provision because they are
subject to the income-related additional
premium amount (5 percent); they are
new enrollees during the year (3
percent); or they do not have their Part
B premiums withheld from social
security benefit payments (19 percent),
including those who qualify for both
Medicare and Medicaid and have their
Part B premiums paid on their behalf by
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$75,545
62,065
Liabilities
(millions)
$12,581
14,902
Assets less
liabilities
(millions)
$62,964
47,163
Medicaid (17 percent).) In order for Part
B to be adequately funded in 2011, the
2011 contingency margin has been
increased to account for this situation.
However, the result is a larger-thanusual premium paid by or on behalf of
a minority of Part B enrollees.
Two other, smaller factors affect the
contingency margin for 2011. Starting in
2011, manufacturers and importers of
brand-name prescription drugs will pay
a fee that is allocated to the Part B
account of the SMI trust. For 2011, the
total of these brand-name drug fees will
be $2.5 billion. The contingency margin
has been reduced to account for this
additional revenue.
Another small factor impacting the
contingency margin comes from the
requirement that certain payment
incentives, to encourage the
development and use of health
information technology (HIT) by
Medicare physicians, are to be excluded
from the premium determination. HIT
bonuses or penalties will be directly
offset through transfers with the general
fund of the Treasury. The monthly
actuarial rate includes an adjustment of
¥$1.05 for HIT bonus payments in
2011.
The traditional goal for the Part B
reserve has been that assets minus
liabilities at the end of a year should
represent between 15 and 20 percent of
the following year’s total incurred
expenditures. Within this range, 17
percent has been the normal target. In
view of the strong likelihood of actual
expenditures exceeding estimated
levels, due to the enactment of
legislation after the financing has been
set for a given year, a contingency
reserve ratio in excess of 20 percent of
the following year’s expenditures would
better ensure that the assets of the Part
B account can adequately cover the cost
of incurred-but-not-reported benefits
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together with variations between actual
and estimated cost levels.
The actuarial rate of $230.70 per
month for aged beneficiaries, as
announced in this notice for 2011,
reflects the combined net effect of the
factors described above and the
projection assumptions listed in Table
2.
3. Monthly Actuarial Rate for Disabled
Enrollees
Disabled enrollees are those persons
under age 65 who are enrolled in Part
B because of entitlement to Social
Security disability benefits for more
than 24 months or because of
entitlement to Medicare under the endstage renal disease (ESRD) program.
Projected monthly costs for disabled
enrollees (other than those with ESRD)
are prepared in a fashion parallel to the
projection for the aged using
appropriate actuarial assumptions (see
Table 2). Costs for the ESRD program are
projected differently because of the
different nature of services offered by
the program.
As shown in Table 4, the projected
monthly rate required to pay for onehalf of the total of benefits and
administrative costs for disabled
enrollees for 2011 is $228.22. The
monthly actuarial rate of $266.30 also
provides an adjustment of ¥$2.39 for
interest earnings and $40.47 for a
contingency margin, reflecting the same
factors described above for the aged
actuarial rate. Based on current
estimates, the assets associated with the
disabled Medicare beneficiaries are not
sufficient to cover the amount of
incurred, but unpaid, expenses and to
provide for a significant degree of
variation between actual and projected
costs. Thus, a large contingency margin
is needed to increase assets to an
appropriate level.
The actuarial rate of $266.30 per
month for disabled beneficiaries, as
announced in this notice for 2011,
reflects the combined net effect of the
factors described above for aged
beneficiaries and the projection
assumptions listed in Table 2.
4. Sensitivity Testing
Several factors contribute to
uncertainty about future trends in
medical care costs. It is appropriate to
test the adequacy of the rates using
alternative assumptions. The results of
those assumptions are shown in Table 5.
One set represents increases that are
lower and, therefore, more optimistic
than the current estimate. The other set
represents increases that are higher and,
therefore, more pessimistic than the
current estimate. The values for the
alternative assumptions were
determined from a statistical analysis of
the historical variation in the respective
increase factors.
As indicated in Table 5, the monthly
actuarial rates would result in an excess
of assets over liabilities of $64,247
million by the end of December 2011
under the assumptions used in
preparing this report. This amounts to
28.5 percent of the estimated total
incurred expenditures for the following
year.
Assumptions that are somewhat more
pessimistic (and that therefore test the
adequacy of the assets to accommodate
projection errors) produce a surplus of
$52,472 million by the end of December
2011, which amounts to 21.0 percent of
the estimated total incurred
expenditures for the following year.
Under fairly optimistic assumptions, the
monthly actuarial rates would result in
a surplus of $73,097 million by the end
of December 2011, or 35.8 percent of the
estimated total incurred expenditures
for the following year.
The above analysis indicates that the
premium and general revenue financing
established for 2011, together with
existing Part B account assets would be
adequate to cover estimated Part B costs
for 2011 under current law, even if
actual costs prove to be somewhat
greater than expected.
5. Premium Rates and Deductible
As determined in accordance with
section 1839 of the Act, listed below are
the 2011 Part B monthly premium rates
to be paid by beneficiaries who file an
individual tax return (including those
who are single, head of household,
qualifying widow(er) with dependent
child, or married filing separately who
lived apart from their spouse for the
entire taxable year), or a joint tax return.
Beneficiaries who file an individual tax return with
income:
Beneficiaries who file a joint tax return with income:
Less than or equal to $85,000 .................................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$160,000.
Greater than $160,000 and less than or equal to
$214,000.
Greater than $214,000 .............................................
Less than or equal to $170,000 ...............................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$320,000.
Greater than $320,000 and less than or equal to
$428,000.
Greater than $428,000 .............................................
In addition, the monthly premium
rates to be paid by beneficiaries who are
married and lived with their spouse at
any time during the taxable year, but file
$0.00
46.10
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$115.40
161.50
115.30
230.70
184.50
299.90
253.70
369.10
Income-related
monthly adjustment amount
Less than or equal to $85,000 ........................................................................................................................
Greater than $85,000 and less than or equal to $129,000 .............................................................................
Greater than $129,000 ....................................................................................................................................
VerDate Mar<15>2010
Total monthly
premium amount
a separate tax return from their spouse,
are listed below.
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate
tax return from their spouse:
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
Income-related
monthly adjustment amount
E:\FR\FM\09NON1.SGM
$0.00
184.50
253.70
09NON1
Total monthly
premium amount
$115.40
299.90
369.10
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TABLE 2—PROJECTION FACTORS1 12-MONTH PERIODS ENDING DECEMBER 31 OF 2008–2011
[In percent]
Physicians’ services
Residual 3
Durable
medical
equipment
Calendar year
Fees 2
Aged:
2008
2009
2010
2011
Disabled:
2008
2009
2010
2011
Other
carrier
services 5
Carrier
lab 4
Outpatient
hospital
Home
health
agency
Other
intermediary
services 7
Hospital
lab 6
Managed
care
...............................
...............................
...............................
...............................
0.4
1.6
1.2
¥26.0
3.3
2.4
5.0
9.9
7.1
¥9.0
5.8
2.9
7.3
9.7
6.0
¥0.1
4.2
4.6
3.8
4.5
6.4
10.1
6.6
6.2
12.3
10.4
1.6
¥0.8
4.3
10.1
1.9
¥2.4
6.1
10.2
5.8
¥3.1
5.4
0.3
¥1.8
0.7
...............................
...............................
...............................
...............................
