Annual Statistical Supplement, 2007

 

History of SSI, Medicare, and Medicaid Provisions

Supplemental Security Income

Medicare

Medicaid

Table 2.B1 Federal benefit rates, by living arrangement, 1974–2007
Act Effective date Amount a (dollars)
Individual Couple
Own household b
1972 January 1, 1974 c 130.00 195.00
1973 January 1, 1974 140.00 210.00
1973 July 1, 1974 146.00 219.00
1974 d July 1, 1975 157.70 236.60
July 1, 1976 167.80 251.80
July  1, 1977 177.70 266.70
July  1, 1978 189.40 284.10
July  1, 1979 208.20 312.30
July  1, 1980 238.00 357.00
July  1, 1981 264.70 397.00
July  1, 1982 284.30 426.40
1983 July  1, 1983 e 304.30 456.40
January 1, 1984 314.00 472.00
January 1, 1985 325.00 488.00
January 1, 1986 336.00 504.00
January 1, 1987 340.00 510.00
January 1, 1988 354.00 532.00
January 1, 1989 368.00 553.00
January 1, 1990 386.00 579.00
January 1, 1991 407.00 610.00
January 1, 1992 422.00 633.00
January 1, 1993 434.00 652.00
January 1, 1994 446.00 669.00
January 1, 1995 458.00 687.00
January 1, 1996 470.00 705.00
January 1, 1997 484.00 726.00
January 1, 1998 494.00 741.00
January 1, 1999 500.00 751.00
January 1, 2000 513.00 f 769.00
January 1, 2001 531.00 f 796.00
January 1, 2002 545.00 817.00
January 1, 2003 552.00 829.00
January 1, 2004 564.00 846.00
January 1, 2005 579.00 869.00
January 1, 2006 603.00 904.00
January 1, 2007 623.00 934.00
Receiving institutional care covered by Medicaid g
1972 January 1, 1974 25.00 50.00
1987 July 1, 1988 30.00 60.00
SOURCES: Social Security Act of 1935 (the Act), as amended through December 31, 2006; regulations issued under the Act; and precedential case decisions (rulings). Specific laws, regulations, rulings, legislation, and a link to the Federal Register can be found at the Social Security Program Rules page (http://www.socialsecurity.gov/regulations/index.htm). Social Security Administration, Office of the Chief Actuary, "SSI Federal Payment Amounts," http://www.socialsecurity.gov/OACT/COLA/SSIamts.html.
NOTE: For those in another person's household receiving support and maintenance there, the federal benefit rate is reduced by one-third.
a. For those without countable income. These payments are reduced by the amount of countable income of the individual or couple.
b. Includes persons in private institutions whose care is not provided by Medicaid.
c. Superseded by the provision of 1973.
d. Mechanism established for providing cost-of-living adjustments.
e. General benefit increase.
f. Benefits originally paid in 2000 and through July 2001 were based on federal benefit rates of $512 and $530, respectively. Pursuant to Public Law 106-554, monthly payments beginning in August 2001 were effectively based on the higher $531 amount. Lump-sum compensation payments were made on the basis of an adjusted benefit rate for months prior to August 2001.
g. Must be receiving more than 50 percent of the cost of the care from Medicaid (Title XIX of the Social Security Act).
CONTACT: Alfreda Brooks (410) 965-9849.
Table 2.C1 Medicare cost sharing and premium amounts, 1966–2008
Effective date a Hospital Insurance (Medicare Part A) Supplementary Medical Insurance (Medicare Parts B and D)
Part B Part D
All expenses in "benefit period" covered except— Monthly
premium b
(dollars)
Annual
deductible c
(dollars)
Coinsurance c
(percent)
Monthly premium (dollars) Annual
deductible d,e
(dollars)
Initial
coverage
limit d,e
(dollars)
Out-of- pocket
thresh-old d,e
(dollars)
Base
beneficiary
premium d,f
(dollars)
Inpatient
hospital
deductible
(IHD)
covers first
60 days
(dollars)
Inpatient hospital
daily coinsurance
Skilled
nursing
facility daily
coinsurance
after 20 days (1/8 × IHD)
(dollars)
For
enrollee g,h
(aged and
disabled)
Government
amounts for—
Days 61
through 90
(1/4 × IHD)
(dollars)
Lifetime
reserve
days after 90 days
(1/2 × IHD)
Aged Disabled h
1966 40 10 i i . . . 50 20 3.00 3.00 . . . . . . . . . . . . . . .
