[Federal Register Volume 80, Number 220 (Monday, November 16, 2015)]
[Notices]
[Pages 70811-70820]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-29181]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-8061-N]
RIN 0938-AS38


Medicare Program; Medicare Part B Monthly Actuarial Rates, 
Premium Rate, and Annual Deductible Beginning January 1, 2016

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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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, 2016. In addition, this notice announces the 
monthly premium for aged and disabled beneficiaries, the deductible for 
2016, the income-related monthly adjustment amounts to be paid by 
beneficiaries with modified adjusted gross income above certain 
threshold amounts, and the transfer amount equal to the reduction in 
premiums payable as a result of amendments made by the Bipartisan 
Budget Act of 2015. The monthly actuarial rates for 2016 are $237.60 
for aged enrollees and $282.60 for disabled enrollees. The standard 
monthly Part B premium rate for all enrollees for 2016 is $121.80, 
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) plus $3.00. (The 2015 
standard premium rate was $104.90.) The Part B deductible for 2016 is 
$166.00 for all Part B beneficiaries. If a beneficiary has to pay an 
income-related monthly adjustment, they will have to pay a total 
monthly premium of about 35, 50, 65, or 80 percent of the total cost of 
Part B coverage plus $4.20, $6.00, $7.80, or $9.60. Section 1844(d) of 
the Social Security Act, as added by section 601(b) of the Bipartisan 
Budget Act of 2015, provides for a transfer from the general fund to 
the Part B account

[[Page 70812]]

of the SMI Trust Fund. This transfer of $7,440,648,000 consists of 
$5,237,880,000 in reduced premium revenue for enrollees age 65 and 
older, and $2,202,768,000 in reduced premium revenue for enrollees 
under age 65.

DATES: Effective Date: January 1, 2016.

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 premiums paid by (or on 
behalf of) all enrollees fund approximately one-fourth of the total 
incurred costs, and transfers from the general fund of the Treasury pay 
approximately three-fourths of these costs.
    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 2016 
Part B deductible is calculated by multiplying the 2015 deductible by 
the ratio of the 2016 aged actuarial rate to the 2015 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

[[Page 70813]]

income'' is greater than the legislated threshold amounts (for 2016, 
$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. (For 2018 and 
subsequent years, the income thresholds are lower for the two highest 
income ranges, as a result of the Medicare Access and CHIP 
Reauthorization Act of 2015 (MACRA) (Pub. L. 114-10).) 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-year transition to full implementation of this provision. However, 
section 5111 of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-
171) 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 2015, 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 
for these years. Section 211 of MACRA permanently extended this 
expenditure, which is included in the calculation of the Part B 
actuarial rates for 2016 and subsequent years.
    Another 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) of the Act 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 premium 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.
    For 2016, social security benefits will receive no cost-of-living 
adjustment under section 215(i) of the Act. As a result, the majority 
of Part B enrollees can pay no increase in their monthly premium. The 
Bipartisan Budget Act of 2015 helps to ensure the financial adequacy of 
the Part B account of the SMI Trust Fund without transferring the 
financial burden of the entire increase in 2016 premium requirements to 
the minority of enrollees who are not held harmless.
    Section 1839 of the Social Security Act, as amended by section 
601(a) of the Bipartisan Budget Act of 2015 (Pub. L. 114-74), specifies 
that the 2016 actuarial rate for enrollees age 65 and older be 
determined as if the hold-harmless provision does not apply. The 
premium revenue that is lost by using the resulting lower premium 
(excluding the foregone income-related premium revenue) is to be 
replaced by a transfer of general revenue from the Treasury, which will 
be repaid over time to the general fund. The transfer amount will be 
$7,440,648,000, consisting of $5,237,880,000 for the lost aged premium 
revenue and $2,202,768,000 for the lost disabled premium revenue.
    Starting in 2016, in order to repay the balance due (which is to 
include the transfer amount and the foregone income-related premium 
revenue), the Part B premium otherwise determined will be increased by 
$3.00. These repayment amounts will be added to the Part B premium 
otherwise determined each year and paid back to the general fund of the 
Treasury.


[[Page 70814]]

High-income enrollees will pay an additional $1.20, $3.00, $4.80, or 
$6.60 as part of the income-related monthly adjustment amount (IRMAA) 
premium dollars, which reduce (dollar for dollar) the amount of general 
revenue received by Part B from the general fund of the Treasury. 
Because of this general revenue offset, the repayment IRMAA premium 
dollars are not included in the direct repayments made to the general 
fund of the Treasury from Part B in order to avoid a double repayment. 
(Only the $3.00 monthly repayment amounts are included in the direct 
repayments).
    These repayment amounts will continue until the total amount 
collected is equal to the beginning balance due. (In the final year of 
the repayment, the additional amounts may be modified in order to avoid 
an overpayment.) The repayment amounts (excluding the repayment amounts 
for high-income enrollees) are subject to the hold harmless provision. 
The beginning balance due is $9,066,409,000, consisting of the transfer 
amount plus $1,625,761,000 in foregone income-related premium revenue.