0.4
1.6
1.2
¥26.0
3.2
6.7
5.2
9.9
7.4
¥2.4
5.6
3.2
11.6
23.5
7.9
¥0.2
8.8
8.2
3.9
4.3
7.7
12.3
6.8
6.1
14.3
10.5
3.2
¥0.7
5.9
13.0
1.7
¥2.4
6.9
18.3
9.1
¥0.3
5.9
0.5
¥1.5
0.9
1 All
values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
recognized for payment under the program.
3 Increase in the number of services received per enrollee and greater relative use of more expensive services.
4 Includes services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
5 Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
6 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
7 Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, rehabilitation and psychiatric hospitals, etc.
2 As
TABLE 3—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS
ENDING DECEMBER 31, 2008 THROUGH DECEMBER 31, 2011
Financing periods
CY 2008
Covered services (at level recognized):
Physician fee schedule .............................................................................
Durable medical equipment ......................................................................
Carrier lab 1 ...............................................................................................
Other carrier services 2 .............................................................................
Outpatient hospital ....................................................................................
Home health .............................................................................................
Hospital lab 3 .............................................................................................
Other intermediary services 4 ...................................................................
Managed care ...........................................................................................
CY 2009
CY 2010
CY 2011
78.35
9.95
4.09
19.81
30.70
10.64
2.78
13.30
49.90
79.29
8.80
4.36
20.15
32.86
11.42
2.98
14.25
54.19
83.37
9.21
4.58
20.67
34.63
11.48
3.00
14.91
54.77
67.42
9.43
4.55
21.48
36.60
11.33
2.91
14.37
55.87
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
HIT payment incentives ...................................................................................
219.53
228.30
236.60
223.97
¥5.50
¥30.21
0.00
¥5.50
¥30.42
0.00
¥6.32
¥31.22
0.00
¥6.61
¥27.82
¥1.05
Total benefits .....................................................................................
Administrative expenses ..................................................................................
183.82
2.93
192.37
2.98
199.06
3.44
188.49
2.75
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
186.75
¥3.34
195.35
¥2.80
202.50
¥2.47
191.24
¥1.76
9.29
0.14
20.97
41.22
Monthly actuarial rate ........................................................................
192.70
192.70
221.00
230.70
1 Includes
2 Includes
services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, sup-
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
plies, etc.
3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
4 Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, and rehabilitation and psychiatric hospitals, etc.
TABLE 4—DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED ENROLLEES FOR FINANCING PERIODS ENDING
DECEMBER 31, 2008 THROUGH DECEMBER 31, 2011
Financing Periods
CY 2008
Covered services (at level recognized):
Physician fee schedule .............................................................................
Durable medical equipment ......................................................................
Carrier lab 1 ...............................................................................................
Other carrier services 2 .............................................................................
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CY 2009
78.89
17.59
5.35
24.29
E:\FR\FM\09NON1.SGM
83.25
16.67
6.24
25.64
09NON1
CY 2010
88.30
17.53
6.68
26.52
CY 2011
72.86
18.38
6.76
28.06
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Federal Register / Vol. 75, No. 216 / Tuesday, November 9, 2010 / Notices
TABLE 4—DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED ENROLLEES FOR FINANCING PERIODS ENDING
DECEMBER 31, 2008 THROUGH DECEMBER 31, 2011—Continued
Financing Periods
CY 2008
CY 2009
CY 2010
CY 2011
Outpatient hospital ....................................................................................
Home health .............................................................................................
Hospital lab 3 .............................................................................................
Other intermediary services 4 ...................................................................
Managed care ...........................................................................................
41.73
9.10
4.42
40.34
36.46
45.70
9.81
4.85
42.60
40.55
48.63
10.09
4.91
44.35
40.23
52.43
10.21
4.86
45.12
37.80
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
HIT payment incentives
258.18
275.31
287.23
276.46
¥5.14
¥43.88
0.00
¥5.15
¥45.90
0.00
¥5.92
¥47.26
0.00
¥6.18
¥44.23
¥1.11
Total benefits .....................................................................................
Administrative expenses ..................................................................................
209.15
3.33
224.26
3.47
234.05
3.70
224.94
3.28
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
212.49
¥4.26
227.73
¥3.33
237.75
¥2.91
228.22
¥2.39
1.47
¥0.19
35.56
40.47
Monthly actuarial rate ........................................................................
209.70
224.20
224.20
266.30
1 Includes
services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
2 Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
4 Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, rehabilitation and psychiatric hospitals,
etc.
TABLE 5—ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SMI TRUST FUND UNDER THREE SETS OF ASSUMPTIONS
FOR FINANCING PERIODS THROUGH DECEMBER 31, 2011
As of December 31,
2009
This projection:
Actuarial status (in millions):
Assets ...................................................................................................................................
Liabilities ...............................................................................................................................
Assets less liabilities .....................................................................................................
Ratio (in percent) 1 ................................................................................................................
Low cost projection:
Actuarial status (in millions):
Assets ...................................................................................................................................
Liabilities ...............................................................................................................................
2010
2011
75,545
12,581
62,065
14,902
78,995
14,721
62,964
28.7
47,163
22.1
64,274
28.5
75,545
12,581
62,065
14,379
87,001
13,904
Assets less liabilities .....................................................................................................
Ratio (in percent) 1 ................................................................................................................
High cost projection:
Actuarial status (in millions):
Assets ...................................................................................................................................
Liabilities ...............................................................................................................................
62,964
29.4
47,686
23.9
73,097
35.8
75,545
12,581
62,065
15,436
68,305
15,833
Assets less liabilities .....................................................................................................
Ratio (in percent) 1 ................................................................................................................
62,964
28.0
46,628
20.3
52,472
21.0
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
1 Ratio
of assets less liabilities at the end of the year to the total incurred expenditures during the following year, expressed as a percent.
III. Regulatory Impact Analysis
We have examined the impacts of this
notice as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), the
Regulatory Flexibility Act (RFA)
(September 19, 1980, Pub. L. 96–354),
section 1102(b) of the Social Security
Act, section 202 of the Unfunded
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Jkt 223001
Mandates Reform Act of 1995 (Pub. L.
104–4), Executive Order 13132 on
Federalism (August 4, 1999), and the
Congressional Review Act (5 U.S.C.
804(2)).
Executive Order 12866 directs
agencies to assess all costs and benefits
of available regulatory alternatives and,
if regulation is necessary, to select
PO 00000
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Fmt 4703
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regulatory approaches that maximize
net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity). A regulatory impact
analysis (RIA) must be prepared for
major rules with economically
significant effects ($100 million or more
in any one year).
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We have examined the impact of this
notice as required by Executive Order
12866 (September 1993, Regulatory
Planning and Review) and the
Regulatory Flexibility Act (RFA)
(September 19, 1980, Pub. L. 96–354).
Executive Order 12866 directs agencies
to assess all costs and benefits of
available regulatory alternatives and, if
regulation is necessary, to select
regulatory approaches that maximize
net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity).
The RFA requires agencies to analyze
options for regulatory relief of small
businesses, if a rule has a significant
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and small
governmental jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of $6.7 million to $34.5 million in any
1 year. Individuals and States are not
included in the definition of a small
entity. This notice will not have a
significant impact on a substantial
number of small businesses or other
small entities. Therefore, the Secretary
has determined that this notice will not
have a significant economic impact on
a substantial number of small entities.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 604 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds. We have
determined that this notice will not
have a significant effect on a substantial
number of small entities or on the
operations of a substantial number of
small rural hospitals. Therefore, we are
not preparing analyses for either the
RFA or section 1102(b) of the Act.
