Answers to some of the most commonly asked Medicare questions
Q: I heard the Medicare Part B premium and deductible for 2015 will remain the same as it was in 2014; is this true? Also, what are the premiums and deductibles for Medicare Part A in 2015?
A: Good news! The standard monthly Part B premium and deductible will remain the same as it has been the last two years, leaving more of the Social Security cost of living adjustment in the pockets of Medicare beneficiaries. The Medicare Part B premium which will be $104.90 in 2015, exactly the same as it was in 2014, helps cover physicians’ services, outpatient hospital services, certain home health services, durable medical equipment and other items. The Part B deductible which will be $147 in 2015 is also the same as it was in 2014. This is the amount one pays towards Medicare Part B services before Medicare pays. However, most preventive benefits have no out-of-pocket costs before they are completely covered by Medicare.
The premium has either been less than projected or remained the same, for the past four years. The stabilization of Part B premiums is another example of how we are containing health care costs to provide a more sustainable and affordable health delivery system.
About 99 percent of people on Medicare don’t pay any premium for Part A, because they or their spouse paid into the Medicare Trust Fund through payroll withholding for at least 40 quarters during their working lifetimes. For those few beneficiaries who do pay premiums for Part A, depending on the number of quarters worked, premiums are going down by either $10 a month or $19 a month in 2015. Medicare Part A covers inpatient hospital, skilled nursing facility and some home health care services.
The Medicare Part A deductible that beneficiaries pay when admitted to the hospital will be $1,260 in 2015, a modest increase of $44 from this year’s $1,216 deductible. The Part A deductible covers beneficiary’s share of the costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. For days 61 through 90 beneficiaries will pay an additional $315 per day and after that $630 per day for hospital stays beyond the 90th day.
For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 will be $157.50 in 2015, an increase of a little more than $5 from 2014. Beneficiaries do not pay anything for the first 20 days of skilled nursing facility care. However, to qualify for Medicare coverage, your doctor must certify that you need daily skilled care, like intravenous injections or physical therapy, and your stay follows at least a 3-day, medically necessary, inpatient hospital stay for a related illness or injury.
Less than 5 percent of the current Medicare population will pay higher Medicare Part B premiums, based on his or her annual income. This means your Part B premiums are higher in 2015 if the income shown on your 2013 tax return (the one you filed in April of 2014) is greater than $85,000 for an individual return, or $170,000 for a joint return. If this is the case for you, you will get a special notification about it, along with information about how to pay, and how to appeal if you think you shouldn’t have to pay the higher premiums. If you are in this group, and if you also have a Medicare Prescription Drug Plan (including Medicare Advantage plans which incorporate prescription drug coverage), you will also have to pay a surcharge based on income. This will also be sent to you separately. The income related monthly premium rates will also remain the same as they were in 2014.
However, people with low incomes can participate in state programs that reduce or even eliminate Part B premiums, deductibles, and/or co-payments. For information about this, contact your local State Health Insurance Assistance Program (SHIP). The contact number is printed on the back of your Medicare & You handbook, or call 1-800-MEDICARE [1-800-633-4227] and ask for the SHIP number in your state.
Low-income Medicare beneficiaries who have a Medicare prescription drug plan may also qualify for the Extra-Help program to help with their out-of-pocket prescription costs. The Social Security Administration qualifies and enrolls Medicare beneficiaries into this program. Call 1-800-772-1213 (TTY 1-800-325-0778) or apply online at www.ssa.gov.
Finally, remember that the annual Open Enrollment period for Medicare health and drug plans began on October 15, and ends December 7. Each year, plan costs and covered benefits can change. Medicare beneficiaries should look at their Medicare coverage choices and decide what options best meet their needs. Beneficiaries who need assistance can visit www.medicare.gov, call 1-800-MEDICARE, [1-800-633-4227] or contact their State Health Insurance Assistance Program (SHIP) for an enrollment event or appointment in their area; 1-800-MEDICARE can help you locate the SHIP in your state.
