Identification Number:
HI 01005 TN 26
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Premium Health Insurance
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 010 – Premium Collections
Subchapter 05 – Premium Health Insurance
Transmittal No. 26, 12/11/2020

Audience

PSC: CA, CS, EIE, ICDS, IES, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: CAQCR, CR, EIE, ERE, PETL, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DSEI, LCC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal and no change to policy or procedure.

Summary of Changes

HI 01005.012 Exhibit — Reduced Hospital Insurance (HI) Premiums and Surcharges

Updated policy with new rates.

HI 01005.012 Exhibit — Reduced Hospital Insurance (HI) Premiums and Surcharges

INCLUSIVE PERIOD

REDUCED PREMIUM AMOUNT

SURCHARGE AMOUNT

01/21-12/21 259.00 284.90

01/2020-12/2020

252.00

277.20

01/19- 12/19 240.00 264.00

01/18–12/18

232.00

255.20

01/17–12/17

227.00

249.70

01/16–12/16

226.00

248.60

01/15-12/15

224.00

246.40

01/14–12/14

234.00

257.40

01/13-12/13

243.00

267.30

01/12-12/12

248.00

272.80

01/11-12/11

248.00

272.80

01/10-12/10

254.00

279.40

01/09-12/09

244.00

268.40

01/08-12/08

233.00

256.30

01/07-12/07

226.00

248.60

01/06-12/06

216.00

237.60

01/05-12/05

206.00

226.60

01/04-12/04

189.00

207.90

01/03-12/03

174.00

191.40

01/02-12/02

175.00

192.50

01/01-12/01

165.00

181.50

01/00-12/00

166.00

182.60

01/98-12/99

170.00

187.00

01/97-12/97

187.00

205.70

01/96-12/96

188.00

206.80

01/95-12/95

183.00

201.30

01/94-12/94

184.00

202.40


HI 01005 TN 26 - Premium Health Insurance - 12/11/2020