Section 202 of the Unfunded
Mandates Reform Act of 1995 (UMRA)
also requires that agencies assess
anticipated costs and benefits before
issuing any rule whose mandates
require spending in any 1 year of $100
million in 1995 dollars, updated
annually for inflation. In 2010, that
threshold is approximately $135
million. This notice has no
consequential effect on State, local, or
Tribal governments. We believe the
private sector costs of this notice fall
below this threshold as well.
Executive Order 13132 establishes
certain requirements that an agency
must meet when it publishes a proposed
rule (and subsequent final rule) that
imposes substantial direct compliance
costs on State and local governments,
preempts State law, or otherwise has
Federalism implications. We have
determined that this notice does not
significantly affect the rights, roles, and
responsibilities of States.
This notice announces that the
monthly actuarial rates applicable for
2011 are $230.70 for enrollees age 65
and over and $266.30 for disabled
enrollees under age 65. It also
announces the 2011 monthly Part B
premium rates to be paid by
beneficiaries who file an individual tax
return (including those who are single,
head of household, qualifying
widow(er) with a dependent child, or
married filing separately who lived
apart from their spouse for the entire
taxable year), or a joint tax return.
Beneficiaries who file an individual tax return with income:
Beneficiaries who file a joint tax return with income:
Less than or equal to $85,000 .....................................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$160,000.
Greater than $160,000 and less than or equal to
$214,000.
Greater than $214,000 .................................................
Income-related
monthly
adjustment
amount
Total monthly
premium
amount
$0.00
46.10
$115.40
161.50
115.30
230.70
184.50
299.90
253.70
369.10
Less than or equal to $170,000 ...................................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$320,000.
Greater than $320,000 and less than or equal to
$428,000.
Greater than $428,000 .................................................
In addition, the monthly premium
rates to be paid by beneficiaries who are
married and lived with their spouse at
any time during the taxable year, but file
a separate tax return from their spouse,
are also announced and listed below.
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax
return from their spouse:
Income-related
monthly
adjustment
amount
Total monthly
premium
amount
$0.00
184.50
253.70
$115.40
299.90
369.10
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
Less than or equal to $85,000 ................................................................................................................................
Greater than $85,000 and less than or equal to $129,000 .....................................................................................
Greater than $129,000 ............................................................................................................................................
The standard Part B premium rate of
$115.40 is $4.90 higher than the
premium for 2010, so there will be
about $700 million of additional costs in
2011 to the approximately 12 million
Part B enrollees who pay the increase in
the Part B premium. Therefore, this
notice is a major rule as defined in 5
U.S.C. 804(2) and is an economically
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15:18 Nov 08, 2010
Jkt 223001
significant rule under Executive Order
12866.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
IV. Waiver of Proposed Notice
The Medicare statute requires the
publication of the monthly actuarial
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Fmt 4703
Sfmt 4703
rates and the Part B premium amounts
in September. We ordinarily use general
notices, rather than notice and comment
rulemaking procedures, to make such
announcements. In doing so, we note
that, under the Administrative
Procedure Act, interpretive rules,
general statements of policy, and rules
of agency organization, procedure, or
E:\FR\FM\09NON1.SGM
09NON1
68798
Federal Register / Vol. 75, No. 216 / Tuesday, November 9, 2010 / Notices
practice are excepted from the
requirements of notice and comment
rulemaking.
We considered publishing a proposed
notice to provide a period for public
comment. However, we may waive that
procedure if we find, for good cause,
that prior notice and comment are
impracticable, unnecessary, or contrary
to the public interest. The statute
establishes the time period for which
the premium rates will apply, and
delaying publication of the Part B
premium rate such that it would not be
published before that time would be
contrary to the public interest.
Moreover, we find that notice and
comment are unnecessary because the
formulas used to calculate the Part B
premiums are statutorily directed.
Therefore, we find good cause to waive
publication of a proposed notice and
solicitation of public comments.
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: October 27, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: October 29, 2010.
Kathleen Sebelius,
Secretary.
[FR Doc. 2010–28248 Filed 11–4–10; 2:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8041–N]
RIN 0938–AP85
Medicare Program; Part A Premiums
for CY 2011 for the Uninsured Aged
and for Certain Disabled Individuals
Who Have Exhausted Other
Entitlement
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This annual notice announces
Medicare’s Hospital Insurance (Part A)
premium for uninsured enrollees in
calendar year (CY) 2011. This premium
is paid by enrollees age 65 and over who
are not otherwise eligible for benefits
under Medicare Part A (hereafter known
as the ‘‘uninsured aged’’) and by certain
disabled individuals who have
exhausted other entitlement. The
monthly Part A premium for the 12
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
SUMMARY:
VerDate Mar<15>2010
15:18 Nov 08, 2010
Jkt 223001
months beginning January 1, 2011 for
these individuals will be $450. The
reduced premium for certain other
individuals as described in this notice
will be $248.
DATES: Effective Date: This notice is
effective on January 1, 2011.
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786–6390.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1818 of the Social Security
Act (the Act) provides for voluntary
enrollment in the Medicare Hospital
Insurance Program (Medicare Part A),
subject to payment of a monthly
premium, of certain persons aged 65
and older who are uninsured under the
Old-Age, Survivors, and Disability
Insurance (OASDI) program or the
Railroad Retirement Act and do not
otherwise meet the requirements for
entitlement to Medicare Part A. (Persons
insured under the OASDI program or
the Railroad Retirement Act and certain
others do not have to pay premiums for
Medicare Part A.)
Section 1818A of the Act provides for
voluntary enrollment in Medicare Part
A, subject to payment of a monthly
premium of certain disabled individuals
who have exhausted other entitlement.
These are individuals who were entitled
to coverage due to a disabling
impairment under section 226(b) of the
Act, but are no longer entitled to
disability benefits and free Medicare
Part A coverage because they have gone
back to work and their earnings exceed
the statutorily defined ‘‘substantial
gainful activity’’ amount (section
223(d)(4) of the Act).
Section 1818A(d)(2) of the Act
specifies that the provisions relating to
premiums under section 1818(d)
through section 1818(f) of the Act for
the aged will also apply to certain
disabled individuals as described above.
Section 1818(d) of the Act requires us
to estimate, on an average per capita
basis, the amount to be paid from the
Federal Hospital Insurance Trust Fund
for services incurred in the following
calendar year (CY) (including the
associated administrative costs) on
behalf of individuals aged 65 and over
who will be entitled to benefits under
Medicare Part A. We must then
determine, during September of each
year, the monthly actuarial rate for the
following year (the per capita amount
estimated above divided by 12) and
publish the dollar amount for the
monthly premium in the succeeding CY.
If the premium is not a multiple of $1,
the premium is rounded to the nearest
multiple of $1 (or, if it is a multiple of
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Sfmt 4703
50 cents but not of $1, it is rounded to
the next highest $1).
Section 13508 of the Omnibus Budget
Reconciliation Act of 1993 (Pub. L. 103–
66) amended section 1818(d) of the Act
to provide for a reduction in the
premium amount for certain voluntary
enrollees (section 1818 and section
1818A of the Act). The reduction
applies to an individual who is eligible
to buy into the Medicare Part A program
and who, as of the last day of the
previous month—
• Had at least 30 quarters of coverage
under Title II of the Act;
• Was married, and had been married
for the previous 1-year period, to a
person who had at least 30 quarters of
coverage;
• Had been married to a person for at
least 1 year at the time of the person’s
death if, at the time of death, the person
had at least 30 quarters of coverage; or
• Is divorced from a person and had
been married to the person for at least
10 years at the time of the divorce if, at
the time of the divorce, the person had
at least 30 quarters of coverage.
