Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible Beginning January 1, 2014, 64943-64951 [2013-25668]
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Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices
Center, (3) University of Alabama,
Birmingham, (4) University of California
at San Diego, (5) University of Miami
Medical School, and (6) University of
Washington in the state of Washington.
This proposed data collection will occur
over 3 years.
The intervention that is part of this
project focuses primarily on HIV
patients who have a detectable viral
load, i.e., their viral load is not as low
as it can be and is not fully controlled.
The intervention components include:
(1) Brief counseling from medical
providers during primary care visits
informed by a behavioral screener
completed by patients; (2) a computerbased intervention (CBI) in which
patients see short videos of HIV medical
providers (not their own providers)
talking about the importance of regular
clinic attendance, adherence to ART,
and safer sex; and (3) one-on-one
counseling from a prevention specialist
if needed.
The following data will be collected
in this project:
• A data manager at each clinic will
electronically transmit patient clinical
data to CDC using a unique study
identification code as the only means of
identifying a patient’s data. The data
files sent to CDC will not contain any
medical record numbers, names, or
social security numbers. The
information will be encrypted and
stored in a secure CDC server. The data
collected from patients include (1) a
behavioral screener self-administered by
patients each time they have a primary
care visit. Patients complete the
screener in the waiting room before
seeing their primary care provider. (2)
CBI assessment items on demographic
factors, clinic attendance, ART status,
ART adherence, and sexual risk
behavior that are completed before
patients see the CBI videos. Patients
with detectable viral loads will be asked
to do the CBI three times, spaced
approximately three months apart.
Patients’ CBI responses are not shared
with their clinic providers. (3) On a
quarterly basis, 50 patients at each
clinic will be asked to complete a brief
exit survey after their medical exam,
asking about topics that the provider
may have discussed with them at their
medical visit (e.g., adherence, clinic
attendance).
• Data collected from primary care
medical providers includes a quarterly
survey asking them to indicate the types
of topics/issues they discussed with
their HIV patients.
There are no costs to respondents
other than their time. The total
annualized burden hours are 3,378.
ESTIMATED ANNUALIZED BURDEN HOURS
Form name
Data manager at clinic ............
Electronic transmittal of clinical variables archived in clinic
databases (no form).
Behavioral screener (patients with detectable or
undetectable VL; paper form).
CBI assessment items for patients with detectable VL (electronic form).
Patient exit survey (electronic form) ......................................
Provider survey (electronic form) ...........................................
Patient .....................................
Patient .....................................
Patient .....................................
Primary care provider .............
LeRoy Richardson,
Chief, Information Collection Review Office,
Office of Scientific Integrity, Office of the
Associate Director for Science Office of the
Director, Centers for Disease Control and
Prevention.
[FR Doc. 2013–25711 Filed 10–29–13; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8055–N]
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RIN 0938–AR58
Medicare Program; Medicare Part B
Monthly Actuarial Rates, Premium
Rate, and Annual Deductible
Beginning January 1, 2014
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
monthly actuarial rates for aged (age 65
SUMMARY:
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and over) and disabled (under age 65)
beneficiaries enrolled in Part B of the
Medicare Supplementary Medical
Insurance (SMI) program beginning
January 1, 2014. 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 2014 are $209.80 for aged enrollees
and $218.90 for disabled enrollees. The
standard monthly Part B premium rate
for all enrollees for 2014 is $104.90,
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 2013
standard premium rate was $104.90.)
The Part B deductible for 2014 is
$147.00 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.
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Number of
responses per
respondent
Number of
respondents
Type of respondent
Sfmt 4703
Average
burden per
response
(hours)
6
4
24
6,315
4
5/60
2,069
3
5/60
1,200
120
1
4
5/60
10/60
Effective Date: January 1, 2014.
M.
Kent Clemens, (410) 786–6391.
SUPPLEMENTARY INFORMATION:
DATES:
FOR FURTHER INFORMATION CONTACT:
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
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enrollees and total incurred costs is met
by transfers from the general fund of the
Treasury.
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 of the expected
average monthly cost of Part B for each
aged enrollee (age 65 or over) and onehalf of 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, 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 2014 Part B
deductible is calculated by multiplying
the 2013 deductible by the ratio of the
2014 aged actuarial rate to the 2013 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
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
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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. 99–272), 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
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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 2014, $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 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-
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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 2013,
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
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 either—
• 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 2014 are
$209.80 for enrollees age 65 and over
and $218.90 for disabled enrollees
under age 65. In section II.B. of this
notice, we present the actuarial
assumptions and bases from which
these rates are derived. The Part B
standard monthly premium rate for all
enrollees for 2014 is $104.90. The Part
B annual deductible for 2014 is $147.00.
