Annual Statistical Supplement, 2012

Program Provisions and SSA Administrative Data

Other Programs

Supplemental Security Income

Medicare

Medicaid

Table 2.B1 Federal benefit rates, by living arrangement, 1974–2012
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
January 1, 2008 637.00 956.00
January 1, 2009 674.00 1,011.00
January 1, 2010 674.00 1,011.00
January 1, 2011 674.00 1,011.00
January 1, 2012 698.00 1,048.00
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, 2011; 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: (410) 965-0090 or statistics@ssa.gov.
Table 2.C1 Medicare cost sharing and premium amounts, 1966–2013 a
Effective date b Hospital Insurance (Medicare Part A) Supplementary Medical Insurance (Medicare Parts B and D)
Part B Part D c
All expenses in "benefit period" covered except— Monthly premium d (dollars) Annual deductible e (dollars) Coinsurance e (percent) Monthly premium (dollars) Annual deductible f (dollars) Initial coverage limit f (dollars) Out-of-pocket threshold f (dollars) Base beneficiary monthly premium g (dollars)
Inpatient hospital deductible (IHD) covers first 60 days (dollars) Inpatient hospital daily coinsurance Skilled nursing facility daily coinsurance for days 21 through 100 (1/8 x IHD) (dollars) For enrollee h (aged and disabled) Government amounts for—
Days 61 through 90 (1/4 x IHD) (dollars) Lifetime reserve days after 90 days (1/2 x IHD) Aged Disabled
1966 40 10 . . . . . . . . . 50 20 3.00 3.00 . . . . . . . . . . . . . . .
1967 40 10 . . . 5.00 . . . 50 20 3.00 3.00 . . . . . . . . . . . . . . .
1968 40 10 20 5.00 . . . i 50 i 20 j 4.00 j 4.00 . . . . . . . . . . . . . . .
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 k 20 5.80 5.80 . . . . . . . . . . . . . . .
1973 72 18 36 9.00 33 60 20 l 6.30 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 m,n 60 n 20 11.00 34.20 62.20 . . . . . . . . . . . .
1982 260 65 130 32.50 113 o 75 o 20 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 p 560 p p q  25.50 156 75 20 r 31.90 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 87.00 245 100 20 41.10 82.50 111.10 . . . . . . . . . . . .
1995 716 179 358 89.50 261 100 20 46.10 100.10 165.50 . . . . . . . . . . . .
1996 736 184 368 92.00 289 100 20 42.50 127.30 167.70 . . . . . . . . . . . .
1997 760 190 380 95.00 311 100 20 43.80 131.40 177.00 . . . . . . . . . . . .
1998 764 191 382 95.50 309 100 20 43.80 132.00 150.40 . . . . . . . . . . . .
1999 768 192 384 96.00 309 100 20 45.50 139.10 160.50 . . . . . . . . . . . .
2000 776 194 388 97.00 301 100 20 45.50 138.30 196.70 . . . . . . . . . . . .
2001 792 198 396 99.00 300 100 20 50.00 152.00 214.40 . . . . . . . . . . . .
2002 812 203 406 101.50 319 100 20 54.00 164.60 192.20 . . . . . . . . . . . .
2003 840 210 420 105.00 316 100 20 58.70 178.70 223.30 . . . . . . . . . . . .
2004 876 219 438 109.50 343 100 20 66.60 199.80 284.40 s s s s
2005 912 228 456 114.00 375 110 20 78.20 234.60 305.40 s s s s
2006 952 238 476 119.00 393 124 20 88.50 265.30 318.90 250 2,250 t 3,600 32.20
2007 992 248 496 124.00 410 131 20 u 93.50 v 280.50 v 301.10 265 2,400 t 3,850 27.35
2008 1,024 256 512 128.00 423 135 20 u 96.40 v 289.00 v 323.00 275 2,510 t 4,050 27.93
2009 1,068 267 534 133.50 443 135 20 u 96.40 v 289.00 v 352.00 295 2,700 t 4,350 30.36
2010 1,100 275 550 137.50 461 155 20 u,w 110.50 v 331.50 v 430.30 310 2,830 t 4,550 31.94
2011 1,132 283 566 141.50 450 162 20 u,x 115.40 v 346.00 v 417.20 310 2,840 t 4,550 y 32.34
2012 1,156 289 578 144.50 451 140 20 u 99.90 v 299.70 v 285.10 320 2,930 t 4,700 y 31.08
2013 1,184 296 592 148.00 441 147 20 u 104.90 v 314.70 v 366.10 325 2,970 t 4,750 y 31.17
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 consulted for specific details.