Section 1818(d)(4)(A) of the Act
specifies that the premium that these
individuals will pay for CY 2011 will be
equal to the premium for uninsured
aged enrollees reduced by 45 percent.
II. Monthly Premium Amount for CY
2011
The monthly premium for the
uninsured aged and certain disabled
individuals who have exhausted other
entitlement for the 12 months beginning
January 1, 2011, is $450.
The monthly premium for those
individuals subject to the 45 percent
reduction in the monthly premium is
$248.
III. Monthly Premium Rate Calculation
As discussed in section I of this
notice, the monthly Medicare Part A
premium is equal to the estimated
monthly actuarial rate for CY 2011
rounded to the nearest multiple of $1
and equals one-twelfth of the average
per capita amount, which is determined
by projecting the number of Part A
enrollees aged 65 years and over as well
as the benefits and administrative costs
that will be incurred on their behalf.
The steps involved in projecting these
future costs to the Federal Hospital
Insurance Trust Fund are:
• Establishing the present cost of
services furnished to beneficiaries, by
type of service, to serve as a projection
base;
• Projecting increases in payment
amounts for each of the service types;
and
• Projecting increases in
administrative costs.
E:\FR\FM\09NON1.SGM
09NON1
]]>Agencies
[Federal Register Volume 75, Number 216 (Tuesday, November 9, 2010)]
[Notices]
[Pages 68790-68798]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-28248]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8042-N]
RIN 0938-AP81
Medicare Program; Medicare Part B Monthly Actuarial Rates,
Premium Rate, and Annual Deductible Beginning January 1, 2011
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the monthly actuarial rates for aged
(age 65 and over) and disabled (under age 65) beneficiaries enrolled in
Part B of the Medicare Supplementary Medical Insurance (SMI) program
beginning January 1, 2011. In addition, this notice announces the
monthly premium for aged and disabled beneficiaries as well as the
income-related monthly adjustment amounts to be paid by beneficiaries
with modified adjusted gross income above certain threshold amounts.
The monthly actuarial rates for 2011 are $230.70 for aged enrollees and
$266.30 for disabled enrollees. The standard monthly Part B premium
rate for 2011 is $115.40, which is equal to 50 percent of the monthly
actuarial rate for aged enrollees or approximately 25 percent of the
expected average total cost of Part B coverage for aged enrollees. (The
2010 standard premium rate was $110.50.) The Part B deductible for 2011
is $162.00 for all Part B beneficiaries. If a beneficiary has to pay an
income-related monthly adjustment, they may have to pay a total monthly
premium of about 35, 50, 65, or 80 percent of the total cost of Part B
coverage.
DATES: Effective Date: January 1, 2011.
FOR FURTHER INFORMATION CONTACT: M. Kent Clemens, (410) 786-6391.
SUPPLEMENTARY INFORMATION:
I. Background
Part B is the voluntary portion of the Medicare program that pays
all or part of the costs for physicians' services, outpatient hospital
services, certain home health services, services furnished by rural
health clinics, ambulatory surgical centers, comprehensive outpatient
rehabilitation facilities, and certain other medical and health
services not covered by Medicare Part A, Hospital Insurance. Medicare
Part B is available to individuals who are entitled to Medicare Part A,
as well as to U.S. residents who have attained age 65 and are citizens,
and aliens who were lawfully admitted for permanent residence and have
resided in the United States for 5 consecutive years. Part B requires
enrollment and payment of monthly premiums, as described in 42 CFR part
407, subpart B, and part 408, respectively. The difference between the
premiums paid by all enrollees and total incurred costs is met by
payments from the Supplementary Medical Insurance Fund.
The Secretary of the Department of Health and Human Services (the
Secretary) is required by section 1839 of the Social Security Act (the
Act) to announce the Part B monthly actuarial rates for aged and
disabled beneficiaries as well as the monthly Part B premium. The Part
B annual deductible is included because its determination is directly
linked to the aged actuarial rate.
The monthly actuarial rates for aged and disabled enrollees are
used to determine the correct amount of general revenue financing per
beneficiary each month. These amounts, according to actuarial
estimates, will equal, respectively, one-half the expected average
monthly cost of Part B for each aged enrollee (age 65 or over) and one-
half the expected average monthly cost of Part B for each disabled
enrollee (under age 65).
The Part B deductible to be paid by enrollees is also announced.
Prior to the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Pub. L. 108-173), the Part B deductible was set in
statute. After setting the 2005 deductible amount at $110.00, section
629 of the MMA (amending section 1833(b) of the Act) requires that the
Part B deductible be indexed beginning in 2006. The inflation factor to
be used each year is the annual percentage increase in the Part B
actuarial rate for enrollees age 65 and over. Specifically, the 2011
Part B deductible is calculated by multiplying the 2010 deductible by
the ratio of the 2011 aged actuarial rate over the 2010 aged actuarial
rate. The amount determined under this formula is then rounded to the
nearest $1.
The monthly Part B premium rate to be paid by aged and disabled
enrollees is also announced. (Although the costs to the program per
disabled enrollee are different than for the aged, the statute provides
that they pay the same premium amount.) Beginning with the passage of
section 203 of the Social Security Amendments of 1972 (Pub. L. 92-603),
the premium rate, which was determined on a fiscal year basis, was
limited to the lesser of the actuarial rate for aged enrollees, or the
current monthly premium rate increased by the
[[Page 68791]]
same percentage as the most recent general increase in monthly Title II
social security benefits.
However, the passage of section 124 of the Tax Equity and Fiscal
Responsibility Act of 1982 (TEFRA) (Pub. L. 97-248) suspended this
premium determination process. Section 124 of TEFRA changed the premium
basis to 50 percent of the monthly actuarial rate for aged enrollees
(that is, 25 percent of program costs for aged enrollees). Section 606
of the Social Security Amendments of 1983 (Pub. L. 98-21), section 2302
of the Deficit Reduction Act of 1984 (DEFRA 84) (Pub. L. 98-369),
section 9313 of the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA 85) (Pub. L. 9-272), section 4080 of the Omnibus Budget
Reconciliation Act of 1987 (OBRA 87) (Pub. L. 100-203), and section
6301 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) (Pub.
L. 101-239) extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees). This extension expired at
the end of 1990.
The premium rate for 1991 through 1995 was legislated by section
1839(e)(1)(B) of the Act, as added by section 4301 of the Omnibus
Budget Reconciliation Act of 1990 (OBRA 90) (Pub. L. 101-508). In
January 1996, the premium determination basis would have reverted to
the method established by the 1972 Social Security Act Amendments.
However, section 13571 of the Omnibus Budget Reconciliation Act of 1993
(OBRA 93) (Pub. L. 103-66) changed the premium basis to 50 percent of
the monthly actuarial rate for aged enrollees (that is, 25 percent of
program costs for aged enrollees) for 1996 through 1998.
Section 4571 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33) permanently extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees).
