Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2022
Notice.
RIN Number: "RIN 0938-AU48"
Citation: "86 FR 64205"
Document Number: "CMS-8079-N"
Page Number: "64205"
"Notices"
Agency: "
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
DATES: The premium and related amounts announced in this notice are effective on
FOR FURTHER INFORMATION CONTACT:
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 A,
The Secretary of the
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
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 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
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
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
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
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
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
High-income enrollees pay the
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
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 2022 are
The following are the 2022 Part B monthly premium rates to be paid by (or on behalf of) beneficiaries 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.
Beneficiaries who file individual tax returns Beneficiaries who file joint tax returns with Income-related Total monthly
with modified modified monthly adjustment premium amount
adjusted gross income: adjusted gross income: amount
Less than or equal to $ 91,000 Less than or equal to $ 182,000 $ 0.00 $ 170.10
Greater than $ 91,000 and less than or equal to Greater than $ 182,000 and less than or equal to 68.00 238.10
$ 114,000 $ 228,000
Greater than $ 114,000 and less than or equal to Greater than $ 228,000 and less than or equal to 170.10 340.20
$ 142,000 $ 284,000
Greater than $ 142,000 and less than or equal to Greater than $ 284,000 and less than or equal to 272.20 442.30
$ 170,000 $ 340,000
Greater than $ 170,000 and less than $ 500,000 Greater than $ 340,000 and less than $ 750,000 374.20 544.30
Greater than or equal to $ 500,000 Greater than or equal to $ 750,000 408.20 578.30
In addition, the monthly premium rates to be paid by (or on behalf of) beneficiaries 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:
Beneficiaries who are married and lived with their spouses at any Income-related Total monthly
time during the year, but who file separate tax returns from monthly adjustment premium amount
their spouses, with modified adjusted gross income: amount
Less than or equal to $ 91,000 $ 0.00 $ 170.10
Greater than $ 91,000 and less than $ 409,000 374.20 544.30
Greater than or equal to $ 409,000 408.20 578.30
The Part B annual deductible for 2022 is
B. Statement of Actuarial Assumptions and Bases Employed in Determining the Monthly Actuarial Rates and the Monthly Premium Rate for Part B Beginning
The actuarial assumptions and bases used to determine the monthly actuarial rates and the monthly premium rates for Part B are established by the
1. Actuarial Status of the Part B Account in the
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 2022, the five most important of these factors are (1) the impact of the COVID-19 pandemic on program spending; (2) the impact on program spending of Aduhelm (aducanumab-avwa), the drug newly approved by the
Table 1 summarizes the estimated actuarial status of the trust fund as of the end of the financing period for 2020 and 2021.
Table 1-Estimated Actuarial Status of the Part B Account in theSupplementary Medical Insurance Trust Fund as of the End of the Financing Period Financing period ending Assets Liabilities fn1 Assets less (in millions) (in millions) liabilities fn1 (in millions)December 31, 2020 $ 133,283 $ 42,000 $ 91,283 December 31, 2021 153,017 49,721 103,296 fn1 These amounts include only items incurred but not paid. They do not include the amounts that are to be paid back to the general fund of theTreasury over time as specified by section 1839 of the Act as amended by section 601(a) of the Bipartisan Budget Act of 2015 and further amended by section 2401 of the Continuing Appropriations Act, 2021 and Other Extensions Act, or the Accelerated and Advance Payments Program amounts that are to be repaid by providers and returned to the general fund of theTreasury .
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 2022 is determined by first establishing per enrollee costs by type of service from program data through 2020 and then projecting these costs for subsequent years. The projection factors used for financing periods from
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 2022 is
The contingency margin for 2022 is affected by several factors. First, as noted previously, Aduhelm is a drug newly approved by the FDA for the treatment of Alzheimer's disease. The annual cost per patient for a course of treatment is reported to be
Second, in order to take the uncertainty and potential impact of the COVID-19 pandemic into account, assumptions were developed for testing and treatment for COVID-19, utilization of non-COVID-related care, potential costs for COVID-19 vaccines, and possible paths of the pandemic. The Part B projected program costs were developed based on these assumptions and were included in the margin development.
Third, 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. For 2022, the total of these brand-name drug fees are estimated to be
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. The financing rates for 2022 are set above the normal target due to the higher-than-usual uncertainty for 2022. The actuarial rate of
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
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 2022 is
The actuarial rate of
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. The historical variation may not be representative of the current level of uncertainty due to the COVID-19 pandemic and the Alzheimer's drug Aduhelm.
As indicated in Table 5, the monthly actuarial rates would result in an excess of assets over liabilities of
Assumptions that are somewhat more pessimistic (and that therefore test the adequacy of the assets to accommodate projection errors) produce a surplus of
The sensitivity analysis indicates that, in a typical year, the premium and general revenue financing established for 2022, together with existing Part B account assets, would be adequate to cover estimated Part B costs for 2022 under current law, should actual costs prove to be somewhat greater than expected. However, the current level of uncertainty due to the pandemic and Aduhelm may differ from the historical variation included in this analysis.