1967 40 10 i 5.00 . . . 50 20 3.00 3.00 . . . . . . . . . . . . . . .
1968 40 10 20 5.00 . . . 50 j 20 j 4.00 k 4.00 k . . . . . . . . . . . . . . .
1969 44 11 22 5.50 . . . 50 20 4.00 4.00 . . . . . . . . . . . . . . .
1970 52 13 26 6.50 . . . 50 20 5.30 5.30 . . . . . . . . . . . . . . .
1971 60 15 30 7.50 . . . 50 20 5.60 5.60 . . . . . . . . . . . . . . .
1972 68 17 34 8.50 . . . 50 20 l 5.80 5.80 . . . . . . . . . . . . . . .
1973 72 18 36 9.00 33 60 20 6.30 m 6.30 22.70 . . . . . . . . . . . .
1974 84 21 42 10.50 36 60 20 6.70 6.70 29.30 . . . . . . . . . . . .
1975 92 23 46 11.50 40 60 20 6.70 8.30 30.30 . . . . . . . . . . . .
1976 104 26 52 13.00 45 60 20 7.20 14.20 30.80 . . . . . . . . . . . .
1977 124 31 62 15.50 54 60 20 7.70 16.90 42.30 . . . . . . . . . . . .
1978 144 36 72 18.00 63 60 20 8.20 18.60 41.80 . . . . . . . . . . . .
1979 160 40 80 20.00 69 60 20 8.70 18.10 41.30 . . . . . . . . . . . .
1980 180 45 90 22.50 78 60 20 9.60 23.00 41.40 . . . . . . . . . . . .
1981 204 51 102 25.50 89 n,o 60 20 o 11.00 34.20 62.20 . . . . . . . . . . . .
1982 260 65 130 32.50 113 75 p 20 p 12.20 37.00 72.00 . . . . . . . . . . . .
1983 304 76 152 38.00 113 75 20 12.20 41.80 80.00 . . . . . . . . . . . .
1984 356 89 178 44.50 155 75 20 14.60 43.80 94.00 . . . . . . . . . . . .
1985 400 100 200 50.00 174 75 20 15.50 46.50 89.90 . . . . . . . . . . . .
1986 492 123 246 61.50 214 75 20 15.50 46.50 66.10 . . . . . . . . . . . .
1987 520 130 260 65.00 226 75 20 17.90 53.70 88.10 . . . . . . . . . . . .
1988 540 135 270 67.50 234 75 20 24.80 74.40 72.40 . . . . . . . . . . . .
1989 560 q q q r  25.50 156 75 20 31.90 s 83.70 40.70 . . . . . . . . . . . .
1990 592 148 296 74.00 175 75 20 28.60 85.80 59.60 . . . . . . . . . . . .
1991 628 157 314 78.50 177 100 20 29.90 95.30 82.10 . . . . . . . . . . . .
1992 652 163 326 81.50 192 100 20 31.80 89.80 129.80 . . . . . . . . . . . .
1993 676 169 338 84.50 221 100 20 36.60 104.40 129.20 . . . . . . . . . . . .
1994 696 174 348 87.00 245 t 100 20 41.10 82.50 111.10 . . . . . . . . . . . .
1995 716 179 358 89.50 261 t 100 20 46.10 100.10 165.50 . . . . . . . . . . . .
1996 736 184 368 92.00 289 t 100 20 42.50 127.30 167.70 . . . . . . . . . . . .
1997 760 190 380 95.00 311 t 100 20 43.80 131.40 177.00 . . . . . . . . . . . .