The BBA included a further provision affecting the calculation of
the Part B actuarial rates and premiums for 1998 through 2003. Section
4611 of the BBA modified the home health benefit payable under Part A
for individuals enrolled in Part B. Under this section, beginning in
1998, expenditures for home health services not considered ``post-
institutional'' are payable under Part B rather than Part A. However,
section 4611(e)(1) of the BBA required that there be a transition from
1998 through 2002 for the aggregate amount of the expenditures
transferred from Part A to Part B. Section 4611(e)(2) of the BBA also
provided a specific yearly proportion for the transferred funds. The
proportions were \1/6\ for 1998, \1/3\ for 1999, \1/2\ for 2000, \2/3\
for 2001, and \5/6\ for 2002. For the purpose of determining the
correct amount of financing from general revenues of the Federal
Government, it was necessary to include only these transitional amounts
in the monthly actuarial rates for both aged and disabled enrollees,
rather than the total cost of the home health services being
transferred.
Section 4611(e)(3) of the BBA also specified, for the purpose of
determining the premium, that the monthly actuarial rate for enrollees
age 65 and over be computed as though the transition would occur for
1998 through 2003 and that \1/7\ of the cost be transferred in 1998,
\2/7\ in 1999, \3/7\ in 2000, \4/7\ in 2001, \5/7\ in 2002, and \6/7\
in 2003. Therefore, the transition period for incorporating this home
health transfer into the premium was 7 years while the transition
period for including these services in the actuarial rate was 6 years.
Section 811 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Pub. L. 108-173, also known as the Medicare
Modernization Act, or MMA), which amended section 1839 of the Act,
requires that, starting on January 1, 2007, the Part B premium a
beneficiary pays each month be based on their annual income.
Specifically, if a beneficiary's ``modified adjusted gross income'' is
greater than the legislated threshold amounts (for 2011, $85,000 for a
beneficiary filing an individual income tax return, and $170,000 for a
beneficiary filing a joint tax return) the beneficiary is responsible
for a larger portion of the estimated total cost of Part B benefit
coverage. In addition to the standard 25 percent premium, these
beneficiaries will now have to pay an income-related monthly adjustment
amount. The MMA made no change to the actuarial rate calculation, and
the standard premium, which will continue to be paid by beneficiaries
whose modified adjusted gross income is below the applicable
thresholds, still represents 25 percent of the estimated total cost to
the program of Part B coverage for an aged enrollee. However, depending
on income and tax filing status, a beneficiary can now be responsible
for 35, 50, 65, or 80 percent of the estimated total cost of Part B
coverage, rather than 25 percent. The end result of the higher premium
is that the Part B premium subsidy is reduced and less general revenue
financing is required for beneficiaries with higher income because they
are paying a larger share of the total cost with their premium. That
is, the premium subsidy continues to be approximately 75 percent for
beneficiaries with income below the applicable income thresholds, but
will be reduced for beneficiaries with income above these thresholds.
The MMA specified that there be a 5-year transition to full
implementation of this provision. However, section 5111 of the Deficit
Reduction Act of 2005 (Pub. L. 109-171) (DRA) modified the transition
to a 3-year period.
Section 4732(c) of the BBA added section 1933(c) of the Act, which
required the Secretary to allocate money from the Part B trust fund to
the State Medicaid programs for the purpose of providing Medicare Part
B premium assistance from 1998 through 2002 for the low-income Medicaid
beneficiaries who qualify under section 1933 of the Act. This
allocation, while not a benefit expenditure, was an expenditure of the
trust fund and was included in calculating the Part B actuarial rates
through 2002. For 2003 through 2007, the expenditure was made from the
trust fund because the allocation was temporarily extended. However,
because the extension occurred after the financing was determined, the
allocation was not included in the calculation of the financing rates.
A further provision affecting the calculation of the Part B premium
is section 1839(f) of the Act, as amended by section 211 of the
Medicare Catastrophic Coverage Act of 1988 (MCCA 88) (Pub. L. 100-360).
(The Medicare Catastrophic Coverage Repeal Act of 1989 (Pub. L. 101-
234) did not repeal the revisions to section 1839(f) made by MCCA 88.)
Section 1839(f) of the Act, referred to as the ``hold-harmless''
provision, provides that if an individual is entitled to benefits under
section 202 or 223 of the Act (the Old-Age and Survivors Insurance
Benefit and the Disability Insurance Benefit, respectively) and has the
Part B premiums deducted from these benefit payments, the premium
increase will be reduced, if necessary, to avoid causing a decrease in
the individual's net monthly payment. This decrease in payment occurs
if the increase in the individual's social security benefit due to the
cost-of-living adjustment under section 215(i) of the Act is less than
the increase in the premium. Specifically, the reduction in the premium
amount applies if the individual is entitled to benefits under section
202 or 223 of the Act for November and December of a particular year
and the individual's Part B premiums for December and the following
January are deducted from the
[[Page 68792]]
respective month's section 202 or 223 benefits. The ``hold-harmless''
provision does not apply to beneficiaries who are required to pay an
income-related monthly adjustment amount.
A check for benefits under section 202 or 223 of the Act is
received in the month following the month for which the benefits are
due. The Part B premium that is deducted from a particular check is the
Part B payment for the month in which the check is received. Therefore,
a benefit check for November is not received until December, but has
December's Part B premium deducted from it.
Generally, if a beneficiary qualifies for hold-harmless protection,
the reduced premium for the individual for that January and for each of
the succeeding 11 months is the greater of the following--
The monthly premium for January reduced as necessary to
make the December monthly benefits, after the deduction of the Part B
premium for January, at least equal to the preceding November's monthly
benefits, after the deduction of the Part B premium for December; or
The monthly premium for that individual for that December.
In determining the premium limitations under section 1839(f) of the
Act, the monthly benefits to which an individual is entitled under
section 202 or 223 of the Act do not include retroactive adjustments or
payments and deductions on account of work. Also, once the monthly
premium amount is established under section 1839(f) of the Act, it will
not be changed during the year even if there are retroactive
adjustments or payments and deductions on account of work that apply to
the individual's monthly benefits.
Individuals who have enrolled in Part B late or who have re-
enrolled after the termination of a coverage period are subject to an
increased premium under section 1839(b) of the Act. The increase is a
percentage of the premium and is based on the new premium rate before
any reductions under section 1839(f) of the Act are made.
II. Provisions of the Notice
A. Notice of Medicare Part B Monthly Actuarial Rates, Monthly Premium
Rates, and Annual Deductible
The Medicare Part B monthly actuarial rates applicable for 2011 are
$230.70 for enrollees age 65 and over and $266.30 for disabled
enrollees under age 65. Section II.B. of this notice below, presents
the actuarial assumptions and bases from which these rates are derived.
The Part B standard monthly premium rate for 2011 is $115.40. The Part
B annual deductible for 2011 is $162.00. Listed below are the 2011 Part
B monthly premium rates to be paid by beneficiaries who file an
individual tax return (including those who are single, head of
household, qualifying widow(er) with dependent child, or married filing
separately who lived apart from their spouse for the entire taxable
year), or a joint tax return.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file an individual tax Beneficiaries who file a joint monthly Total monthly
return with income: tax return with income: adjustment premium amount
amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000................. Less than or equal to $170,000.. $0.00 $115.40
Greater than $85,000 and less than or equal to Greater than $170,000 and less 46.10 161.50
$107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 115.30 230.70
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 184.50 299.90
to $214,000. than or equal to $428,000.
Greater than $214,000......................... Greater than $428,000........... 253.70 369.10
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by beneficiaries
who are married and lived with their spouse at any time during the
taxable year, but file a separate tax return from their spouse, are
listed below.
