[Federal Register Volume 88, Number 199 (Tuesday, October 17, 2023)]
[Notices]
[Pages 71555-71570]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22823]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-8085-N]
RIN 0938-AV13


Medicare Program; Medicare Part B Monthly Actuarial Rates, 
Premium Rates, and Annual Deductible Beginning January 1, 2024

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (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, 2024. In addition, this notice announces the 
monthly premium for aged and disabled beneficiaries, the deductible for 
2024, and the income-related monthly adjustment amounts to be paid by 
beneficiaries with modified adjusted gross income above certain 
threshold amounts. The monthly actuarial rates for 2024 are $343.40 for 
aged enrollees and $427.20 for disabled enrollees. The standard monthly 
Part B premium rate for all enrollees for 2024 is $174.70, 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 the $3.00 repayment amount required 
under current law. (The 2024 premium is 5.9 percent or $9.80 higher 
than the 2023 standard premium rate of $164.90, which included the 
$3.00 repayment amount.) The Part B deductible for 2024 is $240.00 for 
all Part B beneficiaries. If a beneficiary has to pay an income-related 
monthly adjustment amount, that individual will have to pay a total 
monthly premium of about 35, 50, 65, 80, or 85 percent of the total 
cost of Part B coverage plus a repayment amount of $4.20, $6.00, $7.80, 
$9.60, or $10.20, respectively. Beginning in 2023, certain Medicare 
enrollees who are 36 months post kidney transplant, and therefore are 
no longer eligible for full Medicare coverage, can elect to continue 
Part B coverage of immunosuppressive drugs by paying a premium. For 
2024, the immunosuppressive drug premium is $103.00.

DATES: The monthly actuarial rates are effective on January 1, 2024.

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, and comprehensive 
outpatient rehabilitation facilities; and certain other medical and 
health services not covered by Medicare Part

[[Page 71556]]

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 to non-citizens 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 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, income-related monthly adjustment amounts, and the 
immunosuppressive drug premium are included because their 
determinations are 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 $110.00, section 
629 of the MMA (amending section 1833(b) of the Act) required 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 2024 
Part B deductible is calculated by multiplying the 2023 deductible by 
the ratio of the 2024 aged actuarial rate to the 2023 aged actuarial 
rate. The amount determined under this formula is then rounded to the 
nearest $1.00.
    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 the two groups 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 93130 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 one-sixth for 1998, one-third for 1999, one-half for 
2000, two-thirds for 2001, and five-sixths 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 one-seventh of the cost be transferred in 
1998, two-sevenths in 1999, three-sevenths in 2000, four-sevenths in 
2001, five-sevenths in 2002, and six-sevenths 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 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 that individual's annual 
income. (The MMA specified that there be a 5-year transition period to 
reach 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, which ended in 2009.) Specifically, if a 
beneficiary's modified adjusted gross income is greater than the 
legislated threshold amounts (for 2024, $103,000 for a beneficiary 
filing an individual income tax return and $206,000 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

[[Page 71557]]

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, 80, or 85 percent of the estimated 
total cost of Part B coverage, rather than 25 percent. Section 402 of 
the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (Pub. 
L. 114-10) modified the income thresholds beginning in 2018, and 
section 53114 of the Bipartisan Budget Act of 2018 (BBA of 2018) (Pub. 
L. 115-123) further modified the income thresholds beginning in 2019. 
For years beginning in 2019, the BBA of 2018 established a new income 
threshold. If a beneficiary's modified adjusted gross income is greater 
than or equal to $500,000 for a beneficiary filing an individual income 
tax return and $750,000 for a beneficiary filing a joint tax return, 
the beneficiary is responsible for 85 percent of the estimated total 
cost of Part B coverage. The BBA of 2018 specified that these new 
income threshold levels be inflation-adjusted beginning in 2028. 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 it will be reduced for 
beneficiaries with income above these thresholds.
    The Consolidated Appropriations Act, 2021 (Pub. L. 116-260) 
established a new basis for Medicare Part B eligibility for post-
kidney-transplant immunosuppressive drug coverage only. Medicare 
eligibility due solely to end-stage renal disease generally ends 36 
months after a successful kidney transplant. Beginning in 2023, post-
kidney-transplant individuals without certain types of insurance 
coverage can elect to enroll in Part B and receive coverage of 
immunosuppressive drugs only. The premium for this continuation of 
coverage is 15 percent of a different aged actuarial rate, which is 
equal to 100 percent of costs for aged enrollees (rather than the 
standard aged actuarial rate, which is equal to one-half of the costs 
for aged enrollees). Enrollees paying the immunosuppressive premium are 
not subject to the late enrollment penalty and the $3.00 repayment 
amounts, but they are subject to the hold-harmless provision (described 
later) and the income-related monthly adjustment amounts. The law 
requires transfers equal to the reduction in aggregate premiums payable 
that results from enrollees with coverage only for immunosuppressive 
drugs paying the immunosuppressive drug Part B premium rather than the 
standard Part B premium. These transfers are to be treated as premiums 
payable for general revenue matching purposes.
    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 
December's Part B premium has been 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.
    Section 1839 of the Act, as amended by section 601(a) of the 
Bipartisan Budget Act of 2015 (Pub. L. 114-74), specified that the 2016 
actuarial rate for enrollees age 65 and older be determined as if the 
hold-harmless provision did not apply. The premium revenue that was 
lost by using the resulting lower premium (excluding the forgone 
income-related premium revenue) was replaced by a transfer of general 
revenue from the Treasury,