II. Provisions of the Notice

A. Notice of Medicare Part B Monthly Actuarial Rates, Monthly Premium 
Rates, Annual Deductible, and Transfer Amount

    The Medicare Part B monthly actuarial rates applicable for 2016 are 
$237.60 for enrollees age 65 and over and $282.60 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 2016 is 
$121.80. The following are the 2016 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 tax      monthly      Total monthly
            return with income:                      return with income:            adjustment    premium amount
                                                                                      amount
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Less than or equal to $85,000..............  Less than or equal to $170,000.....           $0.00         $121.80
Greater than $85,000 and less than or equal  Greater than $170,000 and less than           48.70          170.50
 to $107,000.                                 or equal to $214,000.
Greater than $107,000 and less than or       Greater than $214,000 and less than          121.80          243.60
 equal to $160,000.                           or equal to $320,000.
Greater than $160,000 and less than or       Greater than $320,000 and less than          194.90          316.70
 equal to $214,000.                           or equal to $428,000.
Greater than $214,000......................  Greater than $428,000..............          268.00          389.80
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    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:

------------------------------------------------------------------------
 Beneficiaries who are married and lived  Income-related
with their spouse at any time during the      monthly      Total monthly
  year, but file a separate tax return      adjustment    premium amount
           from their spouse:                 amount
------------------------------------------------------------------------
Less than or equal to $85,000...........           $0.00         $121.80
Greater than $85,000 and less than or             194.90          316.70
 equal to $129,000......................
Greater than $129,000...................          268.00          389.80
------------------------------------------------------------------------

    The Part B annual deductible for 2016 is $166.00 for all 
beneficiaries.
    The transfer amount is the estimate by the Chief Actuary of the 
aggregate reduction in premiums payable, separately for enrollees age 
65 and older and for enrollees under age 65, as a result of the 
amendments made by the Bipartisan Budget Act of 2015 (excluding the 
reduction in the income-related monthly adjustment amounts). The 2016 
actuarial rate for enrollees age 65 and older is $237.60, and the 
actuarial rate portion of the 2016 premium is $118.80. If the only 
change to the 2016 actuarial rate for enrollees age 65 and older was 
the absence of the Bipartisan Budget Act amendments, then the 2016 
actuarial rate for enrollees age 65 and older would be $318.00, and the 
actuarial rate portion of the 2016 premium would be $159.00.
    The reduction in premiums payable as a result of the Bipartisan 
Budget Act amendments is estimated separately for--(1) enrollees held 
harmless; (2) enrollees not held harmless who are age 65 or older; and 
(3) enrollees not held harmless who are under age 65. All enrollees 
that are subject to the hold harmless provision will have no reduction 
in their premiums payable in 2016 as a result of these amendments. (The 
2016 monthly premium for enrollees subject to the hold harmless 
provision in 2016 will be the same as their 2015 monthly premium.) An 
estimated 11.8 million enrollees age 65 and older (with 10.8 million 
enrollee years of premium payments) will not be held harmless and will 
have a reduction in monthly premiums payable from $159.00 to $118.80. 
Based on this difference in premiums payable and adjusting for the 
additional premiums payable by individuals subject to the late 
enrollment penalty (assuming a historical average penalty), the 
transfer amount for enrollees age 65 and older is $5,237,880,000. An 
estimated 4.9 million enrollees under age 65 (with 4.6 million enrollee 
years of premium payments) will not be held harmless and will have a 
reduction in monthly premiums payable from $159.00 to $118.80. Based on 
this difference in premiums payable and adjusting for the additional 
premiums payable by individuals subject to the late enrollment penalty 
(assuming a historical average penalty), the transfer amount for 
enrollees under age 65 is $2,202,768,000. The total transfer amount 
will be $7,440,648,000.

[[Page 70815]]

B. Statement of Actuarial Assumptions and Bases Employed in Determining 
the Monthly Actuarial Rates and the Monthly Premium Rate for Part B 
Beginning January 2016

    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 Centers for Medicare & Medicaid Services 
Office of the Actuary. 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 section 1839 of the Act, 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 the: (1) Difference from prior years between the actual 
performance of the program and estimates made at the time financing was 
established; (2) 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) 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 2014 and 2015.