1998 764 191 382 95.50 309 t 100 20 43.80 132.00 150.40 . . . . . . . . . . . .
1999 768 192 384 96.00 309 t 100 20 45.50 139.10 160.50 . . . . . . . . . . . .
2000 776 194 388 97.00 301 t 100 20 45.50 138.30 196.70 . . . . . . . . . . . .
2001 792 198 396 99.00 300 t 100 20 50.00 152.00 214.40 . . . . . . . . . . . .
2002 812 203 406 101.50 319 t 100 20 54.00 164.60 192.20 . . . . . . . . . . . .
2003 840 210 420 105.00 316 t 100 20 58.70 178.70 223.30 . . . . . . . . . . . .
2004 876 219 438 109.50 343 t 100 20 66.60 199.80 284.40 u u u u
2005 912 228 456 114.00 375 t 110 20 78.20 234.60 305.40 u u u u
2006 952 238 476 119.00 393 t 124 20 88.50 265.30 318.90 250 2,250 3,600 v 32.20 w
2007 992 248 496 124.00 410 t 131 20 93.50 x 280.50 y 301.10 y 265 2,400 3,850 v 27.35 w
2008 1,024 256 512 128.00 423 t 135 20 96.40 x 289.00 y 323.00 y 275 2,510 4,050 v 27.93 w
SOURCE: Centers for Medicare & Medicaid Services.
NOTES: The structure of Medicare has become increasingly complex over the years. This table provides a summary of Medicare cost sharing and premium provisions. It should be used as an overview and general guide. It is not intended to explain fully all of the provisions or exclusions of the applicable Medicare laws, regulations, and rulings. Original sources of authority should be researched and utilized.
. . . = not applicable.
a. The deductible and coinsurance amounts begin in January unless otherwise noted. The monthly premium amounts were effective in July through 1983 and in January for 1984 and succeeding years.
b. Standard premium rate for voluntary enrollment by certain aged and disabled individuals not otherwise entitled to Hospital Insurance (HI). (Most individuals aged 65 and older and many disabled individuals under age 65 are insured for HI benefits without payment of any premium.) In most (but not all) cases, a surcharge applies for those beneficiaries who enroll after their initial enrollment period.
c. Most (but not all) services under Part B are subject to the annual deductible and coinsurance percentages shown. Some noteworthy exceptions are footnoted. Noteworthy exceptions in recent years, as of this writing, include (1) clinical lab tests, home health agency services, and certain prescribed preventive care services, which are not subject to the deductible or coinsurance and for which the beneficiary pays nothing; (2) outpatient psychiatric services, for which the coinsurance is 50 percent; and (3) most services reimbursed under the outpatient hospital prospective payment system, for which the coinsurance percentage varies by service but currently falls in the range of 20 percent to 50 percent. Original sources of authority, such as the laws, regulations, and rulings for Part B, should be consulted if specific details are required.
d. There are substantial premium and cost-sharing subsidies for Part D beneficiaries who meet certain low-income and limited-resources criteria. Subsidy levels vary on the basis of dual-eligibility status (that is, coverage by both Medicaid and Medicare), income level, asset level, and institutionalized/noninstitutionalized status. Premiums and cost-sharing amounts for beneficiaries meeting the criteria may be reduced or waived. (The subsidies are financed by certain payments from the general fund of the U.S. Treasury and from the states.) Original sources of authority, such as the laws, regulations, and rulings for Part D, should be consulted if specific details are required.