5. Premium Rates and Deductible
As determined in accordance with section 1839 of the Act, the following are the 2022 Part B monthly premium rates to be paid by beneficiaries 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.
Beneficiaries who file individual tax returns Beneficiaries who file joint tax returns with Income-related Total monthly
with modified monthly adjustment premium amount
modified adjusted gross income: adjusted gross income: amount
Less than or equal to $ 91,000 Less than or equal to $ 182,000 $ 0.00 $ 170.10
Greater than $ 91,000 and less than or equal to Greater than $ 182,000 and less than or equal to 68.00 238.10
$ 114,000 $ 228,000
Greater than $ 114,000 and less than or equal to Greater than $ 228,000 and less than or equal to 170.10 340.20
$ 142,000 $ 284,000
Greater than $ 142,000 and less than or equal to Greater than $ 284,000 and less than or equal to 272.20 442.30
$ 170,000 $ 340,000
Greater than $ 170,000 and less than $ 500,000 Greater than $ 340,000 and less than $ 750,000 374.20 544.30
Greater than or equal to $ 500,000 Greater than or equal to $ 750,000 408.20 578.30
In addition, the monthly premium rates to be paid by beneficiaries 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:
Beneficiaries who are married and lived with their spouses at any Income-related Total monthly
time during the year, but who file separate tax returns from monthly adjustment premium amount
their spouses, with modified adjusted gross income: amount
Less than or equal to $ 91,000 $ 0.00 $ 170.10
Greater than $ 91,000 and less than $ 409,000 374.20 544.30
Greater than or equal to $ 409,000 408.20 578.30
Table 2-Projection Factors fn1
Calendar year Physician Durable Carrier Physician- Other Outpatient Home Hospital Other Managed
(CY) fee medical administered carrier hospital health intermediary care
schedule equipment lab fn2 drugs agency lab fn4
services fn3 services fn5
Aged:
2019 4.1 7.4 4.6 11.2 2.4 5.4 0.9 - 3.5 5.7 8.1
2020 - 11.3 2.7 8.1 4.2 - 0.3 - 7.8 - 11.0 10.6 - 5.0 8.6
2021 20.9 2.5 8.4 14.9 6.2 23.6 17.2 5.1 6.7 5.5
2022 - 0.3 2.4 - 5.8 11.5 4.3 9.2 4.3 - 6.1 5.5 3.7
Disabled:
2019 3.2 3.1 8.2 9.2 3.4 4.3 1.9 - 1.7 10.5 8.1
2020 - 8.3 - 0.4 - 7.2 9.2 8.4 - 9.2 - 11.1 9.6 - 2.3 9.7
2021 16.8 1.1 8.1 16.9 2.4 18.5 23.3 6.6 12.8 5.6
2022 - 0.1 2.6 - 5.9 11.8 4.9 9.8 7.7 - 6.1 8.2 3.8
fn1 All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
fn2 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
fn3 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
fn4 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
fn5 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 EndingDecember 31, 2019 ThroughDecember 31, 2022 CY 2019 CY 2020 CY 2021 CY 2022 Covered services (at level recognized): Physician fee schedule$ 73.10 $ 62.11 $ 70.96 $ 68.60 Durable medical equipment 6.32 6.21 6.02 5.98 Carrier lab fn1 4.35 4.51 4.62 4.22 Physician-administered drugs 17.37 17.34 20.68 24.56 Other carrier 9.29 8.87 8.91 9.01 services fn2 Outpatient hospital 50.83 44.89 52.46 55.52 Home health agency 8.70 7.41 8.21 8.30 Hospital lab fn3 2.04 2.16 2.15 1.95 Other intermediary 19.12 17.40 17.55 17.94 services fn4 Managed care 113.35 130.43 147.20 157.93 Total services 304.47 301.33 338.75 354.02 Cost sharing: Deductible - 6.32 - 6.75 - 6.93 - 7.94 Coinsurance - 28.74 - 25.73 - 29.74 - 26.06 Sequestration of benefits - 5.38 - 1.79 0.00 - 6.31 Total benefits 264.02 267.06 302.08 313.70 Administrative expenses 4.11 4.40 4.33 3.98 Incurred expenditures 268.14 271.46 306.41 317.68 Value of interest - 1.89 - 1.33 - 1.64 - 2.15 Contingency margin for - 1.35 13.07 - 13.77 18.67 projection error and to amortize the surplus or deficit fn5 Monthly actuarial rate 264.90 283.20 291.00 334.20 fn1 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab. fn2 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. fn3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. fn4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc. fn5 The significant negative margin included in the 2021 actuarial rate is attributable to the application of the provisions of the Continuing Appropriations Act, 2021 and Other Extensions Act.