------------------------------------------------------------------------
Beneficiaries who are married and lived Income-related
with their spouse at any time during the monthly Total monthly
year, but file a separate tax return adjustment premium amount
from their spouse: amount
------------------------------------------------------------------------
Less than or equal to $85,000........... $0.00 $115.40
Greater than $85,000 and less than or 184.50 299.90
equal to $129,000......................
Greater than $129,000................... 253.70 369.10
------------------------------------------------------------------------
The Part B annual deductible for 2011 is $162.00 for all
beneficiaries.
B. Statement of Actuarial Assumptions and Bases Employed in Determining
the Monthly Actuarial Rates and the Monthly Premium Rate for Part B
Beginning January 2011
1. Actuarial Status of the Part B Account in the Supplementary Medical
Insurance Trust Fund
Under the statute, the starting point for determining the standard
monthly premium is the amount that would be necessary to finance Part B
on an incurred basis. This is the amount of income that would be
sufficient to pay for services furnished during that year (including
associated administrative costs) even though payment for some of these
services will not be made until after the close of the year. The
portion of income required to cover benefits not paid until after the
close of the year is added to the trust fund and used when needed.
The premium rates are established prospectively and are, therefore,
subject to projection error. Additionally, legislation enacted after
the financing was established, but effective for the period in which
the financing is set, may affect program costs. As a result, the income
to the program may not equal incurred costs. Therefore, trust fund
assets must be maintained at a level that is adequate to cover an
appropriate degree of variation between actual and projected costs, and
the amount of incurred, but unpaid,
[[Page 68793]]
expenses. Numerous factors determine what level of assets is
appropriate to cover variation between actual and projected costs. The
three most important of these factors are: (1) The difference from
prior years between the actual performance of the program and estimates
made at the time financing was established; (2) the likelihood and
potential magnitude of expenditure changes resulting from enactment of
legislation affecting Part B costs in a year subsequent to the
establishment of financing for that year, and (3) the expected
relationship between incurred and cash expenditures. These factors are
analyzed on an ongoing basis, as the trends can vary over time.
Table 1 summarizes the estimated actuarial status of the trust fund
as of the end of the financing period for 2009 and 2010.
Table 1--Estimated Actuarial Status of the Part B Account in the Supplementary Medical Insurance Trust Fund as
of the End of the Financing Period
----------------------------------------------------------------------------------------------------------------
Assets less
Financing period ending Assets Liabilities liabilities
(millions) (millions) (millions)
----------------------------------------------------------------------------------------------------------------
December 31, 2009............................................... $75,545 $12,581 $62,964
December 31, 2010............................................... 62,065 14,902 47,163
----------------------------------------------------------------------------------------------------------------
2. Monthly Actuarial Rate for Enrollees Age 65 and Older
The monthly actuarial rate for enrollees age 65 and older is one-
half of the sum of monthly amounts for: (1) The projected cost of
benefits; and (2) administrative expenses for each enrollee age 65 and
older, after adjustments to this sum to allow for interest earnings on
assets in the trust fund and an adequate contingency margin. The
contingency margin is an amount appropriate to provide for possible
variation between actual and projected costs and to amortize any
surplus assets or unfunded liabilities.
The monthly actuarial rate for enrollees age 65 and older for 2011
is determined by first establishing per-enrollee cost by type of
service from program data through 2009 and then projecting these costs
for subsequent years. The projection factors used for financing periods
from January 1, 2008 through December 31, 2011 are shown in Table 2.
As indicated in Table 3, the projected monthly rate required to pay
for one-half of the total of benefits and administrative costs for
enrollees age 65 and over for 2011 is $191.24. Based on current
estimates, the assets are not sufficient to cover the amount of
incurred, but unpaid, expenses and to provide for a significant degree
of variation between actual and projected costs. Thus, a positive
contingency margin is needed to increase assets to a more appropriate
level. The monthly actuarial rate of $230.70 provides an adjustment of
$41.22 for a contingency margin and -$1.76 for interest earnings.
The size of the contingency margin for 2011 is affected by several
factors. The first, and largest, factor involves the current law
formula for physician fees, which will result in a reduction in
physician fees of 23 percent in December 2010 and is projected to
result in a reduction of about 6.5 percent in January 2011. For each
year from 2003 through November 2010, Congress has acted to prevent
physician fee reductions from occurring. In recognition of the strong
possibility of substantial increases in Part B expenditures that would
result from similar legislation to override the decreases in physician
fees in 2010 and 2011, it is appropriate to maintain a significantly
larger Part B contingency reserve than would otherwise be necessary.
The asset level projected for the end of 2010 is not adequate to
accommodate this contingency.
The second factor also has a large impact on the level of the
contingency reserve. As noted previously, for most Part B beneficiaries
the hold-harmless provision prevents their benefits under Section 202
or 223 of the Act from decreasing as a result of an increase in the
Part B premium. The increase in the benefits under Section 202 and 223
of the Act was 0 percent in 2010, and could be 0 percent for 2012. As a
result, the increase in the Part B premium for 2010 (the $14.10
increase from the 2009 standard monthly premium of $96.40 to the 2010
standard monthly premium of $110.50) was paid by only a small
percentage of Part B enrollees. Similarly, the increase in the Part B
premium for 2011 will be paid by only a small percentage of Part B
enrollees. (Approximately 27 percent of beneficiaries are not subject
to the hold-harmless provision because they are subject to the income-
related additional premium amount (5 percent); they are new enrollees
during the year (3 percent); or they do not have their Part B premiums
withheld from social security benefit payments (19 percent), including
those who qualify for both Medicare and Medicaid and have their Part B
premiums paid on their behalf by Medicaid (17 percent).) In order for
Part B to be adequately funded in 2011, the 2011 contingency margin has
been increased to account for this situation. However, the result is a
larger-than-usual premium paid by or on behalf of a minority of Part B
enrollees.
Two other, smaller factors affect the contingency margin for 2011.
Starting in 2011, manufacturers and importers of brand-name
prescription drugs will pay a fee that is allocated to the Part B
account of the SMI trust. For 2011, the total of these brand-name drug
fees will be $2.5 billion. The contingency margin has been reduced to
account for this additional revenue.
Another small factor impacting the contingency margin comes from
the requirement that certain payment incentives, to encourage the
development and use of health information technology (HIT) by Medicare
physicians, are to be excluded from the premium determination. HIT
bonuses or penalties will be directly offset through transfers with the
general fund of the Treasury. The monthly actuarial rate includes an
adjustment of -$1.05 for HIT bonus payments in 2011.
The traditional goal for the Part B reserve has been that assets
minus liabilities at the end of a year should represent between 15 and
20 percent of the following year's total incurred expenditures. Within
this range, 17 percent has been the normal target. In view of the
strong likelihood of actual expenditures exceeding estimated levels,
due to the enactment of legislation after the financing has been set
for a given year, a contingency reserve ratio in excess of 20 percent
of the following year's expenditures would better ensure that the
assets of the Part B account can adequately cover the cost of incurred-
but-not-reported benefits
[[Page 68794]]
together with variations between actual and estimated cost levels.
The actuarial rate of $230.70 per month for aged beneficiaries, as
announced in this notice for 2011, reflects the combined net effect of
the factors described above and the projection assumptions listed in
Table 2.
3. Monthly Actuarial Rate for Disabled Enrollees
Disabled enrollees are those persons under age 65 who are enrolled
in Part B because of entitlement to Social Security disability benefits
for more than 24 months or because of entitlement to Medicare under the
end-stage renal disease (ESRD) program. Projected monthly costs for
disabled enrollees (other than those with ESRD) are prepared in a
fashion parallel to the projection for the aged using appropriate
actuarial assumptions (see Table 2). Costs for the ESRD program are
projected differently because of the different nature of services
offered by the program.
