PROGRAM UPDATES:
QI PROGRAM EXTENDED AND
MEDICARE PREMIUMS AND
DEDUCTIBLES
ANNOUNCED FOR 2008
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Cost-Sharing for Part A and Part B
On October 1, 2007 the Centers for Medicare & Medicaid Services (CMS) announced Part A and Part B premiums and deductibles for 2008.[1]
Hospital Deductible: $1,024 / benefit period
Hospital Coinsurance:
· Days 0-60: $0
· Days 61-90: $256 / day
· Days 91-150: $512 / day
Skilled Nursing Facility Coinsurance
· Days 0-20: $0
· Days 21-100: $128 / day
Part A Premium (for voluntary enrollees only)
· With 30-39 quarters of Social Security coverage: $233 / month
· With 29 or fewer quarters of Social Security coverage: $423 / month
Part B
· Deductible: $135 / year
· Standard Premium: $96.40 / month
Part B Income-Related Premium
|
Beneficiaries who file an individual tax return with income: |
Beneficiaries who file a joint tax return with income: |
Income-related monthly adjustment amount |
Total monthly premium amount |
|
Less than or equal to $82,000 |
Less than or equal to $164,000 |
$0.00 |
$96.40 |
|
Greater than $82,000 and less than or equal to $102,000 |
Greater than $164,000 and less than or equal to $204,000 |
$25.80 |
$122.20 |
|
Greater than $102,000 and less than or equal to $153,000 |
Greater than $204,000 and less than or equal to $306,000 |
$64.50 |
$160.90 |
|
Greater than $153,000 and less than or equal to $205,000 |
Greater than $306,000 and less than or equal to $410,000 |
$103.30 |
$199.70 |
|
Greater than $205000 |
Greater than $410,000 |
$142.90 |
$238.40 |
In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at some time during the taxable year are:
|
Beneficiaries who are married but file a separate tax return from their spouse: |
Income-related monthly adjustment amount |
Total monthly premium amount |
|
Less than or equal to $82,000 |
$0.00 |
$96.40 |
|
Greater than $82,000 and less than or equal to $123,000 |
$103.30 |
$199.70 |
|
Greater than $123,000 |
$142.00 |
$238.40 |
Medicare Advantage Eligibility
· Must be enrolled in Medicare Parts A & B; enrollees are still in the Medicare program,
· Must continue to pay the Part B premium ($96.40 / month in 2008),
· Must live in the plan’s service area,
· Must not have end-stage renal disease (ESRD) at time of enrollment.
Standard Part D Cost-Sharing for 2008
On April 2, 2007 CMS issued information about Part D cost-sharing for 2008:[2]
Base Beneficiary Premium $27.93
Deductible $275.00
Initial Coverage Limit $2,510.00
Out-of-pocket Threshold $4,050.00
Total Covered Part D Drugs to Get to Catastrophic Limit $5,726.25
Catastrophic cost-sharing: Generic/ Preferred Drug $2.25
Other $5.60
Low-Income Subsidy Co-Payments (LIS)
Full Benefit Dual Eligibles w/incomes
≤ 100% Federal Poverty Level
Generic/Preferred Drugs $1.05
Other $3.10
Above Catastrophic Limit $0.00
Full Benefit Duals with Incomes
>100% Federal Poverty Level &
Other Full-Subsidy Eligible Beneficiaries
Generic/preferred drugs $2.25
Other $5.60
Above Catastrophic Limit $0.00
Partial Subsidy Eligible Beneficiaries
Deductible $56.00
Co-insurance to ICL 15%
Generics above catastrophic limit $2.25
Others above catastrophic limit $5.60
CMS has also announced the elimination of the 2008 late enrollment penalty for any beneficiary who qualifies for the low-income subsidy and who enrolls in a drug plan through December 31, 2008.
Qualified Individual (QI) Program Extended
The President has signed legislation that will continue the Qualified Individual (QI) program through the end of 2007. The President is expected to sign the legislation. This will assure the continued payment of Part B premiums for the approximately 1.5 million people who receive QI benefits. The Center for Medicare Advocacy is working with many other organizations for the passage of legislation, before the end of the year, which would make the QI program permanent, rather than subject to periodic sunset provisions. The QI benefit is doubly valuable to those who are eligible, as it pays the Part B premium (currently $93.50/month) and also entitles the beneficiary to the full Part D low income subsidy.
[1] CMS Announces Medicare Premiums, Deductibles for 2008 (Oct. 1, 2007), http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=2488&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
© Center for Medicare Advocacy, Inc. 05/05/2008