Identification Number:
HI 00601 TN 3
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Hospital Insurance
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 006 – Covered Services (HI-SMI)
Subchapter 01 – Hospital Insurance
Transmittal No. 3, 12/31/2018

Audience

PSC: CA, CS, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, CTE, EIE, FCR, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

12/31/2018

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

HI 00601.550 Inpatient Hospital Deductible

Add new row for 2019 rate $1364.00

HI 00601.560 Inpatient Hospital Coinsurance

Changed 2018 amount from $335 to $355.00. Added new row for 2019 rate $341.00

HI 00601.570 Extended Care Coinsurance

Add a new row to the table for 2019 rate $170.50.

HI 00601.550 Inpatient Hospital Deductible

CITATIONS:

Social Security Act, Section 1813
20 CFR 405.113 through 405.115

The beneficiary is responsible for an inpatient hospital deductible amount before the program begins paying for inpatient hospital services in each benefit period. The Secretary has in the past been required to determine each year the amount of the deductible for the following year. For 1987, however, the amount of the deductible has been set by law at $520. For each year after 1987, the Secretary is required to promulgate the deductible and related coinsurance amounts between September 1 and September 15 of the preceding year.

For inpatient hospital services rendered in years prior to 1982 and after 1986, the applicable inpatient deductible is the one in effect during the calendar year in which the beneficiary's benefit period begins (i.e., in most cases, the year in which the first inpatient hospital services are furnished in the benefit period). For services rendered in 1982 through 1986, the applicable deductible is the one in effect during the year in which the services were furnished. The following chart shows the applicable deductible amounts for benefit periods beginning in each year since 1974:

Year in Which Benefit Period Began

Deductible Amount

2019 $1364.00

2018

$1340.00

2017

$1316.00

2016

$1288

2015

$1260

2014

$1216

2013

$1,184

2012

$1,156

2011

$1,132

2010

$1,100

2009

$1,068

2008

$1,024

2007

$992

2006

$952

2005

$912

2004

$876

2003

$840

2002

$812

2001

$792

2000

$776

1999

$768

1998

$764

1997

$760

1996

$736

1995

$716

1994

$696

1993

$676

1992

$652

1991

$628

1990

$592

1989

$560

1988

$540

1987

$520

1986

$492

1985

$400

1984

$356

1983

$304

1982

$260

1981

$204

1980

$180

1979

$160

1978

$144

1977

$124

1976

$104

1975

$ 92

1974

$ 84

Expenses incurred in one benefit period cannot be applied toward the deductible in a later benefit period. Expenses incurred in meeting the blood deductible do not count toward the inpatient hospital deductible.

HI 00601.560 Inpatient Hospital Coinsurance

A. Coinsurance

The beneficiary is responsible for a daily coinsurance amount of one-fourth of the inpatient hospital deductible for the 61st through the 90th days of inpatient hospital services used during each benefit period.

Where the actual charge to the patient for the 61st through the 90th day of inpatient hospital services is less than the applicable coinsurance amount, the coinsurance is the actual charge. (Where the actual charge to the patient for lifetime reserve days is less than the coinsurance amount for those days, the beneficiary is deemed to have elected not to use the days because he/she would not benefit from their utilization.) (See HI 00601.065B.)

The following chart shows the inpatient hospital coinsurance amounts for benefit periods beginning in each year since 1974:

Year in Which Benefit Period Began

Coinsurance Amount

2019 $341.00

2018

$355.00

2017

$329.00

2016

$322

2015

$315

2014

$304

2013

$296

2012

$289

2011

$283

2010

$275

2009

$267

2008

$256

2007

$248

2006

$238

2005

$228

2004

$219

2003

$210

2002

$203

2001

$198

2000

$194

1999

$192

1998

$191

1997

$190

1996

$184

1995

$179

1994

$174

1993

$169

1992

$163

1991

$157

1990

$148

1989

$0 *

1988

$135

1987

$130

1986

$123

1985

$100

1984

$89

1983

$76

1982

$65

1981

$51

1980

$45

1979

$40

1978

$36

1977

$31

1976

$26

1975

$23

1974

$21

*Coinsurance was not charged for inpatient hospital care in calendar year 1989 due to Catastrophic Coverage; the deductible was applied.

B. Lifetime reserve coinsurance

The beneficiary is responsible for a daily coinsurance amount of one-half of the inpatient hospital deductible for each of the lifetime reserve days (the 91st through the l50th day) used in a benefit period.

The following chart shows the lifetime reserve day coinsurance amounts for benefit periods beginning in each year since 1974:

Year in Which Benefit Period Began

Coinsurance Amount

2019 $682

2018

$670

2017

$658

2016

$644

2015

$630

2014

$608

2013

$592

2012

$578

2011

$566

2010

$550

2009

$534

2008

$512

2007

$496

2006

$476

2005

$456

2004

$438

2003

$420

2002

$406

2001

$398

2000

$388

1999

$384

1998

$382

1997

$380

1996

$368

1995

$358

1994

$348

1993

$338

1992

$326

1991

$314

1990

$296

1989

$0 *

1988

$270

1987

$260

1986

$246

1985

$200

1984

$178

1983

$152

1982

$130

1981

$102

1980

$ 90

1979

$ 80

1978

$ 72

1977

$ 62

1976

$ 52

1975

$ 46

1974

$ 42

* Coinsurance was not charged for inpatient hospital care in calendar year 1989 due to Catastrophic Coverage; the deductible was applied.

HI 00601.570 Extended Care Coinsurance

The beneficiary is responsible for a daily coinsurance amount of one-eighth of the inpatient hospital deductible for the 21st through the 100th day of extended care services used during each benefit period.

Where the actual charge to the patient for the 2lst through the l00th day is less than the applicable coinsurance amount, the coinsurance is the actual charge.

The following chart shows the extended care coinsurance amounts for benefit periods beginning in each year since 1974:

Year in Which Benefit Period Began

Coinsurance Amount

2019 $170.50

2018

$167.50

2017

$164.50

2016

$161.00

2015

$157.50

2014

$152.00

2013

$148.00

2012

$144.50

2011

$141.50

2010

$137.50

2009

$133.50

2008

$128.00

2007

$124.00

2006

$119.00

2005

$114.00

2004

$109.50

2003

$105.00

2002

$101.50

2001

$99.00

2000

$97.00

1999

$96.00

1998

$95.50

1997

$95.00

1996

$92.00

1995

$89.50

1994

$87.00

1993

$84.50

1992

$81.50

1991

$78.50

1990

$74.00

1989

$0 *

1988

$67.50

1987

$65.00

1986

$61.50

1985

$50.00

1984

$44.50

1983

$38.00

1982

$32.50

1981

$25.50

1980

$22.50

1979

$20.00

1978

$18.00

1977

$15.50

1976

$13.00

1975

$11.50

1974

$10.50

*Under Catastrophic Coverage, a coinsurance payment of $25.50 was due for days 1 – 8 of SNF care. No SNF coinsurance was due after day 8 in 1989.


HI 00601 TN 3 - Hospital Insurance - 12/31/2018