e. Under the standard Part D benefit design, there is an initial deductible. After meeting the deductible, the beneficiary pays 25 percent of the remaining costs until the initial coverage limit is reached. The beneficiary is then responsible for all costs until the out-of-pocket threshold is reached. (Included in the total out-of-pocket expenditures are the deductible, the 25 percent of costs that is paid by the beneficiary after the deductible is met until the initial coverage limit is reached, and the 100 percent the beneficiary pays for costs above the initial coverage limit. In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception to this "true out-of-pocket" provision is cost-sharing assistance from the low-income subsidies provided under Part D and from State Pharmacy Assistance programs.) For costs thereafter, there is catastrophic coverage that requires enrollees to pay the greater of 5 percent coinsurance or a small defined copayment amount ($2 in 2006, $2.15 in 2007, and $2.25 in 2008 for generic or preferred multisource drugs, and $5.00 in 2006, $5.35 in 2007, and $5.60 in 2008 for other drugs). Many Part D plans offer alternative coverage that differs from the standard coverage described above. In fact, the majority of beneficiaries are not enrolled in the standard benefit design but rather in plans with low or no deductibles, flat payments for covered drugs, and, in some cases, partial coverage in the coverage gap. Covered drugs may vary by plan. Original sources of authority, such as the laws, regulations, and rulings for Part D, should be consulted if more specific details are required.
f. Part D base beneficiary premium. The actual Part D premiums paid by individual beneficiaries equal the base beneficiary premiums adjusted by a number of factors. Premiums vary significantly from one Part D plan to another and seldom equal the base beneficiary premium. A surcharge for enrollment after an individual's initial enrollment period may apply. (Late enrollment penalties do not apply to enrollees who have maintained creditable prescription drug coverage.) Enrollment in Part D is voluntary.
g. Standard premium rate for voluntary enrollment in Part B. While this will be the amount paid by most Part B beneficiaries, there are three provisions that can alter the premium rate for certain enrollees. First, in most (but not all) cases, a surcharge applies for those beneficiaries who enroll after their initial enrollment period. Second, beginning in 2007, beneficiaries whose income is above certain thresholds are required to pay an income-related monthly adjustment amount, in addition to their standard monthly premium; see footnote x. Finally, a "hold-harmless" provision, which prohibits increases in the standard Part B premium from exceeding the dollar amount of an individual's Social Security cost-of-living adjustment, lowers the premium rate for certain individuals who have their premiums deducted from their Social Security checks.
h. Beginning in July 1973 for the disabled.
i. Benefit not provided.
j. Professional inpatient services of pathologists and radiologists not subject to deductible or coinsurance, beginning in April 1968.
k. Beginning in April 1968.
l. Home health services not subject to coinsurance, beginning in January 1973.
m. Standard monthly premiums for July and August 1973 were reduced to $5.80 and $6.10, respectively, by the Cost of Living Council.
n. Home health services not subject to deductible, beginning July 1, 1981.
o. Professional inpatient services of pathologists and radiologists not subject to deductible or coinsurance, beginning in April 1968, but only when physician accepts assignment.
p. Effective October 1, 1982, professional inpatient services of pathologists and radiologists are subject to deductible and coinsurance.
q. Unlike all other years, the 1989 deductible was applied on an annual, rather than a benefit period, basis. Once the deductible was paid by the beneficiary, Medicare paid the balance of expenses for covered hospital services, regardless of the number of days of hospitalization (except for psychiatric hospital care, which was still limited by the 190-day lifetime maximum).
r. The coinsurance amount in 1989 was equal to 20 percent of the estimated national average daily cost of covered skilled nursing facility care, rather than 1/8 of the inpatient hospital deductible. The beneficiary paid the coinsurance amount for the first 8 days of care in 1989, rather than for days of care 21 to 100 in a benefit period as in all other years. Skilled nursing facility benefits were available for up to 150 days of care per year in 1989, rather than for up to 100 days of care per benefit period as in all other years.
s. Includes the standard monthly Part B premium and a supplemental monthly flat premium under the Medicare Catastrophic Coverage Act of 1988. Amount shown is for most Part B enrollees. Residents of Puerto Rico and other territories and commonwealths, as well as persons enrolled in Part B only, paid different supplemental flat premiums, resulting in a smaller premium than that shown.
t. A reduced premium is available to individuals aged 65 and older who are not otherwise entitled to HI but who have (or who were married to, widowed, or divorced from a spouse for certain periods of time who has or had) at least 30 quarters of Medicare-covered employment. The reduced premium is $184, $183, $188, $187, $170, $170, $166, $165, $175, $174, $189, $206, $216, $226, and $233, for 1994 to 2008, respectively.