[[Page 71558]]

which will be repaid over time to the general fund.
    Similarly, section 1839 of the Act, as amended by section 2401 of 
the Continuing Appropriations Act, 2021 and Other Extensions Act (Pub. 
L. 116-159), specified that the 2021 actuarial rate for enrollees age 
65 and older be determined as the sum of the 2020 actuarial rate for 
enrollees age 65 and older and one-fourth of the difference between the 
2020 actuarial rate and the preliminary 2021 actuarial rate (as 
determined by the Secretary) for such enrollees. The premium revenue 
lost by using the resulting lower premium (excluding the forgone 
income-related premium revenue) was replaced by a transfer of general 
revenue from the Treasury, which will be repaid over time.
    Starting in 2016, in order to repay the balance due (which includes 
the transfer amounts and the forgone income-related premium revenue 
from the Bipartisan Budget Act of 2015 and the Continuing 
Appropriations Act, 2021 and Other Extensions Act), 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 will be paid back to the general fund of the Treasury, and 
they will continue until the balance due is paid back.
    High-income enrollees pay the $3.00 repayment amount plus an 
additional $1.20, $3.00, $4.80, $6.60, or $7.20 in repayment 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 balance due is 
zero. (In the final year of the repayment, the additional amounts may 
be modified to avoid an overpayment.) The repayment amounts (excluding 
those for high-income enrollees) are subject to the hold-harmless 
provision. The original balance due was $9,066,409,000, consisting of 
$1,625,761,000 in forgone income-related premium revenue plus a 
transfer amount of $7,440,648,000 from the provisions of the Bipartisan 
Budget Act of 2015. The increase in the balance due in 2021 was 
$8,799,829,000, consisting of $946,046,000 in forgone income-related 
premium income plus a transfer amount of $7,853,783,000 from the 
provisions of the Continuing Appropriations Act, 2021 and Other 
Extensions Act. An estimated $14,624,044,000 will have been repaid to 
the general fund by the end of 2023, with an estimated $3,242,194,000 
remaining to be repaid.

II. Provisions of the Notice

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

    The Medicare Part B monthly actuarial rates applicable for 2024 are 
$343.40 for enrollees age 65 and over and $427.20 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 2024 is 
$174.70. The Part B immunosuppressive drug premium is $103.00.
    The following are the 2024 Part B monthly premium rates to be paid 
by (or on behalf of) beneficiaries with full Part B coverage who file 
either individual tax returns (and are single individuals, heads of 
households, qualifying widows or widowers with dependent children, or 
married individuals filing separately who lived apart from their 
spouses for the entire taxable year) or joint tax returns.
BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TN17OC23.014

    For beneficiaries with immunosuppressive drug only Part B coverage, 
who file either individual tax returns (and are single individuals, 
heads of households, qualifying widows or widowers with dependent 
children, or married individuals filing separately who lived apart from 
their spouses for the entire taxable year) or joint tax returns, the 
2024 Part B monthly premium rates are shown below.

[[Page 71559]]

[GRAPHIC] [TIFF OMITTED] TN17OC23.015

    In addition, the monthly premium rates to be paid by (or on behalf 
of) beneficiaries with full Part B coverage who are married and lived 
with their spouses at any time during the taxable year, but who file 
separate tax returns from their spouses, are as follows:
[GRAPHIC] [TIFF OMITTED] TN17OC23.016

    The monthly premium rates to be paid by (or on behalf of) 
beneficiaries with immunosuppressive drug only Part B coverage who are 
married and lived with their spouses at any time during the taxable 
year, but who file separate tax returns from their spouses, are as 
follows:
[GRAPHIC] [TIFF OMITTED] TN17OC23.017

BILLING CODE 4120-01-C
    The Part B annual deductible for 2024 is $240.00 for all 
beneficiaries.