The following are the 2014 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 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 .............................................
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Beneficiaries who file an individual tax return with
income:
Income-related
monthly
adjustment
amount
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
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married and lived with their spouse at
any time during the taxable year, but file
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Total
monthly
premium
amount
$0.00
42.00
$104.90
146.90
104.90
209.80
167.80
272.70
230.80
335.70
a separate tax return from their spouse,
are as follows:
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Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate
tax return from their spouse:
Incomerelated
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 ....................................................................................................................................
The Part B annual deductible for 2014
is $147.00 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 2014
Except where noted, the actuarial
assumptions and bases used to
determine the monthly actuarial rates
and the monthly premium rates for Part
B are established by the Office of the
Actuary in the Centers for Medicare &
Medicaid Services. The estimates
underlying these determinations are
prepared by actuaries meeting the
qualification standards and following
the actuarial standards of practice
established by the Actuarial Standards
Board.
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
$0.00
167.80
230.80
Total
monthly
premium
amount
$104.90
272.70
335.70
amount of incurred, but unpaid,
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 2012
and 2013.
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, 2012 .........................................................................................................
December 31, 2013 .........................................................................................................
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 2014 is
determined by first establishing perenrollee cost by type of service from
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program data through 2012 and then
projecting these costs for subsequent
years. The projection factors used for
financing periods from January 1, 2011
through December 31, 2014 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 2014 is $198.42. 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 $209.80 provides an
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Sfmt 4703
Liabilities
(millions)
$66,226
75,828
$18,485
19,209
Assets less
liabilities
(millions)
$47,742
56,619
adjustment of $13.53 for a contingency
margin and ¥$2.15 for interest
earnings.
The size of the contingency margin for
2014 is affected by several factors. The
largest factor involves the current law
formula for physician fees, which is
scheduled to result in a reduction in
physician fees of 23.7 percent in 2014.
For each year from 2003 through 2013,
Congress has acted to prevent physician
fee reductions from occurring. In
recognition of the strong possibility of
substantial increase in Part B
expenditures that would result from
similar legislation to override the
decreases in physician fees in 2014, it
is appropriate to maintain a
significantly larger Part B contingency
reserve than would otherwise be
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necessary. The asset level projected for
the end of 2013 is not adequate to
accommodate this contingency.
Two other, smaller factors affect the
contingency margin for 2014. Starting in
2011, manufacturers and importers of
brand-name prescription drugs have
paid a fee that is allocated to the Part
B account of the SMI trust. For 2014, the
total of these brand-name drug fees is
estimated to be $3 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
¥$3.11 for HIT bonus payments in
2014.
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. To accomplish this goal, a
17 percent reserve ratio has been the
normal target used to calculate the Part
B premium. In view of the strong
likelihood of actual expenditures
exceeding estimated levels, due to the
likelihood of the enactment of
legislation after the financing has been
set for 2014 as a result of the scheduled
2014 physician update, 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
together with variations between actual
and estimated cost levels.
The actuarial rate of $209.80 per
month for aged beneficiaries, as
announced in this notice for 2014,
reflects the combined net effect of the
factors previously described 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 2014 is $234.57. The
monthly actuarial rate of $218.90 also
provides an adjustment of ¥$3.72 for
interest earnings and ¥$11.95 for a
contingency margin, reflecting the same
factors described previously for the aged
actuarial rate. Based on current
estimates, the assets associated with the
disabled Medicare beneficiaries more
than 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 negative contingency
margin is needed to decrease assets to
an appropriate level.
The actuarial rate of $218.90 per
month for disabled beneficiaries, as
announced in this notice for 2014,
reflects the combined net effect of the
factors described previously for aged
beneficiaries and the projection
assumptions listed in Table 2.
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 $71,024
million by the end of December 2014
under the cost growth rate assumptions
used in preparing this report and
assuming that the provisions of current
law are fully implemented. This
amounts to 27.5 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
$36,697 million by the end of December
2014 under current law, which amounts
to 12.8 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 $96,302
million by the end of December 2014, or
41.5 percent of the estimated total
incurred expenditures for the following
year.
