Identification Number:
HI 01005 TN 25
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. 25, 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 does not introduce new policy or procedure.

Summary of Changes

HI 01005.011 Exhibit — Standard Hospital Insurance (HI) Premiums and Surcharges

Updated POMS section with new rates.

HI 01005.011 Exhibit — Standard Hospital Insurance (HI) Premiums and Surcharges

INCLUSIVE PERIOD

HI PREMIUM AMOUNT

SURCHARGE AMOUNT

01/21-12/21 471.00 518.00

01/20-12/20

458.00

503.80

01/19- 12/19 437.00 480.70

01/18–12/18

422.00

464.20

01/17–12/17

413.00

454.30

01/16–12/16

411.00

452.10

01/15-12/15

407.00

447.70

01/14–12/14

426.00

468.60

01/13-12/13

441.00

485.10

01/12-12/12

451.00

496.10

01/11-12/11

450.00

495.00

01/10-12/10

461.00

507.10

01/09-12/09

443.00

487.30

01/08-12/08

423.00

465.30

01/07-12/07

410.00

451.00

01/06-12/06

393.00

432.30

01/05-12/05

375.00

412.50

01/04-12/04

343.00

377.30

01/03-12/03

316.00

347.60

01/02-12/02

319.00

350.90

01/01-12/01

300.00

330.00

01/00-12/00

301.00

331.10

01/98-12/99

309.00

339.90

01/97-12/97

311.00

342.10

01/96-12/96

289.00

317.90

01/95-12/95

261.00

287.10

01/94-12/94

245.00

269.50

01/93-12/93

221.00

243.10

01/92-12/92

192.00

211.20

01/91-12/91

177.00

194.70

01/90-12/90

175.00

192.50

01/89-12/89

156.00

171.60

01/88-12/88

234.00

257.40

01/87-12/87

226.00

248.60

07/86-12/86

214.00

235.40


HI 01005 TN 25 - Premium Health Insurance - 12/11/2020