- Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay
- 2018 Medicare Cost Sharing
- REMINDER: Medicare Enrollment Continues through December 7th
- Tax Bill Facing Vote in the Senate Next Week – Time to Talk Turkey!
Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay
Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage. However, depending on the length of their absence, beneficiaries may be charged a "bed hold" fee by their skilled nursing facility (SNF).
Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 Presenters: |
Part A Monthly Premium (For those not automatically enrolled)
- 0-29 qualifying quarters of employment: $422.00
- 30-39 quarters: $232.00
Inpatient Hospital
- Deductible, Per Spell of Illness: $1,340.00
- Co-pay, Days 1 – 60: $0
- Co-pay, Days 61 – 90: $335.00/day
- Co-pay, Lifetime Reserve Days: $670.00/day
Skilled Nursing Facility
- Co-pay, Days 1 – 20: $0
- Co-pay, Days 21 – 100: $167.50
Standard Monthly Part B Premium
- $134.00 (see discussion below)
Part B Deductible
- $183.00 for all Part B beneficiaries (same as 2017)
Parts B and D Income-Related Premiums
Beneficiaries who file an individual tax return with income: | Beneficiaries who file a joint tax return with income: | Beneficiaries who are married, but file a separate tax return with income: | Total monthly Part B premium amount | Part D income-related monthly adjusted amount paid to Medicare (in addition to plan premiums) |
Less than or equal to $85,000 | Less than or equal to $170,000 | Less than or equal to $85,000 | $134 | $0 |
Greater than $85,000 and less than or equal to $107,000 | Greater than $170,000 and less than or equal to $214,000 |
| $187.50 | $13 |
Greater than $107,000 and less than or equal to $133,500 | Greater than $214,000 and less than or equal to $267,000 |
| $267.90 | $33.60 |
Greater than $133,500 and less than or equal to $160,000 | Greater than $267,000 and less than or equal to $320,000 |
| $348.30 | $54.20 |
Greater than $160,000 | Greater than $320,000 | Greater than $85,000 | $428.60 | $74.80 |
Note: Legislation passed in 2015 made changes to the income thresholds for 2018 and 2019 (the upper 3 brackets were lowered, meaning higher charges apply to people earning less income compared to previous years). In 2020 and thereafter, the thresholds will be adjusted annually for inflation. See Section 402 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; Public Law 114-10).
The following article by Kaiser Health News describes both the impact of this change in the income thresholds and the effect of the hold harmless provision on Part B premiums in 2018, as discussed below (the bottom line – more people will be paying higher Part B premiums): “Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind” by Judith Graham, Kaiser Health News (October 5, 2017).
Part B Premium in 2018 and the Hold Harmless Provision
The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017. However, some people with Part B in 2018 will be partially protected from premium increases by a statutory “hold harmless” provision, which prevents Medicare beneficiaries from having their monthly Social Security payment decrease as a result of an increase in Part B premiums. See 42 U.S.C. §1395r(f). After several years of no or very small increases, Social Security benefits will increase by 2.0 percent in 2018 due to the Cost of Living Adjustment. Therefore, some beneficiaries who were held harmless against Part B premiums increases in prior years will have a premium increase in 2018.
Part B enrollees who were held harmless in 2016 and 2017 will see an increase in the monthly Part B premium from the roughly $109, on average, they paid in 2017. The amount of this increase depends on how much an individual receives in Social Security benefits. An estimated 42 percent of all Part B enrollees are subject to the hold harmless provision in 2018 but will pay the full monthly premium of $134, because the increase in their Social Security benefit will be greater than or equal to an increase in their Part B premiums up to the full 2018 amount. About 28 percent of all Part B enrollees are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase.
Approximately 30 percent of all Part B enrollees who are not subject to the “hold harmless” provision will pay the full premium of $134 per month in 2018. Part B enrollees not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2018, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium.
- This section is adopted from CMS’ Fact Sheet “2018 Medicare Parts A & B Premiums and Deductibles” (11/17/17) available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-17.html.
- CMS published 2018 cost-sharing amounts in the Federal Register on 11/21/17, available at: https://www.federalregister.gov/d/2017-24913; https://www.federalregister.gov/d/2017-24912; and https://www.federalregister.gov/d/2017-24877.
REMINDER: Medicare Enrollment Continues through December 7th
The Medicare Annual Coordinated Election Period (ACEP), from October 15th through December 7th, allows Medicare beneficiaries to make certain changes to their Medicare coverage, effective the following January 1st. As we discussed in a previous Alert, official Center for Medicare & Medicaid Services (CMS) Medicare Open Enrollment materials for 2018 tip the scales to encourage beneficiaries to choose a private Medicare plan over original Medicare.
Make sure to consider all of your options – including Original Medicare – during the ACEP.
Tax Bill Facing Vote in the Senate Next Week – Time to Talk Turkey!
As families around the country prepare to gather with loved ones for the Thanksgiving holiday, the House passed a tax bill that would threaten the health and economic security of many low-income and middle-class families. The Senate is planning to vote on their version of the bill next week.
In the meantime, this Thanksgiving, talk turkey about taxes! It’s not too late to protect our health care and our families. Here’s a link to some talking points and action steps.
Download the “Talk Turkey About Taxes” flyer produced by the Center for Medicare Advocacy and the Medicare Rights Center.