As shown in Table 4, the projected monthly rate required to pay for
one-half of the total of benefits and administrative costs for disabled
enrollees for 2011 is $228.22. The monthly actuarial rate of $266.30
also provides an adjustment of -$2.39 for interest earnings and $40.47
for a contingency margin, reflecting the same factors described above
for the aged actuarial rate. Based on current estimates, the assets
associated with the disabled Medicare beneficiaries are not sufficient
to cover the amount of incurred, but unpaid, expenses and to provide
for a significant degree of variation between actual and projected
costs. Thus, a large contingency margin is needed to increase assets to
an appropriate level.
The actuarial rate of $266.30 per month for disabled beneficiaries,
as announced in this notice for 2011, reflects the combined net effect
of the factors described above for aged beneficiaries and the
projection assumptions listed in Table 2.
4. Sensitivity Testing
Several factors contribute to uncertainty about future trends in
medical care costs. It is appropriate to test the adequacy of the rates
using alternative assumptions. The results of those assumptions are
shown in Table 5. One set represents increases that are lower and,
therefore, more optimistic than the current estimate. The other set
represents increases that are higher and, therefore, more pessimistic
than the current estimate. The values for the alternative assumptions
were determined from a statistical analysis of the historical variation
in the respective increase factors.
As indicated in Table 5, the monthly actuarial rates would result
in an excess of assets over liabilities of $64,247 million by the end
of December 2011 under the assumptions used in preparing this report.
This amounts to 28.5 percent of the estimated total incurred
expenditures for the following year.
Assumptions that are somewhat more pessimistic (and that therefore
test the adequacy of the assets to accommodate projection errors)
produce a surplus of $52,472 million by the end of December 2011, which
amounts to 21.0 percent of the estimated total incurred expenditures
for the following year. Under fairly optimistic assumptions, the
monthly actuarial rates would result in a surplus of $73,097 million by
the end of December 2011, or 35.8 percent of the estimated total
incurred expenditures for the following year.
The above analysis indicates that the premium and general revenue
financing established for 2011, together with existing Part B account
assets would be adequate to cover estimated Part B costs for 2011 under
current law, even if actual costs prove to be somewhat greater than
expected.
5. Premium Rates and Deductible
As determined in accordance with section 1839 of the Act, listed
below are the 2011 Part B monthly premium rates to be paid by
beneficiaries who file an individual tax return (including those who
are single, head of household, qualifying widow(er) with dependent
child, or married filing separately who lived apart from their spouse
for the entire taxable year), or a joint tax return.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file an individual tax Beneficiaries who file a joint monthly Total monthly
return with income: tax return with income: adjustment premium amount
amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000............... Less than or equal to $170,000 $0.00 $115.40
Greater than $85,000 and less than or equal Greater than $170,000 and less 46.10 161.50
to $107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 115.30 230.70
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 184.50 299.90
to $214,000. than or equal to $428,000.
Greater than $214,000....................... Greater than $428,000......... 253.70 369.10
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by beneficiaries
who are married and lived with their spouse at any time during the
taxable year, but file a separate tax return from their spouse, are
listed below.
------------------------------------------------------------------------
Beneficiaries who are married and Income-related
lived with their spouse at any time monthly Total monthly
during the year, but file a separate adjustment premium amount
tax return from their spouse: amount
------------------------------------------------------------------------
Less than or equal to $85,000....... $0.00 $115.40
Greater than $85,000 and less than 184.50 299.90
or equal to $129,000...............
Greater than $129,000............... 253.70 369.10
------------------------------------------------------------------------
[[Page 68795]]
Table 2--Projection Factors\1\ 12-Month Periods Ending December 31 of 2008-2011
[In percent]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Physicians' services Other
------------------------ Durable Carrier carrier Outpatient Home Hospital Other Managed
Calendar year Residual medical lab \4\ services hospital health lab \6\ intermediary care
Fees \2\ \3\ equipment \5\ agency services \7\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Aged:
2008...................... 0.4 3.3 7.1 7.3 4.2 6.4 12.3 4.3 6.1 5.4
2009...................... 1.6 2.4 -9.0 9.7 4.6 10.1 10.4 10.1 10.2 0.3
2010...................... 1.2 5.0 5.8 6.0 3.8 6.6 1.6 1.9 5.8 -1.8
2011...................... -26.0 9.9 2.9 -0.1 4.5 6.2 -0.8 -2.4 -3.1 0.7
Disabled:
2008...................... 0.4 3.2 7.4 11.6 8.8 7.7 14.3 5.9 6.9 5.9
2009...................... 1.6 6.7 -2.4 23.5 8.2 12.3 10.5 13.0 18.3 0.5
2010...................... 1.2 5.2 5.6 7.9 3.9 6.8 3.2 1.7 9.1 -1.5
2011...................... -26.0 9.9 3.2 -0.2 4.3 6.1 -0.7 -2.4 -0.3 0.9
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
\2\ As recognized for payment under the program.
\3\ Increase in the number of services received per enrollee and greater relative use of more expensive services.
\4\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\5\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies,
etc.
\6\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\7\ Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, rehabilitation and psychiatric
hospitals, etc.
Table 3--Derivation of Monthly Actuarial Rate for Enrollees Age 65 and Over for Financing Periods Ending
December 31, 2008 Through December 31, 2011
----------------------------------------------------------------------------------------------------------------
Financing periods
---------------------------------------------------------------
CY 2008 CY 2009 CY 2010 CY 2011
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... 78.35 79.29 83.37 67.42
Durable medical equipment................... 9.95 8.80 9.21 9.43
Carrier lab \1\............................. 4.09 4.36 4.58 4.55
Other carrier services \2\.................. 19.81 20.15 20.67 21.48
Outpatient hospital......................... 30.70 32.86 34.63 36.60
Home health................................. 10.64 11.42 11.48 11.33
Hospital lab \3\............................ 2.78 2.98 3.00 2.91
Other intermediary services \4\............. 13.30 14.25 14.91 14.37
Managed care................................ 49.90 54.19 54.77 55.87
---------------------------------------------------------------
Total services.......................... 219.53 228.30 236.60 223.97
Cost sharing:
Deductible.................................. -5.50 -5.50 -6.32 -6.61
Coinsurance................................. -30.21 -30.42 -31.22 -27.82
HIT payment incentives.......................... 0.00 0.00 0.00 -1.05
---------------------------------------------------------------
Total benefits.......................... 183.82 192.37 199.06 188.49
Administrative expenses......................... 2.93 2.98 3.44 2.75
---------------------------------------------------------------
Incurred expenditures........................... 186.75 195.35 202.50 191.24
Value of interest............................... -3.34 -2.80 -2.47 -1.76
Contingency margin for projection error and to 9.29 0.14 20.97 41.22
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 192.70 192.70 221.00 230.70
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services,
parenteral and enteral drug costs, supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health
centers, and rehabilitation and psychiatric hospitals, etc.