Values for certain 2013 premiums, copayments, and out-of-pocket thresholds not shown in the table are provided in footnotes as applicable. Corresponding values for prior years are available in previous editions of this table.
. . . = not applicable.
a. As of November 1, 2012.
b. Deductible and coinsurance amounts begin in January unless otherwise noted. Monthly premium amounts took effect in July through 1983 and in January beginning in 1984.
c. Enrollment in Part D is voluntary. Substantial premium and cost-sharing subsidies and waivers are available for Part D beneficiaries who meet certain low-income and limited-resources criteria. Subsidy levels vary.
d. 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.) Beginning in 1994, a reduced premium is available to premium-paying HI enrollees with at least 30 quarters of Medicare-covered employment (either their own or through a current or former spouse if the marriage meets certain duration criteria). In most cases, a surcharge applies for beneficiaries who enroll after their initial enrollment period.
e. Most services under Part B are subject to the annual deductible and coinsurance percentages shown. Some noteworthy exceptions are footnoted; others 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 but phases down to 20 percent over the 5-year period 2010–2014; 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.
f. Under the standard Part D benefit design, the beneficiary pays an initial deductible and 25 percent of the remaining costs until reaching the initial coverage limit. Between the initial coverage limit and the out-of-pocket threshold is a "coverage gap." Beneficiaries in the coverage gap paid the full cost of their prescription drugs from 2006 to 2009. Beneficiaries in the coverage gap (excluding low-income enrollees eligible for cost-sharing subsidies and enrollees in employer plans that receive Medicare's retiree drug subsidy) received, in 2010, a $250 rebate; in 2011, a 50-percent manufacturer discount on applicable brand-name prescription drugs and a 7-percent drug plan benefit on covered generic drugs; and in 2012, a 50-percent manufacturer discount on applicable brand-name prescription drugs and a 14-percent drug plan benefit on covered generic drugs. In 2013, they will receive a 50-percent manufacturer discount and a 2.5-percent drug plan benefit on applicable brand-name prescription drugs and a 21-percent drug plan benefit on covered generic drugs. In determining out-of-pocket costs, costs reimbursed through insurance are not counted toward the out-of-pocket threshold, except for cost-sharing assistance provided to low-income enrollees by Part D and State Pharmacy Assistance programs and, starting in 2011, the 50-percent manufacturer discount on applicable brand-name drugs purchased by enrollees in the Part D coverage gap. For costs incurred after the out-of-pocket threshold is reached, "catastrophic coverage" requires enrollees to pay the greater of a 5-percent coinsurance or a small copayment (for 2013, $2.65 for generic or preferred multi-source drugs and $6.60 for other drugs). Many Part D plans differ from this standard coverage design; in fact, the majority of beneficiaries are enrolled in plans with low or no deductibles, flat payments for covered drugs, and, in some cases, additional partial coverage in the coverage gap.
g. The Part D premiums paid by individual beneficiaries equal the base beneficiary premium adjusted by a number of factors. Premiums vary significantly from one plan to another and seldom equal the base beneficiary premium. The estimated average monthly premium for 2013, as calculated prior to the start of the year (based on the bids submitted by Part D plans, the specific plan-by-plan premiums, and the estimated number of beneficiaries in each plan) is $30. A surcharge for enrollment after the initial enrollment period may apply.