The previous analysis indicates that
the premium and general revenue
financing established for 2014, together
with existing Part B account assets
would be adequate to cover estimated
Part B costs for 2014 under current law,
even if actual costs prove to be
somewhat greater than expected.
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 cost growth rate
assumptions. The results of those
assumptions are shown in Table 5. One
set represents increases that are lower
and, therefore, more optimistic than the
As determined in accordance with
section 1839 of the Act, listed are the
2013 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.
5. Premium Rates and Deductible
emcdonald on DSK67QTVN1PROD with NOTICES
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.
Income-related
monthly
adjustment
amount
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.
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Total
monthly premium
amount
$0.00
42.00
104.90
209.80
167.80
30OCN1
$104.90
146.90
272.70
64948
Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices
Beneficiaries who file an individual tax return with
income:
Greater than $214,000 .............................................
Income-related
monthly
adjustment
amount
Beneficiaries who file a joint tax return with income:
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
Total
monthly premium
amount
230.80
335.70
a separate tax return from their spouse,
are listed as follows:
Income-related
monthly
adjustment
amount
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate
tax return from their spouse:
Less than or equal to $85,000 ........................................................................................................................
Greater than $85,000 and less than or equal to $129,000 .............................................................................
Greater than $129,000 ....................................................................................................................................
Total
monthly premium
amount
$0.00
167.80
230.80
$104.90
272.70
335.70
TABLE 2—PROJECTION FACTORS 1 12–MONTH PERIODS ENDING DECEMBER 31 OF 2011–2014
[In percent]
Calendar year
Physicians’
services
Fees 2
Aged:
2011
2012
2013
2014
Disabled:
2011
2012
2013
2014
Residual 3
Durable
medical
equipment
Carrier lab 4
Other
carrier
services 5
Outpatient
hospital
Home
health
agency
Hospital
lab 6
Other intermediary
services 7
Managed
care
...........
...........
...........
...........
0.9
¥1.1
¥0.1
¥24.1
2.2
1.1
¥0.3
9.0
¥3.7
0.4
¥5.2
¥4.2
¥2.8
6.4
¥0.5
3.9
4.6
3.3
3.2
4.0
8.0
6.8
1.8
6.0
¥4.9
¥2.1
1.7
0.7
5.0
3.9
¥2.7
3.6
3.1
4.6
¥3.8
¥10.4
1.0
2.3
1.8
3.2
...........
...........
...........
...........
0.9
¥1.1
¥0.1
¥24.1
1.4
3.4
0.9
9.1
¥2.7
2.0
¥4.5
¥4.1
3.1
25.8
5.3
4.1
2.7
3.9
3.1
4.3
7.9
9.2
2.7
6.1
¥3.0
¥1.5
3.7
1.6
6.4
5.8
¥2.5
3.6
1.4
4.8
¥3.8
¥1.6
2.0
1.2
3.6
3.4
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.
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
3 Increase
TABLE 3—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS
ENDING DECEMBER 31, 2011 THROUGH DECEMBER 31, 2014
[In dollars]
Financing periods
CY 2011
emcdonald on DSK67QTVN1PROD with NOTICES
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 2012
CY 2013
CY 2014
82.06
8.47
4.14
24.90
35.19
11.33
3.81
14.49
57.17
80.19
8.31
4.30
22.12
36.74
10.84
3.87
14.81
61.71
78.05
7.70
4.18
22.31
36.57
10.77
3.68
13.92
66.03
64.13
7.32
4.31
23.01
38.47
10.78
3.78
12.37
69.31
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
Sequestration of benefits .................................................................................
HIT payment incentives ...................................................................................
238.55
242.89
243.22
233.47
¥6.19
¥31.04
0.00
¥0.44
¥4.84
¥31.55
0.00
¥1.52
¥5.63
¥28.77
¥3.15
¥1.88
¥5.62
¥25.06
¥4.05
¥3.11
Total benefits .....................................................................................
Administrative expenses ..................................................................................
200.88
3.28
204.98
3.45
203.79
3.20
195.62
2.80
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
204.16
¥2.53
208.43
¥2.21
206.99
¥1.97
198.42
¥2.15
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TABLE 3—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS
ENDING DECEMBER 31, 2011 THROUGH DECEMBER 31, 2014—Continued
[In dollars]
Financing periods
CY 2011
CY 2012
CY 2013
CY 2014
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
29.06
¥6.42
4.78
13.53
Monthly actuarial rate ........................................................................
230.70
199.80
209.80
209.80
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-
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, rehabilitation and psychiatric hospitals,
etc.