Table 4--Derivation of Monthly Actuarial Rate for Disabled Enrollees for Financing Periods Ending December 31,
2008 Through December 31, 2011
----------------------------------------------------------------------------------------------------------------
Financing Periods
---------------------------------------------------------------
CY 2008 CY 2009 CY 2010 CY 2011
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... 78.89 83.25 88.30 72.86
Durable medical equipment................... 17.59 16.67 17.53 18.38
Carrier lab \1\............................. 5.35 6.24 6.68 6.76
Other carrier services \2\.................. 24.29 25.64 26.52 28.06
[[Page 68796]]
Outpatient hospital......................... 41.73 45.70 48.63 52.43
Home health................................. 9.10 9.81 10.09 10.21
Hospital lab \3\............................ 4.42 4.85 4.91 4.86
Other intermediary services \4\............. 40.34 42.60 44.35 45.12
Managed care................................ 36.46 40.55 40.23 37.80
---------------------------------------------------------------
Total services.......................... 258.18 275.31 287.23 276.46
Cost sharing:
Deductible.................................. -5.14 -5.15 -5.92 -6.18
Coinsurance................................. -43.88 -45.90 -47.26 -44.23
HIT payment incentives 0.00 0.00 0.00 -1.11
---------------------------------------------------------------
Total benefits.......................... 209.15 224.26 234.05 224.94
Administrative expenses......................... 3.33 3.47 3.70 3.28
---------------------------------------------------------------
Incurred expenditures........................... 212.49 227.73 237.75 228.22
Value of interest............................... -4.26 -3.33 -2.91 -2.39
Contingency margin for projection error and to 1.47 -0.19 35.56 40.47
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 209.70 224.20 224.20 266.30
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services,
parenteral and enteral drug costs, supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health
centers, rehabilitation and psychiatric hospitals, etc.
Table 5--Actuarial Status of the Part B Account in the SMI Trust Fund Under Three Sets of Assumptions for
Financing Periods Through December 31, 2011
----------------------------------------------------------------------------------------------------------------
As of December 31, 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
This projection:
Actuarial status (in millions):
Assets...................................................... 75,545 62,065 78,995
Liabilities................................................. 12,581 14,902 14,721
-----------------------------------------------
Assets less liabilities................................. 62,964 47,163 64,274
Ratio (in percent) \1\...................................... 28.7 22.1 28.5
Low cost projection:
Actuarial status (in millions):
Assets...................................................... 75,545 62,065 87,001
Liabilities................................................. 12,581 14,379 13,904
-----------------------------------------------
Assets less liabilities................................. 62,964 47,686 73,097
Ratio (in percent) \1\...................................... 29.4 23.9 35.8
High cost projection:
Actuarial status (in millions):
Assets...................................................... 75,545 62,065 68,305
Liabilities................................................. 12,581 15,436 15,833
-----------------------------------------------
Assets less liabilities................................. 62,964 46,628 52,472
Ratio (in percent) \1\...................................... 28.0 20.3 21.0
----------------------------------------------------------------------------------------------------------------
\1\ Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the
following year, expressed as a percent.
III. Regulatory Impact Analysis
We have examined the impacts of this notice as required by
Executive Order 12866 on Regulatory Planning and Review (September 30,
1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub.
L. 96-354), section 1102(b) of the Social Security Act, section 202 of
the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), Executive
Order 13132 on Federalism (August 4, 1999), and the Congressional
Review Act (5 U.S.C. 804(2)).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any one year).
[[Page 68797]]
We have examined the impact of this notice as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review) and the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354).
Executive Order 12866 directs agencies to assess all costs and benefits
of available regulatory alternatives and, if regulation is necessary,
to select regulatory approaches that maximize net benefits (including
potential economic, environmental, public health and safety effects,
distributive impacts, and equity).
The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule has a significant impact on a
substantial number of small entities. For purposes of the RFA, small
entities include small businesses, nonprofit organizations, and small
governmental jurisdictions. Most hospitals and most other providers and
suppliers are small entities, either by nonprofit status or by having
revenues of $6.7 million to $34.5 million in any 1 year. Individuals
and States are not included in the definition of a small entity. This
notice will not have a significant impact on a substantial number of
small businesses or other small entities. Therefore, the Secretary has
determined that this notice will not have a significant economic impact
on a substantial number of small entities.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds. We have determined that
this notice will not have a significant effect on a substantial number
of small entities or on the operations of a substantial number of small
rural hospitals. Therefore, we are not preparing analyses for either
the RFA or section 1102(b) of the Act.
Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2010, that
threshold is approximately $135 million. This notice has no
consequential effect on State, local, or Tribal governments. We believe
the private sector costs of this notice fall below this threshold as
well.
Executive Order 13132 establishes certain requirements that an
agency must meet when it publishes a proposed rule (and subsequent
final rule) that imposes substantial direct compliance costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. We have determined that this notice does not
significantly affect the rights, roles, and responsibilities of States.
This notice announces that the monthly actuarial rates applicable
for 2011 are $230.70 for enrollees age 65 and over and $266.30 for
disabled enrollees under age 65. It also announces the 2011 monthly
Part B premium rates to be paid by beneficiaries who file an individual
tax return (including those who are single, head of household,
qualifying widow(er) with a dependent child, or married filing
separately who lived apart from their spouse for the entire taxable
year), or a joint tax return.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file an individual tax Beneficiaries who file a joint monthly Total monthly
return with income: tax return with income: adjustment premium amount
amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000................. Less than or equal to $170,000.. $0.00 $115.40
Greater than $85,000 and less than or equal to Greater than $170,000 and less 46.10 161.50
$107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 115.30 230.70
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 184.50 299.90
to $214,000. than or equal to $428,000.
Greater than $214,000......................... Greater than $428,000........... 253.70 369.10
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by beneficiaries
who are married and lived with their spouse at any time during the
taxable year, but file a separate tax return from their spouse, are
also announced and listed below.
------------------------------------------------------------------------
Beneficiaries who are married and lived Income-related
with their spouse at any time during the monthly Total monthly
year, but file a separate tax return adjustment premium amount
from their spouse: amount
------------------------------------------------------------------------
Less than or equal to $85,000........... $0.00 $115.40
Greater than $85,000 and less than or 184.50 299.90
equal to $129,000......................
Greater than $129,000................... 253.70 369.10
------------------------------------------------------------------------
The standard Part B premium rate of $115.40 is $4.90 higher than
the premium for 2010, so there will be about $700 million of additional
costs in 2011 to the approximately 12 million Part B enrollees who pay
the increase in the Part B premium. Therefore, this notice is a major
rule as defined in 5 U.S.C. 804(2) and is an economically significant
rule under Executive Order 12866.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
IV. Waiver of Proposed Notice
The Medicare statute requires the publication of the monthly
actuarial rates and the Part B premium amounts in September. We
ordinarily use general notices, rather than notice and comment
rulemaking procedures, to make such announcements. In doing so, we note
that, under the Administrative Procedure Act, interpretive rules,
general statements of policy, and rules of agency organization,
procedure, or
[[Page 68798]]
practice are excepted from the requirements of notice and comment
rulemaking.
We considered publishing a proposed notice to provide a period for
public comment. However, we may waive that procedure if we find, for
good cause, that prior notice and comment are impracticable,
unnecessary, or contrary to the public interest. The statute
establishes the time period for which the premium rates will apply, and
delaying publication of the Part B premium rate such that it would not
be published before that time would be contrary to the public interest.
Moreover, we find that notice and comment are unnecessary because the
formulas used to calculate the Part B premiums are statutorily
directed. Therefore, we find good cause to waive publication of a
proposed notice and solicitation of public comments.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: October 27, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Approved: October 29, 2010.
Kathleen Sebelius,
Secretary.
[FR Doc. 2010-28248 Filed 11-4-10; 2:15 pm]
BILLING CODE 4120-01-P