u. A temporary Medicare-endorsed prescription drug discount card program was offered. For eligible beneficiaries voluntarily enrolling and paying up to $30 annually, discounts on certain prescription drugs were available, as specified by card sponsors. Under a Transitional Assistance (TA) provision, drug-card eligible beneficiaries whose incomes did not exceed 135 percent of the federal poverty level and who did not have third-party prescription drug coverage were eligible for (1) financial assistance of up to $600 per year for purchasing prescription drugs and (2) a subsidized enrollment fee for the discount card. Enrollment began May 2004, discount availability began June 2004, and the program phases out during 2006, as full Part D became available in January 2006.
v. The 2006 out-of-pocket threshold of $3,600 is equivalent to total covered drug costs of $5,100. The 2007 out-of-pocket threshold of $3,850 is equivalent to total covered drug costs of $5,451.25. The 2008 out-of-pocket threshold of $4,050 is equivalent to total covered drug costs of $5,726.25.
w. See footnote f. As of this writing, it is estimated that the average enrollee premium for basic Part D coverage, which reflects the specific plan-by-plan premiums and the actual number of beneficiaries in each plan, was about $23 in 2006, about $22 in 2007, and will be about $25 in 2008.
x. See footnote g. The 2008 Part B income-related monthly adjustment amounts and total monthly premium amounts to be paid by beneficiaries, according to income level and filing status, are shown in the Medicare section of "Program Descriptions and Legislative History" in this Supplement. The analogous amounts for 2007 are shown on page 41 of the 2006 Supplement.
y. Beginning January 2007 for Part B beneficiaries meeting certain income thresholds and thus paying income-related adjustment amounts in addition to their standard Part B premiums (see footnotes g and x), the government amounts are supposed to be reduced accordingly.
CONTACT: Sol Mussey (410) 786-6386.
Table 2.C2 Federal medical assistance percentage and enhanced federal medical assistance percentage, by state or other area, 2006–2008
State or area Federal medical assistance percentage a Enhanced federal medical assistance percentage b
2006 c 2007 d 2008 e 2006 c 2007 d 2008 e
Alabama 69.51 68.85 67.62 78.66 78.20 77.33
Alaska f 57.58 57.58 52.48 70.31 70.31 66.74
Arizona 66.98 66.47 66.20 76.89 76.53 76.34
Arkansas 73.77 73.37 72.94 81.64 81.36 81.06
California 50.00 50.00 50.00 65.00 65.00 65.00
Colorado 50.00 50.00 50.00 65.00 65.00 65.00
Connecticut 50.00 50.00 50.00 65.00 65.00 65.00
Delaware 50.09 50.00 50.00 65.06 65.00 65.00
District of Columbia g 70.00 70.00 70.00 79.00 79.00 79.00
Florida 58.89 58.76 56.83 71.22 71.13 69.78
Georgia 60.60 61.97 63.10 72.42 73.38 74.17
Hawaii 58.81 57.55 56.50 71.17 70.29 69.55
Idaho 69.91 70.36 69.87 78.94 79.25 78.91
Illinois 50.00 50.00 50.00 65.00 65.00 65.00
Indiana 62.98 62.61 62.69 74.09 73.83 73.88
Iowa 63.61 61.98 61.73 74.53 73.39 73.21
Kansas 60.41 60.25 59.43 72.29 72.18 71.60
Kentucky 69.26 69.58 69.78 78.48 78.71 78.85
Louisiana 69.79 69.69 72.47 78.85 78.78 80.73
Maine 62.90 63.27 63.31 74.03 74.29 74.32
Maryland 50.00 50.00 50.00 65.00 65.00 65.00
Massachusetts 50.00 50.00 50.00 65.00 65.00 65.00
Michigan 56.59 56.38 58.10 69.61 69.47 70.67
Minnesota 50.00 50.00 50.00 65.00 65.00 65.00
