Health Law Daily CMS sets inpatient hospital deductible, coinsurance amounts for 2018
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Monday, November 20, 2017

CMS sets inpatient hospital deductible, coinsurance amounts for 2018

By Jeffrey H. Brochin, J.D.

For 2018, the inpatient hospital deductible will be $1,340, and the daily coinsurance amount will be: $335 for the 61st through 90th day of hospitalization in a benefit period; $670 for lifetime reserve days; and $167.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period, according to a CMS advance release notice.

Medicare Part A. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment. Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $232 in 2018, a $5 increase from 2017.

Computing the Inpatient Hospital Deductible for 2018. Section 1813(b) of the Social Security Act prescribes the method for computing the amount of the inpatient hospital deductible, which is an amount equal to the inpatient hospital deductible for the preceding calendar year, adjusted by CMS’ best estimate of the payment-weighted average of the applicable percentage increases used for updating the payment rates to hospitals for discharges in the fiscal year (FY) that begins on October 1 of the same preceding calendar year, and adjusted to reflect changes in real case-mix. The adjustment to reflect real case-mix is determined on the basis of the most recent case-mix data available. The amount determined under this formula is rounded to the nearest multiple of $4 (or, if midway between two multiples of $4, to the next higher multiple of $4).

Dollar amounts of Part A changes. The Medicare Part A annual inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,340 per benefit period in 2018, an increase of $24 from $1,316 in 2017. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay a daily coinsurance amount of $335 per day for the 61st through 90th day of a hospitalization ($329 in 2017) in a benefit period and $670 per day for lifetime reserve days ($658 in 2017); and $167.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period. The new rates will take effect on January 1, 2018.

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