20 North Shore Towers Courier n January 2016 MEDICARE CORNER BY FELICE HANNAH Medicare Costs Sharing 2016 Part B Deductible: $166 Medicare Part B Monthly Premiums Monthly Part B Premiums for 2016 are based on your modified, adjusted income reported on your IRS tax return, reported two years ago. You may pay an Income Related Monthly Adjusted Amount (IRMAA) in 2016, if your reported income was above a certain amount in 2014. Most people will continue to pay $104.90 under the Hold Harmless Provision. When there is no COLA increase the Hold Harmless Provision protects people from paying a higher Part B premium if they meet the following criteria: • You are receiving Social Security benefits • You are entitled to Social Security benefits for November and December of the current year (2015) • The Medicare Part B Premium will be or was deducted from your Social Security benefits in November 2015 through January 2016 • Your Modified Adjusted Gross income is already below a certain amount • You are not paying a late penalty for Medicare Part B. Calculation of your Part B late penalty may increase your Medicare Part B Premium If you are new to Medicare or already paying IRMAA the Hold Harmless Provision does not apply. Annual Income 2014 that you will pay in 2016 If you are not protected under the Hold Harmless Provision In 2016 the standard Part B premium will be $121.80 or higher. File Individual Tax Return File Joint Tax Return You Will Pay $85,000 or less $170,000 or less $121.80 Above $85,000 up to $107,000 above $170,000 up to $214,000 $170.50 Above $107,000 up to $160,000 above $214,000 up to $320,000 $243.60 Above $160,000 up to $214,000 above $320,00 up to $428,000 $316.70 Above $214,000 above $428,000 $389.80 File Married & Separate Tax Return $85,000 or less $121.80 Above $85,000 and up to $129,000 $316.70 Above $129,000 $389.80 Higher Income Part D Monthly Premium File Individual Tax Return File Joint Tax Return You Will Pay Above $85,000 up to $107,000 above $170,000 up to $214,000 $12.70 Above $107,000 up to $160,000 above $214,000 up to $320,000 $32.80 Above $160,000 up to $214,000 above $320,000 up to $428,000 $52.80 Above $214,000 Above $428,000 $72.90 File Married & Separate Tax Return Above $85.000 up to $129,000 $52.80 Above $129,000 $72.90 Part A Hospital Inpatient Deductible and Coinsurance If you are enrolled in a Medicare Advantage Plan the following costs may be lower or higher than Original Medicare. Review the Plans “Evidence of Coverage.” If not covered by employee insurance you may pay the following for Part A inpatient deductibles. Deductible per benefit period $1,288. A benefit period is 1–90 days. You may have more than one benefit period during the year. A new benefit period begins when you haven’t been an inpatient in a hospital or Skilled Nursing Facility for more than 60 consecutive days. Days 1–60 per benefit period: Coinsurance =$0 Days 61–90: per benefit period: Coinsurance = $322 per days Days 91 and beyond up to 60 days over your “lifetime reserve” days: per benefit period $630 After 90 + 60 days (150 days), you pay all costs Skilled Nursing Facility Stay after Qualifying with Three Full Days as an Inpatient Days 1–20: $0 for each benefit period Days 21–100: coinsurance per day of each benefit period $161 Days 101 and beyond: all costs Refer to the Medicare and You 2016 Handbook for costs sharing regarding Mental Health inpatient stay, Durable Medical Equipment (DME), Hospice Care, and Home Health Care Services. Part D Coverage Gap begins when the total drug costs reach $3.310. When the Total Out -Of -Pocket (TROOP) costs for drugs on formulary (covered drugs) reaches $4,850, you will pay five percent of the cost of each drug, or copay, whichever is greater. The above cost sharing may differ if receiving Part D coverage through employee retiree coverage. The Health Care Reform Act provides discounts for covered brand and generic drugs for beneficiaries who reach the Gap (donut hole). In 2016 brand name drugs = 50% and generic drugs = 42% discount. Note that the entire amount will be applied towards the beneficiary’s TROOP. THERAPY CAP Note: Medicare pays for skilled therapy that helps you maintain your ability to function or prevents your health from getting worse. Automatic Exceptions extended through 2017 Hospital or outpatient $1960 Maximum Threshold Limit $3,700
NST012016
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