B. Statement of Actuarial Assumptions and Bases Employed in Determining 
the Monthly Actuarial Rates and the Monthly Premium Rate for Part B 
Beginning January 2024

    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.
    Because the premium rates are established prospectively, they are 
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. Trust fund assets must 
therefore 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. For 2024, the four most important 
of these factors are (1) the impact of expected additional payments 
from the Part B account to 340B providers in response to a judicial 
remand order; (2) the difference from prior years between the actual 
performance of the program and estimates made at the time financing was 
established; (3) the likelihood and potential magnitude of expenditure 
changes resulting from enactment of legislation affecting Part B costs 
in a year subsequent to the

[[Page 71560]]

establishment of financing for that year; and (4) the expected 
relationship between incurred and cash expenditures. The projected 
costs have a somewhat higher degree of uncertainty for 2024 due to the 
impact of the judicial remand order resulting in additional 340B drug 
payments. The other three 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 2022 and 2023.
[GRAPHIC] [TIFF OMITTED] TN17OC23.018

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 2024 
is determined by first establishing per enrollee costs by type of 
service from program data through 2021 and then projecting these costs 
for subsequent years. The projection factors used for financing periods 
from January 1, 2021 through December 31, 2024 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 2024 is $349.10. Based on current 
estimates, the assets at the end of 2023 are sufficient to cover the 
amount of incurred, but unpaid, expenses, to provide for substantial 
variation between actual and projected costs. Thus, a negative 
contingency margin can be included to decrease assets to a more 
appropriate level. The monthly actuarial rate of $343.40 provides an 
adjustment of -$3.30 for a contingency margin and -$2.40 for interest 
earnings.
    The contingency margin for 2024 is affected by several factors. 
Additional payments to 340B drug providers from Part B are expected as 
a result of a judicial remand order. In the unique context of a pending 
rulemaking on remand from a court, we anticipate that additional 340B 
payments will reduce the surplus in 2024, resulting in a higher 
contingency margin. We also anticipate that, should we finalize 
proposed payment decreases in future years to providers, that would 
result in correspondingly lower Part B financing rates in those years. 
Another factor affecting Part B costs is the broader coverage for 
certain newly-approved drugs that treat Alzheimer's disease starting in 
July 2023. The broader coverage of these drugs results in a somewhat 
higher contingency margin. The Part B projected program costs were 
developed based on these assumptions and were included in the margin 
development.
    In addition, starting in 2011, manufacturers and importers of 
brand-name prescription drugs pay a fee that is allocated to the Part B 
account of the SMI trust fund. For 2024, the total of these brand-name 
drug fees is estimated to be $2.8 billion. The contingency margin for 
2024 has been reduced to account for this additional revenue.
    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, which is a fully 
adequate contingency reserve level, has been the normal target used to 
calculate the Part B premium. At the end of 2023, the reserve ratio is 
expected to be 25.3 percent. When the reserve ratio is considerably 
higher than 20 percent, the typical approach in the premium 
determination is to target a gradual reduction in the reserve ratio to 
20 percent over a number of years. The Secretary, who determines the 
Part B premium each year under section 1839 of the Act, directed the 
Office of the Actuary to use a 2024 premium increase of 5.9 percent, 
which targets a reserve ratio for the Part B premium determination of 
22.6 percent by the end of 2024.
    The actuarial rate of $343.40 per month for aged beneficiaries, as 
announced in this notice for 2024, reflects the combined effect of the 
factors and legislation previously described and the projected 
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) are prepared in a 
manner parallel to the projection for the aged using

[[Page 71561]]