Table 4-Derivation of Monthly Actuarial Rate for Disabled Enrollees for Financing Periods EndingDecember 31, 2019 ThroughDecember 31, 2022 CY 2019 CY 2020 CY 2021 CY 2022 Covered services (at level recognized): Physician fee schedule$ 72.64 $ 62.39 $ 67.69 $ 62.92 Durable medical equipment 12.00 11.06 10.29 9.78 Carrier lab fn1 6.00 5.34 5.33 4.65 Physician-administered drugs 15.49 15.58 18.59 20.15 Other carrier 12.37 12.42 11.81 11.52 services fn2 Outpatient hospital 65.12 54.88 60.42 61.44 Home health agency 6.83 5.61 6.35 6.32 Hospital lab fn3 2.48 2.54 2.51 2.19 Other intermediary 53.01 49.88 48.04 49.64 services fn4 Managed care 124.51 151.94 179.62 202.67 Total services 370.42 371.64 410.66 431.27 Cost sharing: Deductible - 6.15 - 6.56 - 6.75 - 7.73 Coinsurance - 41.62 - 37.05 - 39.25 - 33.68 Sequestration of benefits - 6.45 - 2.19 0.00 - 7.74 Total benefits 316.21 325.84 364.65 382.12 Administrative expenses 4.93 5.37 7.39 7.51 Incurred expenditures 321.14 331.21 372.04 389.63 Value of interest - 2.52 - 1.65 - 2.04 - 2.66 Contingency margin for - 3.21 14.04 - 20.10 - 18.07 projection error and to amortize the surplus or deficit fn5 Monthly actuarial rate 315.40 343.60 349.90 368.90 fn1 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab. fn2 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. fn3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. fn4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc. fn5 The significant negative margin included in the 2021 actuarial rate is attributable to the application of the provisions of the Continuing Appropriations Act, 2021 and Other Extensions Act.
Table 5-Actuarial Status of the Part B Account in the SMI Trust Fund Under Three Sets of Assumptions for Financing Periods ThroughDecember 31, 2022 As ofDecember 31, 2020 2021 2022 Actuarial status (in millions): Assets$ 133,283 $ 153,017 $ 170,553 Liabilities$ 42,000 $ 49,721 $ 50,111 Assets less liabilities$ 91,283 $ 103,296 $ 120,442 Ratio fn1 20.7% 22.0% 23.7% Low-cost projection: Actuarial status (in millions): Assets$ 133,283 $ 176,208 $ 246,751 Liabilities$ 42,000 $ 47,145 $ 48,220 Assets less liabilities$ 91,283 $ 129,064 $ 198,532 Ratio fn1 22.0% 30.4% 44.6% High-cost projection: Actuarial status (in millions): Assets$ 133,283 $ 132,266 $ 120,112 Liabilities$ 42,000 $ 52,027 $ 52,186 Assets less liabilities$ 91,283 $ 80,239 $ 67,927 Ratio fn1 19.7% 15.6% 11.9% fn1 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
IV. Regulatory Impact Analysis
A. Statement of Need
This notice announces the Part B monthly actuarial rates and premium rates, as required by Section 1839(a) of the Act, and the Part B annual deductible, as required by Section 1833(b) of the Act, for beneficiaries enrolled in Part B of the
B. Overall Impact
We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (
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). 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
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 rules or other regulatory documents with economically significant effects (
C. Detailed Economic Analysis
As discussed earlier, this notice announces that the monthly actuarial rates applicable for 2022 are
Beneficiaries who file individual tax returns Beneficiaries who file joint tax returns with Income-related monthly adjustment Total monthly
with modified modified amount premium amount
adjusted gross income: adjusted gross income:
Less than or equal to $ 91,000 Less than or equal to $ 182,000 $ 0.00 $ 170.10
Greater than $ 91,000 and less than or equal to Greater than $ 182,000 and less than or equal to 68.00 238.10
$ 114,000 $ 228,000
Greater than $ 114,000 and less than or equal to Greater than $ 228,000 and less than or equal to 170.10 340.20
$ 142,000 $ 284,000
Greater than $ 142,000 and less than or equal to Greater than $ 284,000 and less than or equal to 272.20 442.30
$ 170,000 $ 340,000
Greater than $ 170,000 and less than $ 500,000 Greater than $ 340,000 and less than $ 750,000 374.20 544.30
Greater than or equal to $ 500,000 Greater than or equal to $ 750,000 408.20 578.30
In addition, the monthly premium rates to be paid by beneficiaries 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 chart:
Beneficiaries who are married and lived with their spouses at any Income-related Total monthly time during the year, but who file separate tax returns from monthly adjustment premium amount their spouses, with modified adjusted gross income: amount Less than or equal to$ 91,000 $ 0.00 $ 170.10 Greater than$ 91,000 and less than$ 409,000 374.20 544.30 Greater than or equal to$ 409,000 408.20 578.30
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 2022.
Table 6-Accounting Statement Estimated Aggregate Part B Premium Increase for All Enrollees for 2022 Category Annualized Monetized Transfers$ 15.5 billion . From Whom to Whom? Beneficiaries to Federal Government.
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
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
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
V. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
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 2022. 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. 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.
Dated:
Secretary,
[FR Doc. 2021-25050 Filed 11-12-21;
BILLING CODE 4120-01-P
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