 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 ($ in   Liabilities ($  liabilities ($
                                                                     millions)     in millions)    in millions)
----------------------------------------------------------------------------------------------------------------
December 31, 2014...............................................          68,074          23,716          44,358
December 31, 2015...............................................          58,261          23,292          34,969
----------------------------------------------------------------------------------------------------------------

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 2016 
is determined by first establishing per-enrollee cost by type of 
service from program data through 2015 and then projecting these costs 
for subsequent years. The projection factors used for financing periods 
from January 1, 2013 through December 31, 2016 are shown in Table 2.
    As indicated in Table 3, the projected per-enrollee amount required 
to pay for one-half of the total of benefits and administrative costs 
for enrollees age 65 and over for 2016 is $227.86. Based on current 
estimates, the assets at the end of 2015 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 $237.60 provides 
an adjustment of $11.61 for a contingency margin (determined as if the 
hold harmless provision did not apply for 2016, as required by the 
Bipartisan Budget Act of 2015) and -$1.87 for interest earnings.
    Two other factors affect the contingency margin for 2016. 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 2016, the total of these brand-name drug fees is estimated 
to be $3.0 billion. The contingency margin has been reduced to account 
for this additional revenue.
    Another 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 
positive incentive payments or penalties will be directly offset 
through transfers with the general fund of the Treasury. The monthly 
actuarial rate includes an adjustment of -$0.36 for HIT positive 
incentive payments in 2016.
    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.
    The contingency margin included in establishing the 2016 actuarial 
rate of $237.60 per month for aged beneficiaries, as announced in this 
notice, is projected to fully restore the Part B assets under 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)

[[Page 70816]]

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 per-enrollee amount required to 
pay for one-half of the total of benefits and administrative costs for 
disabled enrollees for 2016 is $272.94. The monthly actuarial rate of 
$282.60 also provides an adjustment of -$2.86 for interest earnings and 
$12.52 for a contingency margin, reflecting the same factors described 
previously for the aged actuarial rate at magnitudes appropriate to the 
disabled rate determination. Based on current estimates, the assets 
associated with the disabled Medicare beneficiaries at the end of 2015 
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 an appropriate level.
    The actuarial rate of $282.60 per month for disabled beneficiaries, 
as announced in this notice for 2016, 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 
higher and, therefore, more pessimistic than the current estimate. The 
other set represents increases that are lower and, therefore, more 
optimistic 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 $53,052 million by the end 
of December 2016 under the cost growth rate assumptions shown in Table 
2 and assuming that the provisions of current law are fully 
implemented. This amounts to 17.0 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 $8,962 million by the end of December 2016 under 
current law, which amounts to 2.5 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 
$94,727 million by the end of December 2016, or 34.9 percent of the 
estimated total incurred expenditures for the following year.
    The sensitivity analysis indicates that the premium and general 
revenue financing established for 2016, together with existing Part B 
account assets would be adequate to cover estimated Part B costs for 
2016 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 2016 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 tax      monthly      Total monthly
            return with income:                      return with income:            adjustment    premium amount
                                                                                      amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000..............  Less than or equal to $170,000.....           $0.00         $121.80
Greater than $85,000 and less than or equal  Greater than $170,000 and less than           48.70          170.50
 to $107,000.                                 or equal to $214,000.
Greater than $107,000 and less than or       Greater than $214,000 and less than          121.80          243.60
 equal to $160,000.                           or equal to $320,000.
Greater than $160,000 and less than or       Greater than $320,000 and less than          194.90          316.70
 equal to $214,000.                           or equal to $428,000.
Greater than $214,000......................  Greater than $428,000..............          268.00          389.80
----------------------------------------------------------------------------------------------------------------

    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 lived  Income-related
with their spouse at any time during the      monthly      Total monthly
  year, but file a separate tax return      adjustment    premium amount
           from their spouse:                 amount
------------------------------------------------------------------------
Less than or equal to $85,000...........           $0.00         $121.80
Greater than $85,000 and less than or             194.90          316.70
 equal to $129,000......................
Greater than $129,000...................          268.00          389.80
------------------------------------------------------------------------


                                    Table 2--Projection Factors \1\ 12-Month Periods Ending December 31 of 2013-2016
                                                                      [In percent]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                 Physicians' services                              Other
                               ------------------------   Durable     Carrier     carrier   Outpatient     Home      Hospital       Other       Managed
         Calendar year                       Residual     medical     lab \4\    services    hospital     health      lab \6\   intermediary     care
                                 Fees \2\       \3\      equipment                  \5\                   agency                services \7\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Aged:
    2013......................        -0.1         0.2       -10.3         0.1         2.6         7.4        -0.7        -0.7         -0.6          1.4