TABLE 4—DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED ENROLLEES FOR FINANCING PERIODS ENDING
DECEMBER 31, 2011 THROUGH DECEMBER 31, 2014
[In dollars]
Financing periods
CY 2011
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 2012
CY 2013
CY 2014
86.54
16.09
5.07
26.09
49.20
10.01
5.36
40.98
43.49
86.02
15.91
6.15
26.13
52.28
9.58
5.50
42.35
49.14
84.59
14.77
6.30
26.22
52.24
9.67
5.22
42.00
54.95
69.61
14.05
6.50
27.06
55.00
9.74
5.37
38.74
57.86
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
Sequestration of benefits .................................................................................
HIT payment incentives ...................................................................................
282.82
293.05
295.96
283.93
¥5.81
¥45.97
0.00
¥0.41
¥4.65
¥46.82
0.00
¥1.57
¥5.29
¥43.64
¥3.72
¥1.99
¥5.28
¥39.17
¥4.79
¥3.32
Total benefits .....................................................................................
Administrative expenses ..................................................................................
230.63
3.76
240.01
4.03
241.31
3.76
231.37
3.20
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
234.39
¥5.02
244.05
¥3.86
245.07
¥2.94
234.57
¥3.72
36.93
¥47.69
¥6.63
¥11.95
Monthly actuarial rate ........................................................................
266.30
192.50
235.50
218.90
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, 2014
emcdonald on DSK67QTVN1PROD with NOTICES
As of December 31,
2012
This projection:
Actuarial status (in $ millions):.
Assets .............................................................................................................................
Liabilities .........................................................................................................................
Assets less liabilities .......................................................................................................
Ratio (in percent) 1 .................................................................................................................
Low cost projection:
Actuarial status (in $ millions):.
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2013
2014
66,226
18,485
75,828
19,209
89,871
18,847
47,742
19.4
56,619
23.3
71,024
27.5
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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, 2014—Continued
As of December 31,
2012
Assets .............................................................................................................................
Liabilities .........................................................................................................................
2013
2014
66,226
18,485
84,654
18,228
114,651
18,349
Assets less liabilities .......................................................................................................
Ratio (in percent) 1 ..........................................................................................................
High cost projection:
Actuarial status (in $ millions):.
Assets .............................................................................................................................
Liabilities .........................................................................................................................
47,742
20.3
66,426
29.2
96,302
41.5
66,226
18,485
62,815
20,654
56,535
19,838
Assets less liabilities .......................................................................................................
47,742
42,161
36,697
Ratio (in percent) 1 ..........................................................................................................
18.4
15.8
12.8
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.
These estimates are based on the assumption that all provisions of current law will be implemented in full, including the approximately 24.0-percent reduction in Medicare payment rates to physicians required by the statutory ‘‘sustainable growth rate’’ formula.
III. Regulatory Impact Analysis
A. Statement of Need
Section 1839 of the Act requires us to
annually announce (that is by
September 30th of each year) the Part B
monthly actuarial rates for aged and
disabled beneficiaries as well as the
monthly Part B premium. We also
announce the Part B annual deductible
because its determination is directly
linked to the aged actuarial rate.
B. Overall Impact
We have examined the impacts of this
rule as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), Executive
Order 13563 on Improving Regulation
and Regulatory Review (January 18,
2011), 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
(March 22, 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 Orders 12866 and 13563
direct 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
notices with economically significant
effects ($100 million or more in any 1
year). For 2014, the standard Part B
premium rate, the Part B income-related
premium rates, and the Part B
deductible are the same as the
respective amounts for 2013. As a result,
this notice is not economically
significant under section 3(f)(1) of
Executive Order 12866 and thus, is not
a major action under the Congressional
Review Act. In accordance with the
provisions of Executive Order 12866,
this notice was reviewed by the Office
of Management and Budget.
As discussed earlier, this notice
announces that the monthly actuarial
rates applicable for 2014 are $209.80 for
enrollees age 65 and over and $218.90
for disabled enrollees under age 65. It
also announces the 2014 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 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 .............................................
emcdonald on DSK67QTVN1PROD with NOTICES
Beneficiaries who file an individual tax return with
income:
Incomerelated
monthly
adjustment
amount
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
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any time during the taxable year, but file
a separate tax return from their spouse,
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Total
monthly
premium
amount
$0.00
42.00
$104.90
146.90
104.90
209.80
167.80
272.70
230.80
335.70
are also announced and listed in the
following chart:
E:\FR\FM\30OCN1.SGM
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Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices
Incomerelated
monthly
adjustment
amount
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate
tax return from their spouse:
emcdonald on DSK67QTVN1PROD with NOTICES
Less than or equal to $85,000 ........................................................................................................................