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 2024 is $436.36. The monthly actuarial rate of 
$427.20 also provides an adjustment of -$2.39 for interest earnings and 
-$6.77 for a contingency margin, reflecting the same factors and 
legislation described previously for the aged actuarial rate at 
magnitudes applicable to the disabled rate determination. Based on 
current estimates, the assets associated with the disabled Medicare 
beneficiaries at the end of 2023 are sufficient to cover the amount of 
incurred, but unpaid, expenses and to provide for a significant degree 
of variation between actual and projected costs.
    The actuarial rate of $427.20 per month for disabled beneficiaries, 
as announced in this notice for 2024, reflects the combined net effect 
of the factors and legislation 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 which 
are shown in Table 5. One set represents increases that are higher and, 
therefore, more pessimistic than the current estimate, and 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 $128,583 million by the end 
of December 2024 under the cost growth rate assumptions shown in Table 
2 and under the assumption that the provisions of current law are fully 
implemented. This result amounts to 21.9 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 $64,240 million by the end of December 2024 under 
current law, which amounts to 9.7 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 
$212,701 million by the end of December 2024, or 41.0 percent of the 
estimated total incurred expenditures for the following year.
    The sensitivity analysis indicates that, in a typical year, the 
premium and general revenue financing established for 2024, together 
with existing Part B account assets, would be adequate to cover 
estimated Part B costs for 2024 under current law, should actual costs 
prove to be somewhat greater than expected.
5. Premium Rates and Deductible
    As determined in accordance with section 1839 of the Act, the 
following are the 2024 Part B monthly premium rates to be paid by (or 
on behalf of) beneficiaries with full Part B coverage who file either 
individual tax returns (and are single individuals, heads of 
households, qualifying widows or widowers with dependent children, or 
married individuals filing separately who lived apart from their 
spouses for the entire taxable year) or joint tax returns.
BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TN17OC23.019

    For beneficiaries with immunosuppressive drug only Part B coverage 
who file either individual tax returns (and are single individuals, 
heads of households, qualifying widows or widowers with dependent 
children, or married individuals filing separately who lived apart from 
their spouses for the entire taxable year) or joint tax returns, the 
2024 Part B monthly premium rates are shown below.

[[Page 71562]]

[GRAPHIC] [TIFF OMITTED] TN17OC23.020

    In addition, the monthly premium rates to be paid by (or on behalf 
of) beneficiaries with full Part B coverage who are married and lived 
with their spouses at any time during the taxable year, but who file 
separate tax returns from their spouses, are as follows:
[GRAPHIC] [TIFF OMITTED] TN17OC23.021

    The monthly premium rates to be paid by (or on behalf of) 
beneficiaries with immunosuppressive drug only Part B coverage who are 
married and lived with their spouses at any time during the taxable 
year, but who file separate tax returns from their spouses, are as 
follows:
[GRAPHIC] [TIFF OMITTED] TN17OC23.022

    The Part B annual deductible for 2024 is $240.00 for all 
beneficiaries.

[[Page 71563]]

[GRAPHIC] [TIFF OMITTED] TN17OC23.023


[[Page 71564]]


[GRAPHIC] [TIFF OMITTED] TN17OC23.024


[[Page 71565]]


[GRAPHIC] [TIFF OMITTED] TN17OC23.025


[[Page 71566]]


[GRAPHIC] [TIFF OMITTED] TN17OC23.026

BILLING CODE 4120-01-C

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

    This notice announces the monthly actuarial rates and premium 
rates, as required by section 1839(a) of the Act, and the annual 
deductible, as required by section 1833(b) of the Act, for 
beneficiaries enrolled in Part B of the Medicare Supplementary Medical 
Insurance (SMI) program beginning January 1, 2024. It also responds to 
section 1839(a)(1) of the Act, which requires the Secretary to provide 
for

[[Page 71567]]

publication of these amounts in the Federal Register during the 
September that precedes the start of each calendar year. As section 
1839 prescribes a detailed methodology for calculating these amounts, 
we do not have the discretion to adopt an alternative approach on these 
issues.