[[Page 70817]]

 
    2014......................         0.5         0.8       -14.4         6.6         2.8        12.7        -1.3       -28.8          4.7          7.0
    2015......................        -0.4        -0.6         4.8         4.4         3.9         5.2        -0.3         4.1          5.7          2.2
    2016......................         0.1         1.2        -5.8         4.6         1.6         4.1         1.6         3.9          4.8          2.8
Disabled:
    2013......................        -0.1         1.4        -9.2        10.8         1.1         7.0         3.9        -1.8          1.7          4.0
    2014......................         0.5         2.5       -10.8        14.0         4.6        14.4        -1.1       -35.4          8.3          9.2
    2015......................        -0.4        -0.8         4.4         6.5         4.8         5.6        -0.3         2.9          7.8          0.7
    2016......................         0.1         1.3        -5.7         4.7         1.4         4.1         2.0         3.9          5.1          2.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
\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, 2013 Through December 31, 2016
                                                  [In dollars]
----------------------------------------------------------------------------------------------------------------
                                                      CY 2013         CY 2014         CY 2015         CY 2016
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
    Physician fee schedule......................           78.23           77.10           74.44           74.40
    Durable medical equipment...................            7.29            6.07            6.21            5.77
    Carrier lab \1\.............................            4.21            4.37            4.45            4.60
    Other carrier services \2\..................           22.07           22.06           22.36           22.43
    Outpatient hospital.........................           37.87           41.49           42.57           43.74
    Home health.................................           10.15            9.75            9.47            9.50
    Hospital lab \3\............................            3.27            2.26            2.30            2.36
    Other intermediary services \4\.............           16.53           16.83           17.35           17.95
    Managed care................................           65.60           74.26           79.49           83.65
                                                 ---------------------------------------------------------------
        Total services..........................          245.22          254.20          258.64          264.39
Cost sharing:
    Deductible..................................           -5.63           -5.63           -5.64           -6.36
    Coinsurance.................................          -29.17          -28.38          -28.84          -28.26
Sequestration of benefits.......................           -3.17           -4.40           -4.48           -4.59
HIT payment incentives..........................           -2.04           -2.40           -0.43           -0.36
                                                 ---------------------------------------------------------------
        Total benefits..........................          205.20          213.38          219.25          224.82
Administrative expenses.........................            2.77            3.49            3.00            3.05
                                                 ---------------------------------------------------------------
Incurred expenditures...........................          207.97          216.87          222.25          227.86
Value of interest...............................           -1.80           -1.93           -1.73           -1.87
Contingency margin for projection error and to              3.63           -5.14          -10.72           11.61
 amortize the surplus or deficit................
                                                 ---------------------------------------------------------------
        Monthly actuarial rate..................          209.80          209.80          209.80          237.60
----------------------------------------------------------------------------------------------------------------
\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,
                                         2013 Through December 31, 2016
                                                  [In dollars]
----------------------------------------------------------------------------------------------------------------
                                                      CY 2013         CY 2014         CY 2015         CY 2016
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule..........................           83.88           83.87           80.07           79.56
Durable medical equipment.......................           13.88           11.99           12.08           11.15
Carrier lab \1\.................................            6.54            7.21            7.42            7.61
Other carrier services \2\......................           25.26           25.43           25.55           25.42
Outpatient hospital.............................           54.25           60.32           61.47           62.72
Home health.....................................            9.18            8.79            8.45            8.43

[[Page 70818]]