Greater than $85,000 and less than or equal to $129,000 .............................................................................
Greater than $129,000 ....................................................................................................................................
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 less than $7.0 million to $34.5
million in any 1 year. Individuals and
States are not included in the definition
of a small entity. This notice announces
the monthly actuarial rates for aged (age
65 and over) and disabled (under 65)
beneficiaries enrolled in Part B of the
Medicare SMI program beginning
January 1, 2014. Also, 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. As a result, we are not
preparing an analysis for the RFA
because 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. As we discussed
previously, we are not preparing an
analysis for section 1102(b) of the Act
because the Secretary has determined
that this notice will not have a
significant effect on a substantial
number of small rural hospitals
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 2013, that
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16:58 Oct 29, 2013
Jkt 232001
threshold is approximately $141
million. This notice does not impose
mandates that will have a consequential
effect of $142 million or more on State,
local, or tribal governments or on the
private sector.
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.
For 2014, the standard Part B
premium rate, the Part B income-related
premium rates, and the Part B
deductible are the same as the
respective amounts for 2013. Therefore,
this notice is not a major rule as defined
in 5 U.S.C. 804(2) and is not 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
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.
PO 00000
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Total
monthly
premium
amount
$0.00
167.80
230.80
$104.90
272.70
335.70
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. 93.774, Medicare—
Supplementary Medical Insurance Program)
Dated: September 20, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: October 18, 2013
Kathleen Sebelius,
Secretary, Department of Health and Human
Services.
[FR Doc. 2013–25668 Filed 10–28–13; 11:15 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8054–N]
RIN 0938–AR57
Medicare Program; Part A Premiums
for CY 2014 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) 2014. 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
months beginning January 1, 2014, for
these individuals will be $426. The
premium for certain other individuals as
described in this notice will be $234.
DATES: Effective Date: This notice is
effective on January 1, 2014.
SUMMARY:
E:\FR\FM\30OCN1.SGM
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]]>Agencies
[Federal Register Volume 78, Number 210 (Wednesday, October 30, 2013)]
[Notices]
[Pages 64943-64951]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-25668]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8055-N]
RIN 0938-AR58
Medicare Program; Medicare Part B Monthly Actuarial Rates,
Premium Rate, and Annual Deductible Beginning January 1, 2014
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, 2014. 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 2014 are $209.80 for aged enrollees and
$218.90 for disabled enrollees. The standard monthly Part B premium
rate for all enrollees for 2014 is $104.90, 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 2013 standard premium rate was
$104.90.) The Part B deductible for 2014 is $147.00 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, 2014.
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
[[Page 64944]]
enrollees and total incurred costs is met by transfers from the general
fund of the Treasury.
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 of the expected average
monthly cost of Part B for each aged enrollee (age 65 or over) and one-
half of 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, 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 2014
Part B deductible is calculated by multiplying the 2013 deductible by
the ratio of the 2014 aged actuarial rate to the 2013 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 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. 99-272), 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 2014, $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 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-
[[Page 64945]]
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 2013, 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 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 either--
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 2014 are
$209.80 for enrollees age 65 and over and $218.90 for disabled
enrollees under age 65. In section II.B. of this notice, we present the
actuarial assumptions and bases from which these rates are derived. The
Part B standard monthly premium rate for all enrollees for 2014 is
$104.90. The Part B annual deductible for 2014 is $147.00. The
following are the 2014 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 $104.90
Greater than $85,000 and less than or equal Greater than $170,000 and less 42.00 146.90
to $107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 104.90 209.80
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 167.80 272.70
to $214,000. than or equal to $428,000.
Greater than $214,000....................... Greater than $428,000......... 230.80 335.70
----------------------------------------------------------------------------------------------------------------
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 as
follows:
[[Page 64946]]
------------------------------------------------------------------------
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 $104.90
Greater than $85,000 and less than 167.80 272.70
or equal to $129,000...............
Greater than $129,000............... 230.80 335.70
------------------------------------------------------------------------
The Part B annual deductible for 2014 is $147.00 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 2014
Except where noted, the actuarial assumptions and bases used to
determine the monthly actuarial rates and the monthly premium rates for
Part B are established by the Office of the Actuary in the Centers for
Medicare & Medicaid Services. The estimates underlying these
determinations are prepared by actuaries meeting the qualification
standards and following the actuarial standards of practice established
by the Actuarial Standards Board.