B. Overall Impact

    We have examined the impact of this notice 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), Executive Order 14094 entitled ``Modernizing 
Regulatory Review'' (April 6, 2023), the Regulatory Flexibility Act 
(RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the 
Social Security Act, section 202 of the Unfunded Mandates Reform Act of 
1995 (March 22, 1995; Pub. L. 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). The 
Executive Order 14094 entitled ``Modernizing Regulatory Review'' 
(hereinafter, the Modernizing E.O.) amends section 3(f)(1) of Executive 
Order 12866 (Regulatory Planning and Review). The amended section 3(f) 
of Executive Order 12866 defines a ``significant regulatory action'' as 
an action that is likely to result in a notice/rule: (1) having an 
annual effect on the economy of $200 million or more in any one year 
(adjusted every 3 years by the Administrator of OIRA for changes in 
gross domestic product), or adversely affect in a material way the 
economy, a sector of the economy, productivity, competition, jobs, the 
environment, public health or safety, or State, local, territorial, or 
tribal governments or communities; (2) creating a serious inconsistency 
or otherwise interfering with an action taken or planned by another 
agency; (3) materially altering the budgetary impacts of entitlement 
grants, user fees, or loan programs or the rights and obligations of 
recipients thereof; or (4) raise legal or policy issues for which 
centralized review would meaningfully further the President's 
priorities, or the principles set forth in the Executive Order, as 
specifically authorized in a timely manner by the Administrator of OIRA 
in each case.
    A regulatory impact analysis (RIA) must be prepared for major rules 
with significant regulatory action/s and/or with significant effects as 
per section 3(f)(1) ($200 million or more in any one year). Based on 
our estimates, OMB's Office of Information and Regulatory Affairs has 
determined this rulemaking is significant per section 3(f)(1) as 
measured by the $200 million threshold or more in any one year, and 
hence also a major rule under Subtitle E of the Small Business 
Regulatory Enforcement Fairness Act of 1996 (also known as the 
Congressional Review Act). The 2024 standard Part B premium of $174.70 
is $9.80 higher than the 2023 premium of $164.90. We estimate that the 
total premium increase, for the approximately 62 million Part B 
enrollees in 2024, will be $7.3 billion, which is an annual effect on 
the economy of $200 million or more. Accordingly, we have prepared a 
Regulatory Impact Analysis that to the best of our ability presents the 
costs and benefits of the rulemaking. Therefore, OMB has reviewed these 
proposed regulations, and the Departments have provided the following 
assessment of their impact.

C. Detailed Economic Analysis

    As discussed earlier, this notice announces that the monthly 
actuarial rates applicable for 2024 are $343.40 for enrollees age 65 
and over and $427.20 for disabled enrollees under age 65. It also 
announces the 2024 monthly Part B premium rates to be paid by (or on 
behalf of) beneficiaries with full Part B coverage who file either 
individual tax returns (and are single individuals, heads of 
households, qualifying widows or widowers with dependent children, or 
married individuals filing separately who lived apart from their 
spouses for the entire taxable year) or joint tax returns.
BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TN17OC23.027

    For beneficiaries with immunosuppressive drug only Part B coverage, 
who file either individual tax returns (and are single individuals, 
heads of households, qualifying widows or widowers with dependent 
children, or married individuals filing separately who lived apart from 
their spouses for the entire taxable year) or joint tax returns, the 
2024 Part B monthly premium rates are announced and shown below.

[[Page 71568]]

[GRAPHIC] [TIFF OMITTED] TN17OC23.028

    In addition, the monthly premium rates to be paid by (or on behalf 
of) beneficiaries with full Part B coverage who are married and lived 
with their spouses at any time during the taxable year, but who file 
separate tax returns from their spouses, are also announced and listed 
in the following table:
[GRAPHIC] [TIFF OMITTED] TN17OC23.029

    The monthly premium rates to be paid by (or on behalf of) 
beneficiaries with immunosuppressive drug only Part B coverage who are 
married and lived with their spouses at any time during the taxable 
year, but who file separate tax returns from their spouses, are 
announced and listed in the following table:
[GRAPHIC] [TIFF OMITTED] TN17OC23.030

D. Accounting Statement and Table

    As required by OMB Circular A-4 (available at www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf), in Table 6 we 
have prepared an accounting statement showing the estimated aggregate 
Part B premium increase for all enrollees in 2024.
[GRAPHIC] [TIFF OMITTED] TN17OC23.031

BILLING CODE 4120-01-C

E. Regulatory Flexibility Act (RFA)

    The RFA requires agencies to analyze options for regulatory relief 
of small businesses, if a rule or other regulatory document 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, 2024. 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

[[Page 71569]]