 
Hospital lab \3\................................            4.64            2.87            2.86            2.91
Other intermediary services \4\.................           44.34           44.87           45.36           46.37
Managed care....................................           55.05           65.50           72.71           78.31
                                                 ---------------------------------------------------------------
    Total services..............................          297.03          310.86          315.95          322.46
Cost sharing:
Deductible......................................           -5.29           -5.29           -5.30           -5.97
Coinsurance.....................................          -44.36          -43.31          -42.74          -41.32
Sequestration of benefits.......................           -3.73           -5.24           -5.36           -5.50
HIT payment incentives..........................           -2.13           -2.58           -0.45           -0.39
                                                 ---------------------------------------------------------------
    Total benefits..............................          241.52          254.43          262.10          269.28
Administrative expenses.........................            3.26            4.16            3.59            3.65
                                                 ---------------------------------------------------------------
Incurred expenditures...........................          244.78          258.59          265.69          272.94
Value of interest...............................           -3.47           -2.50           -1.88           -2.86
Contingency margin for projection error and to             -5.81          -37.19           -9.01           12.52
 amortize the surplus or deficit................
                                                 ---------------------------------------------------------------
    Monthly actuarial rate......................          235.50          218.90          254.80          282.60
----------------------------------------------------------------------------------------------------------------
\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, 2016
----------------------------------------------------------------------------------------------------------------
                       As of December 31,                              2014            2015            2016
----------------------------------------------------------------------------------------------------------------
    Actuarial status (in $ millions):
        Assets..................................................          68,074          58,261          76,806
        Liabilities.............................................          23,716          23,292          23,754
                                                                 -----------------------------------------------
            Assets less liabilities.............................          44,358          34,969          53,052
Ratio (in percent) \1\..........................................            15.9            11.9            17.0
Low cost projection:
    Actuarial status (in $ millions):
        Assets..................................................         68,0741          73,027         117,319
        Liabilities.............................................          23,716          21,651          22,592
                                                                 -----------------------------------------------
            Assets less liabilities.............................          44,358          51,376          94,727
Ratio (in percent) \1\..........................................            16.9            19.3            34.9
High cost projection:
    Actuarial status (in $ millions):
        Assets..................................................          68,074          43,044          34,020
        Liabilities.............................................          23,716          24,982          25,058
                                                                 -----------------------------------------------
            Assets less liabilities.............................          44,358          18,062           8,962
Ratio (in percent) \1\..........................................            15.0             5.6             2.5
----------------------------------------------------------------------------------------------------------------
\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.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

IV. 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, Public Law 96-354), section 1102(b) of the Social Security Act, 
section 202 of the

[[Page 70819]]

Unfunded Mandates Reform Act of 1995 (March 22, 1995, Public Law 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 2016 approximately 70 percent of Part B enrollees will be 
held harmless and pay no increase in their Part B premium, but the 
standard Part B premium rate, the Part B income-related premium rates, 
and the Part B deductible are higher than the respective amounts for 
2015 and have an annual effect on the economy of $100 million or more. 
As a result, this notice is economically significant under section 
3(f)(1) of Executive Order 12866 and is a major action as defined under 
the Congressional Review Act (5 U.S.C. 804(2)).
    As discussed earlier, this notice announces that the monthly 
actuarial rates applicable for 2016 are $237.60 for enrollees age 65 
and over and $282.60 for disabled enrollees under age 65. It also 
announces the 2016 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 tax      monthly      Total monthly
            return with income:                      return with income:            adjustment    premium amount
                                                                                      amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000..............  Less than or equal to $170,000.....           $0.00         $121.80
Greater than $85,000 and less than or equal  Greater than $170,000 and less than           48.70          170.50
 to $107,000.                                 or equal to $214,000.
Greater than $107,000 and less than or       Greater than $214,000 and less than          121.80          243.60
 equal to $160,000.                           or equal to $320,000.
Greater than $160,000 and less than or       Greater than $320,000 and less than          194.90          316.70
 equal to $214,000.                           or equal to $428,000.
Greater than $214,000......................  Greater than $428,000..............          268.00          389.80
----------------------------------------------------------------------------------------------------------------

    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:

------------------------------------------------------------------------
  Beneficiaries who are married
 and lived with their spouse at     Income-related
  any time during the year, but   monthly adjustment     Total monthly
 file a separate tax return from        amount          premium amount
          their spouse:
------------------------------------------------------------------------
Less than or equal to $85,000...  $0.00.............  $121.80
Greater than $85,000 and less     194.90............  316.70
 than or equal to $129,000.
Greater than $129,000...........  268.00............  389.80
------------------------------------------------------------------------

    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. 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, 2016. 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 2015, that 
threshold is approximately $144 million. Part B enrollees who are also 
enrolled in Medicaid have their monthly Part B premiums paid by 
Medicaid. The 2016 premium increase is estimated to be a cost to the 
state Medicaid programs that is less than $144 million per state. This 
notice does not impose mandates that will have a consequential effect 
of $144 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

[[Page 70820]]

Federalism implications. We have determined that this notice does not 
significantly affect the rights, roles, and responsibilities of States. 
Accordingly, the requirements of Executive Order 13132 do not apply to 
this notice.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.

V. 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.

    Dated: November 6, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Dated: November 9, 2015.
Sylvia M. Burwell,
Secretary. Department of Health and Human Services.
[FR Doc. 2015-29181 Filed 11-10-15; 4:15 pm]
BILLING CODE 4120-01-P