h. Represents standard premium for voluntary enrollment in Part B. This is the amount paid by most beneficiaries in most years (2010 and 2011 are notable exceptions). Three factors can alter the premium paid by a beneficiary: enrollment after the initial enrollment period, for which a surcharge may apply; adjustments for beneficiaries whose income is above certain thresholds; and a "hold-harmless" provision that prohibits Part B premium increases that exceed the dollar amount of a beneficiary's Social Security cost-of-living adjustment. See also footnotes u, w, and x.
i. Professional inpatient services of pathologists and radiologists not subject to deductible or coinsurance, beginning in April 1968.
j. Beginning in April 1968.
k. Home health services not subject to coinsurance, beginning in January 1973.
l. Standard monthly premiums for July and August 1973 were reduced to $5.80 and $6.10, respectively, by the Cost of Living Council.
m. Home health services not subject to deductible, beginning July 1, 1981.
n. Professional inpatient services of pathologists and radiologists not subject to deductible or coinsurance, but only when physician accepts assignment.
o. Effective October 1, 1982, professional inpatient services of pathologists and radiologists are subject to deductible and coinsurance.
p. The 1989 deductible was applied on an annual basis rather than a benefit-period basis. Once the beneficiary paid the deductible, 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 to 190 days).
q. In 1989 the coinsurance amount was equal to 20 percent of the estimated national average daily cost of covered skilled nursing facility care, the beneficiary paid the coinsurance amount for the first 8 days of care during the year, and benefits were available for up to 150 days of care during the year.
r. Includes the standard monthly Part B premium and a supplemental monthly flat premium under the Medicare Catastrophic Coverage Act of 1988. Persons enrolled in Part B only and residents of Puerto Rico and other territories and commonwealths paid lower supplemental flat premiums.
s. A temporary Medicare-endorsed prescription drug discount card program was offered. See the Medicare section of "Program Descriptions and Legislative History" (page 52 in this Supplement).
t. Under the defined standard benefit design, the out-of-pocket threshold of $4,750 for 2013 is equivalent to an estimated $6,938.69 in total covered drug costs for enrollees not eligible for low-income cost-sharing subsidies. (This estimated amount is based on an average blend of brand-name and generic drugs used while in the Part D coverage gap. In determining out-of-pocket costs, the dollar value of the 50-percent manufacturer discount on applicable brand-name drugs is included, even though the beneficiary does not pay it. The dollar values of the 21-percent drug plan benefit on covered generic drugs and the 2.5-percent drug plan benefit on applicable brand-name drugs do not count toward out-of-pocket spending.) For enrollees eligible for low-income cost-sharing subsidies, the 2013 out-of-pocket threshold is equivalent to $6,733.75 in total covered drug costs. See previous editions of this table for prior years' equivalent total covered drug costs.
u. See footnote h. The 2013 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" (page 39 in this Supplement). See previous editions of the Supplement for prior years' adjustment and premium amounts.
v. For beneficiaries paying an income-related adjustment, the government amounts are to be reduced accordingly. See also footnotes h and u.
w. Most Part B enrollees are protected by a "hold-harmless" provision prohibiting Part B premium increases that exceed the dollar amount of an individual's Social Security cost-of-living adjustment (COLA). Because the 2010 COLA equaled 0 percent, about 73 percent of Part B enrollees continued to pay the 2009 premium amount in 2010.
x. See footnote w. Because the 2011 COLA again equaled 0 percent, most Part B enrollees continued to pay the same premium amount they paid in 2010.
y. See footnote g. The 2013 Part D income-related monthly adjustment 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" (page 40 in this Supplement). See previous editions of the Supplement for prior years' adjustment amounts.