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 or other regulatory document 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 one year of 
$100 million in 1995 dollars, updated annually for inflation. In 2023, 
that threshold is approximately $177 million. Part B enrollees who are 
also enrolled in Medicaid have their monthly Part B premiums paid by 
Medicaid. The cost to each State Medicaid program from the 2024 premium 
increase is estimated to be more than the threshold. This notice does 
not impose mandates that will have a consequential effect of the 
threshold amount 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 or other regulatory 
document (and subsequent final rule or other regulatory document) that 
imposes substantial direct compliance costs on State and local 
governments, preempts State law, or otherwise has 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 Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comment prior to a rule taking 
effect in accordance with section 1871 of the Act and section 553(b) of 
the Administrative Procedure Act (APA). Section 1871(a)(2) of the Act 
provides that no rule, requirement, or other statement of policy (other 
than a national coverage determination) that establishes or changes a 
substantive legal standard governing the scope of benefits, the payment 
for services, or the eligibility of individuals, entities, or 
organizations to furnish or receive services or benefits under Medicare 
shall take effect unless it is promulgated through notice and comment 
rulemaking. Unless there is a statutory exception, section 1871(b)(1) 
of the Act generally requires the Secretary of the Department of Health 
and Human Services (the Secretary) to provide for notice of a proposed 
rule in the Federal Register and provide a period of not less than 60 
days for public comment before establishing or changing a substantive 
legal standard regarding the matters enumerated by the statute. 
Similarly, under 5 U.S.C. 553(b) of the APA, the agency is required to 
publish a notice of proposed rulemaking in the Federal Register before 
a substantive rule takes effect. Section 553(d) of the APA and section 
1871(e)(1)(B)(i) of the Act usually require a 30-day delay in effective 
date after issuance or publication of a rule, subject to exceptions. 
Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from 
the advance notice and comment requirement and the delay in effective 
date requirements. Sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the 
Act also provide exceptions from the notice and 60-day comment period 
and the 30-day delay in effective date. Section 553(b)(B) of the APA 
and section 1871(b)(2)(C) of the Act expressly authorize an agency to 
dispense with notice and comment rulemaking for good cause if the 
agency makes a finding that notice and comment procedures are 
impracticable, unnecessary, or contrary to the public interest.
    The annual updated amounts for the Part B monthly actuarial rates 
for aged and disabled beneficiaries, the Part B premium, and the Part B 
deductible set forth in this notice do not establish or change a 
substantive legal standard regarding the matters enumerated by the 
statute or constitute a substantive rule that would be subject to the 
notice requirements in section 553(b) of the APA. However, to the 
extent that an opportunity for public notice and comment could be 
construed as required for this notice, we find good cause to waive this 
requirement.
    Section 1839 of the Act requires the Secretary to determine the 
monthly actuarial rates for aged and disabled beneficiaries, as well as 
the monthly Part B premium (including the income-related monthly 
adjustment amounts to be paid by beneficiaries with modified adjusted 
gross income above certain threshold amounts), for each calendar year 
in accordance with the statutory formulae, in September preceding the 
year to which they will apply. Further, the statute requires that the 
agency promulgate the Part B premium amount, in September preceding the 
year to which it will apply, and include a public statement setting 
forth the actuarial assumptions and bases employed by the Secretary in 
arriving at the amount of an adequate actuarial rate for enrollees age 
65 and older. We include the Part B annual deductible, which is 
established in accordance with a specific formula described in section 
1833(b) of the Act, because the determination of the amount is directly 
linked to the rate of increase in actuarial rate under section 
1839(a)(1) of the Act. We have calculated the monthly actuarial rates 
for aged and disabled beneficiaries, the Part B deductible, and the 
monthly Part B premium as directed by the statute; since the statute 
establishes both when the monthly actuarial rates for aged and disabled 
beneficiaries and the monthly Part B premium must be published and the 
information that the Secretary must factor into those amounts, we do 
not have any discretion in that regard. We find notice and comment 
procedures to be unnecessary for this notice, and we find good cause to 
waive such procedures under section 553(b)(B) of the APA and section 
1871(b)(2)(C) of the Act, if such procedures may be construed to be 
required at all. Through this notice, we are simply notifying the 
public of the updates to the monthly actuarial rates for aged and 
disabled beneficiaries and the Part B deductible, as well as the 
monthly Part B premium amounts and the income-related monthly 
adjustment amounts to be paid by certain beneficiaries, in accordance 
with the statute, for CY 2024. As such, we also note that even if 
notice and comment procedures were required for this notice, we would 
find good cause, for the previously stated reason, to waive the delay 
in effective date of the notice, as additional delay would be contrary 
to the public interest under section 1871(e)(1)(B)(ii) of the Act.

[[Page 71570]]

Publication of this notice is consistent with section 1839 of the Act, 
and we believe that any potential delay in the effective date of the 
notice, if such delay were required at all, could cause unnecessary 
confusion for both the agency and Medicare beneficiaries.
    Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & 
Medicaid Services, approved this document on October 11, 2023.

    Dated: October 11, 2023.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2023-22823 Filed 10-12-23; 4:15 pm]
BILLING CODE 4120-01-P