Mississippi 76.00 75.89 76.29 83.20 83.12 83.40
Missouri 61.93 61.60 62.42 73.35 73.12 73.69
Montana 70.54 69.11 68.53 79.38 78.38 77.97
Nebraska 59.68 57.93 58.02 71.78 70.55 70.61
Nevada 54.76 53.93 52.64 68.33 67.75 66.85
New Hampshire 50.00 50.00 50.00 65.00 65.00 65.00
New Jersey 50.00 50.00 50.00 65.00 65.00 65.00
New Mexico 71.15 71.93 71.04 79.81 80.35 79.73
New York 50.00 50.00 50.00 65.00 65.00 65.00
North Carolina 63.49 64.52 64.05 74.44 75.16 74.84
North Dakota 65.85 64.72 63.75 76.10 75.30 74.63
Ohio 59.88 59.66 60.79 71.92 71.76 72.55
Oklahoma 67.91 68.14 67.10 77.54 77.70 76.97
Oregon 61.57 61.07 60.86 73.10 72.75 72.60
Pennsylvania 55.05 54.39 54.08 68.54 68.07 67.86
Rhode Island 54.45 52.35 52.51 68.12 66.65 66.76
South Carolina 69.32 69.54 69.79 78.52 78.68 78.85
South Dakota 65.07 62.92 60.03 75.55 74.04 72.02
Tennessee 63.99 63.65 63.71 74.79 74.56 74.60
Texas 60.66 60.78 60.53 72.46 72.55 72.37
Utah 70.76 70.14 71.63 79.53 79.10 80.14
Vermont 58.49 58.93 59.03 70.94 71.25 71.32
Virginia 50.00 50.00 50.00 65.00 65.00 65.00
Washington 50.00 50.12 51.52 65.00 65.08 66.06
West Virginia 72.99 72.82 74.25 81.09 80.97 81.98
Wisconsin 57.65 57.47 57.62 70.36 70.23 70.33
Wyoming 54.23 52.91 50.00 67.96 67.04 65.00
Outlying areas
American Samoa h 50.00 50.00 50.00 65.00 65.00 65.00
Guam h 50.00 50.00 50.00 65.00 65.00 65.00
Northern Mariana Islands h 50.00 50.00 50.00 65.00 65.00 65.00
Puerto Rico h 50.00 50.00 50.00 65.00 65.00 65.00
Virgin Islands h 50.00 50.00 50.00 65.00 65.00 65.00
SOURCE: Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
a. Section 1905(b) of the Social Security Act (the Act) specifies the method to be used to compute the federal medical assistance percentage. From this section the following formula is derived: N = 3-year average national per capita personal income; S = 3-year average state per capita personal income. Federal medical assistance percentage: State share = (S2/N2) × 45 or (45/N2) × S2; Federal share = 100 − state share with 50–83 percent limits.
b. This is the Title XXI enhanced federal medical assistance percentage rate specified in section 2105(b) of the Act. The enhanced federal medical assistance percentage is limited to no more than 85 percent.
c. Effective October 1, 2005, through September 30, 2006.
d. Effective October 1, 2006, through September 30, 2007.
e. Effective October 1, 2007, through September 30 2008. These percentages may change for some states pending comments received on implementation of Section 6503(b) of the Deficit Reduction Act.
f. The revised federal medical assistance percentages and enhanced federal medical assistance percentages for Alaska for fiscal years 2006 and 2007 have been calculated pursuant to section 6053(a) of the Deficit Reduction Act. These revised percentages replace the percentages previously published for fiscal years 2006 and 2007.
g. The values for the District of Columbia (DC) in the table were set for the state plan under titles XIX and XXI and for capitation payments and Disproportionate Share Hospital (DSH) allotments under those titles. For other purposes, including programs remaining in Title IV of the Act, the percentage for DC is 50.00.
h. For purposes of section 1118 of the Social Security Act, the federal medical assistance percentage used under titles I, X, XIV, and XVI, and part A of title IV will be 75 percent.
CONTACT: Thomas Musco (202) 690-6870.