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, 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 2012 and 2013.
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, 2012......................................... $66,226 $18,485 $47,742
December 31, 2013......................................... 75,828 19,209 56,619
----------------------------------------------------------------------------------------------------------------
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 2014
is determined by first establishing per-enrollee cost by type of
service from program data through 2012 and then projecting these costs
for subsequent years. The projection factors used for financing periods
from January 1, 2011 through December 31, 2014 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 2014 is $198.42. 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 $209.80 provides an adjustment of
$13.53 for a contingency margin and -$2.15 for interest earnings.
The size of the contingency margin for 2014 is affected by several
factors. The largest factor involves the current law formula for
physician fees, which is scheduled to result in a reduction in
physician fees of 23.7 percent in 2014. For each year from 2003 through
2013, Congress has acted to prevent physician fee reductions from
occurring. In recognition of the strong possibility of substantial
increase in Part B expenditures that would result from similar
legislation to override the decreases in physician fees in 2014, it is
appropriate to maintain a significantly larger Part B contingency
reserve than would otherwise be
[[Page 64947]]
necessary. The asset level projected for the end of 2013 is not
adequate to accommodate this contingency.
Two other, smaller factors affect the contingency margin for 2014.
Starting in 2011, manufacturers and importers of brand-name
prescription drugs have paid a fee that is allocated to the Part B
account of the SMI trust. For 2014, the total of these brand-name drug
fees is estimated to be $3 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 -$3.11 for HIT bonus payments in 2014.
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. To
accomplish this goal, a 17 percent reserve ratio has been the normal
target used to calculate the Part B premium. In view of the strong
likelihood of actual expenditures exceeding estimated levels, due to
the likelihood of the enactment of legislation after the financing has
been set for 2014 as a result of the scheduled 2014 physician update, 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 together with variations between actual and estimated cost
levels.
The actuarial rate of $209.80 per month for aged beneficiaries, as
announced in this notice for 2014, reflects the combined net effect of
the factors previously described 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 2014 is $234.57. The monthly actuarial rate of $218.90
also provides an adjustment of -$3.72 for interest earnings and -$11.95
for a contingency margin, reflecting the same factors described
previously for the aged actuarial rate. Based on current estimates, the
assets associated with the disabled Medicare beneficiaries more than
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 negative contingency margin is needed to
decrease assets to an appropriate level.
The actuarial rate of $218.90 per month for disabled beneficiaries,
as announced in this notice for 2014, reflects the combined net effect
of the factors described previously 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 cost growth rate 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 $71,024 million by the end
of December 2014 under the cost growth rate assumptions used in
preparing this report and assuming that the provisions of current law
are fully implemented. This amounts to 27.5 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 $36,697 million by the end of December 2014 under
current law, which amounts to 12.8 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
$96,302 million by the end of December 2014, or 41.5 percent of the
estimated total incurred expenditures for the following year.
The previous analysis indicates that the premium and general
revenue financing established for 2014, together with existing Part B
account assets would be adequate to cover estimated Part B costs for
2014 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
are the 2013 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 $104.90
Greater than $85,000 and less than or equal Greater than $170,000 and less 42.00 146.90
to $107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 104.90 209.80
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 167.80 272.70
to $214,000. than or equal to $428,000.
[[Page 64948]]
Greater than $214,000....................... Greater than $428,000......... 230.80 335.70
----------------------------------------------------------------------------------------------------------------
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 as follows:
------------------------------------------------------------------------
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 $104.90
Greater than $85,000 and less than 167.80 272.70
or equal to $129,000...............