CONTACT: John Shatto (410) 786-0706 or statistics@ssa.gov
Table 2.C2 Federal medical assistance percentage and enhanced federal medical assistance percentage, by state or other area, 2011–2013
State or area Federal medical assistance percentage a Enhanced federal medical assistance percentage b
2011 c 2012 d 2013 e 2011 c 2012 d 2013 e
Alabama 68.54 68.62 68.53 77.98 78.03 77.97
Alaska 50.00 50.00 50.00 65.00 65.00 65.00
Arizona 65.85 67.30 65.68 76.10 77.11 75.98
Arkansas 71.37 70.71 70.17 79.96 79.50 79.12
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 53.15 54.17 55.67 67.21 67.92 68.97
District of Columbia f 70.00 70.00 70.00 79.00 79.00 79.00
Florida 55.45 56.04 58.08 68.82 69.23 70.66
Georgia 65.33 66.16 65.56 75.73 76.31 75.89
Hawaii 51.79 50.48 51.86 66.25 65.34 66.30
Idaho 68.85 70.23 71.00 78.20 79.16 79.70
Illinois 50.20 50.00 50.00 65.14 65.00 65.00
Indiana 66.52 66.96 67.16 76.56 76.87 77.01
Iowa 62.63 60.71 59.59 73.84 72.50 71.71
Kansas 59.05 56.91 56.51 71.34 69.84 69.56
Kentucky 71.49 71.18 70.55 80.04 79.83 79.39
Louisiana 63.61 61.09 61.24 74.53 72.76 72.87
Maine 63.80 63.27 62.57 74.66 74.29 73.80
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 65.79 66.14 66.39 76.05 76.30 76.47
Minnesota 50.00 50.00 50.00 65.00 65.00 65.00
Mississippi 74.73 74.18 73.43 82.31 81.93 81.40
Missouri 63.29 63.45 61.37 74.30 74.42 72.96
Montana 66.81 66.11 66.00 76.77 76.28 76.20
Nebraska 58.44 56.64 55.76 70.91 69.65 69.03
Nevada 51.61 56.20 59.74 66.13 69.34 71.82
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 69.78 69.36 69.07 78.85 78.55 78.35
New York 50.00 50.00 50.00 65.00 65.00 65.00
North Carolina 64.71 65.28 65.51 75.30 75.70 75.86
North Dakota 60.35 55.40 52.27 72.25 68.78 66.59
Ohio 63.69 64.15 63.58 74.58 74.91 74.51
Oklahoma 64.94 63.88 64.00 75.46 74.72 74.80
Oregon 62.85 62.91 62.44 74.00 74.04 73.71
Pennsylvania 55.64 55.07 54.28 68.95 68.55 68.00
Rhode Island 52.97 52.12 51.26 67.08 66.48 65.88
South Carolina 70.04 70.24 70.43 79.03 79.17 79.30
South Dakota 61.25 59.13 56.19 72.88 71.39 69.33
Tennessee 65.85 66.36 66.13 76.10 76.45 76.29
Texas 60.56 58.22 59.30 72.39 70.75 71.51
Utah 71.13 70.99 69.61 79.79 79.69 78.73
Vermont 58.71 57.58 56.04 71.10 70.31 69.23
Virginia 50.00 50.00 50.00 65.00 65.00 65.00
Washington 50.00 50.00 50.00 65.00 65.00 65.00
West Virginia 73.24 72.62 72.04 81.27 80.83 80.43
Wisconsin 60.16 60.53 59.74 72.11 72.37 71.82
Wyoming 50.00 50.00 50.00 65.00 65.00 65.00
Outlying areas
American Samoa g 50.00 50.00 55.00 65.00 65.00 68.50
Guam g 50.00 50.00 55.00 65.00 65.00 68.50
Northern Mariana Islands g 50.00 50.00 55.00 65.00 65.00 68.50
Puerto Rico g 50.00 50.00 55.00 65.00 65.00 68.50
U.S. Virgin Islands g 50.00 50.00 55.00 65.00 65.00 68.50
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) x 45 or (45/N2) x 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 cannot exceed 85 percent.
c. Effective October 1, 2010, through September 30, 2011.
d. Effective October 1, 2011, through September 30, 2012.
e. Effective October 1, 2012, through September 30, 2013.
f. 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.
g. 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 or statistics@ssa.gov.