Greater than $129,000............... 230.80 335.70
------------------------------------------------------------------------
Table 2--Projection Factors \1\ 12-Month Periods Ending December 31 OF 2011-2014
[In percent]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Physicians' services Other
-------------------------- Durable Carrier lab carrier Outpatient Home health Hospital Other Managed
Calendar year Residual medical \4\ services hospital agency lab \6\ intermediary care
Fees \2\ \3\ equipment \5\ services \7\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Aged:
2011..................................................... 0.9 2.2 -3.7 -2.8 4.6 8.0 -4.9 5.0 3.1 1.0
2012..................................................... -1.1 1.1 0.4 6.4 3.3 6.8 -2.1 3.9 4.6 2.3
2013..................................................... -0.1 -0.3 -5.2 -0.5 3.2 1.8 1.7 -2.7 -3.8 1.8
2014..................................................... -24.1 9.0 -4.2 3.9 4.0 6.0 0.7 3.6 -10.4 3.2
Disabled:
2011..................................................... 0.9 1.4 -2.7 3.1 2.7 7.9 -3.0 6.4 1.4 2.0
2012..................................................... -1.1 3.4 2.0 25.8 3.9 9.2 -1.5 5.8 4.8 1.2
2013..................................................... -0.1 0.9 -4.5 5.3 3.1 2.7 3.7 -2.5 -3.8 3.6
2014..................................................... -24.1 9.1 -4.1 4.1 4.3 6.1 1.6 3.6 -1.6 3.4
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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, 2011 Through December 31, 2014
[In dollars]
----------------------------------------------------------------------------------------------------------------
Financing periods
---------------------------------------------------------------
CY 2011 CY 2012 CY 2013 CY 2014
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... 82.06 80.19 78.05 64.13
Durable medical equipment................... 8.47 8.31 7.70 7.32
Carrier lab \1\............................. 4.14 4.30 4.18 4.31
Other carrier services \2\.................. 24.90 22.12 22.31 23.01
Outpatient hospital......................... 35.19 36.74 36.57 38.47
Home health................................. 11.33 10.84 10.77 10.78
Hospital lab \3\............................ 3.81 3.87 3.68 3.78
Other intermediary services \4\............. 14.49 14.81 13.92 12.37
Managed care................................ 57.17 61.71 66.03 69.31
---------------------------------------------------------------
Total services.......................... 238.55 242.89 243.22 233.47
Cost sharing:
Deductible.................................. -6.19 -4.84 -5.63 -5.62
Coinsurance................................. -31.04 -31.55 -28.77 -25.06
Sequestration of benefits....................... 0.00 0.00 -3.15 -4.05
HIT payment incentives.......................... -0.44 -1.52 -1.88 -3.11
---------------------------------------------------------------
Total benefits.......................... 200.88 204.98 203.79 195.62
Administrative expenses......................... 3.28 3.45 3.20 2.80
---------------------------------------------------------------
Incurred expenditures........................... 204.16 208.43 206.99 198.42
Value of interest............................... -2.53 -2.21 -1.97 -2.15
[[Page 64949]]
Contingency margin for projection error and to 29.06 -6.42 4.78 13.53
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 230.70 199.80 209.80 209.80
----------------------------------------------------------------------------------------------------------------
\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 4--Derivation of Monthly Actuarial Rate for Disabled Enrollees for Financing Periods Ending December 31,
2011 Through December 31, 2014
[In dollars]
----------------------------------------------------------------------------------------------------------------
Financing periods
---------------------------------------------------------------
CY 2011 CY 2012 CY 2013 CY 2014
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... 86.54 86.02 84.59 69.61
Durable medical equipment................... 16.09 15.91 14.77 14.05
Carrier lab \1\............................. 5.07 6.15 6.30 6.50
Other carrier services \2\.................. 26.09 26.13 26.22 27.06
Outpatient hospital......................... 49.20 52.28 52.24 55.00
Home health................................. 10.01 9.58 9.67 9.74
Hospital lab \3\............................ 5.36 5.50 5.22 5.37
Other intermediary services \4\............. 40.98 42.35 42.00 38.74
Managed care................................ 43.49 49.14 54.95 57.86
---------------------------------------------------------------
Total services.......................... 282.82 293.05 295.96 283.93
Cost sharing:
Deductible.................................. -5.81 -4.65 -5.29 -5.28
Coinsurance................................. -45.97 -46.82 -43.64 -39.17
Sequestration of benefits....................... 0.00 0.00 -3.72 -4.79
HIT payment incentives.......................... -0.41 -1.57 -1.99 -3.32
---------------------------------------------------------------
Total benefits.......................... 230.63 240.01 241.31 231.37
Administrative expenses......................... 3.76 4.03 3.76 3.20
---------------------------------------------------------------
Incurred expenditures........................... 234.39 244.05 245.07 234.57
Value of interest............................... -5.02 -3.86 -2.94 -3.72
Contingency margin for projection error and to 36.93 -47.69 -6.63 -11.95
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 266.30 192.50 235.50 218.90
----------------------------------------------------------------------------------------------------------------
\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, 2014
----------------------------------------------------------------------------------------------------------------
As of December 31, 2012 2013 2014
----------------------------------------------------------------------------------------------------------------
This projection:
Actuarial status (in $ millions):...........................
Assets...................................................... 66,226 75,828 89,871
Liabilities................................................. 18,485 19,209 18,847
-----------------------------------------------
Assets less liabilities..................................... 47,742 56,619 71,024
Ratio (in percent) \1\.......................................... 19.4 23.3 27.5
Low cost projection:
Actuarial status (in $ millions):...........................
[[Page 64950]]
Assets...................................................... 66,226 84,654 114,651
Liabilities................................................. 18,485 18,228 18,349
-----------------------------------------------
Assets less liabilities..................................... 47,742 66,426 96,302
Ratio (in percent) \1\...................................... 20.3 29.2 41.5
High cost projection:
Actuarial status (in $ millions):...........................
Assets...................................................... 66,226 62,815 56,535
Liabilities................................................. 18,485 20,654 19,838
-----------------------------------------------
Assets less liabilities..................................... 47,742 42,161 36,697
-----------------------------------------------
Ratio (in percent) \1\...................................... 18.4 15.8 12.8
----------------------------------------------------------------------------------------------------------------
\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. These estimates are based on the assumption that all provisions of
current law will be implemented in full, including the approximately 24.0-percent reduction in Medicare
payment rates to physicians required by the statutory ``sustainable growth rate'' formula.
III. Regulatory Impact Analysis
A. Statement of Need
Section 1839 of the Act requires us to annually announce (that is
by September 30th of each year) the Part B monthly actuarial rates for
aged and disabled beneficiaries as well as the monthly Part B premium.
We also announce the Part B annual deductible because its determination
is directly linked to the aged actuarial rate.
B. Overall Impact
We have examined the impacts of this rule as required by Executive
Order 12866 on Regulatory Planning and Review (September 30, 1993),
Executive Order 13563 on Improving Regulation and Regulatory Review
(January 18, 2011), 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 (March 22,
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 Orders 12866 and 13563 direct 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 notices
with economically significant effects ($100 million or more in any 1
year). For 2014, the standard Part B premium rate, the Part B income-
related premium rates, and the Part B deductible are the same as the
respective amounts for 2013. As a result, this notice is not
economically significant under section 3(f)(1) of Executive Order 12866
and thus, is not a major action under the Congressional Review Act. In
accordance with the provisions of Executive Order 12866, this notice
was reviewed by the Office of Management and Budget.
As discussed earlier, this notice announces that the monthly
actuarial rates applicable for 2014 are $209.80 for enrollees age 65
and over and $218.90 for disabled enrollees under age 65. It also
announces the 2014 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 $104.90
Greater than $85,000 and less than or equal Greater than $170,000 and less 42.00 146.90
to $107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 104.90 209.80
to $160,000. than or equal to $320,000.
Greater than $160,000 and less than or equal Greater than $320,000 and less 167.80 272.70
to $214,000. than or equal to $428,000.
Greater than $214,000....................... Greater than $428,000......... 230.80 335.70
----------------------------------------------------------------------------------------------------------------
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 in the following chart:
[[Page 64951]]
------------------------------------------------------------------------
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 $104.90
Greater than $85,000 and less than 167.80 272.70
or equal to $129,000...............
Greater than $129,000............... 230.80 335.70
------------------------------------------------------------------------
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 less than $7.0 million to $34.5 million in any 1 year.
Individuals and States are not included in the definition of a small
entity. This notice announces the monthly actuarial rates for aged (age
65 and over) and disabled (under 65) beneficiaries enrolled in Part B
of the Medicare SMI program beginning January 1, 2014. Also, 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. As a result, we are not preparing an
analysis for the RFA because 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. As we discussed
previously, we are not preparing an analysis for section 1102(b) of the
Act because the Secretary has determined that this notice will not have
a significant effect on a substantial number of small rural hospitals
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 2013, that
threshold is approximately $141 million. This notice does not impose
mandates that will have a consequential effect of $142 million or more
on State, local, or tribal governments or on the private sector.
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.
For 2014, the standard Part B premium rate, the Part B income-
related premium rates, and the Part B deductible are the same as the
respective amounts for 2013. Therefore, this notice is not a major rule
as defined in 5 U.S.C. 804(2) and is not 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 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. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: September 20, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
Approved: October 18, 2013
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2013-25668 Filed 10-28-13; 11:15 am]
BILLING CODE 4120-01-P
