Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71555 

TABLE 2—ESTIMATED TRANSFERS FOR CY 2024 DEDUCTIBLE AND COINSURANCE AMOUNTS

Category Transfers 

Annualized monetized transfers ............................................................... ¥$240 million. 

From Whom to Whom .............................................................................. Beneficiaries to Providers. 

D. Regulatory Flexibility Act 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities, if a rule has a significant impact 

on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

being nonprofit organizations or by 

meeting the Small Business 

Administration’s definition of a small 

business (having revenues of less than 

$9.0 million to $47 million in any 1 

year). Individuals and states are not 

included in the definition of a small 

entity. This annual notice announces 

the Medicare Part A deductible and 

coinsurance amounts for CY 2024 and 

will have an impact on certain Medicare 

beneficiaries. As a result, we are not 

preparing an analysis for the RFA 

because the Secretary has certified that 

this notice will not have a significant 

economic impact on a substantial 

number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare an RIA if a rule 

may have a significant impact on the 

operations of a substantial number of 

small rural hospitals. This analysis must 

conform to the provisions of section 604 

of the RFA. For purposes of section 

1102(b) of the Act, we define a small 

rural hospital as a hospital that is 

located outside of a metropolitan 

statistical area and has fewer than 100 

beds. This annual notice announces the 

Medicare Part A deductible and 

coinsurance amounts for CY 2024 and 

will have an impact on certain Medicare 

beneficiaries. As a result, we are not 

preparing an analysis for section 1102(b) 

of the Act because the Secretary has 

certified that this notice will not have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. 

E. Unfunded Mandates Reform Act 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2023, that threshold is approximately 

$177 million. This notice will not 

impose a mandate that will result in the 

expenditure by state, local, and Tribal 

Governments, in the aggregate, or by the 

private sector, of more than $177 

million in any 1 year. 

F. Federalism 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on state and local 

governments, preempts state law, or 

otherwise has Federalism implications. 

This notice will not have a substantial 

direct effect on state or local 

governments, preempt state law, or 

otherwise have Federalism implications. 

G. Congressional Review 

This notice is subject to the 

Congressional Review Act provisions of 

the Small Business Regulatory 

Enforcement Fairness Act of 1996 (5 

U.S.C. 801 et seq.) and has been 

transmitted to the Congress and the 

Comptroller General for review. 

Chiquita Brooks-LaSure, Administrator of 

the Centers for Medicare & Medicaid 

Services, approved this document on October 

11, 2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–22850 Filed 10–12–23; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8085–N] 

RIN 0938–AV13 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rates, and Annual Deductible 

Beginning January 1, 2024 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Notice. 

SUMMARY: This notice announces the 

monthly actuarial rates for aged (age 65 

and over) and disabled (under age 65) 

beneficiaries enrolled in Part B of the 

Medicare Supplementary Medical 

Insurance (SMI) program beginning 

January 1, 2024. In addition, this notice 

announces the monthly premium for 

aged and disabled beneficiaries, the 

deductible for 2024, and the incomerelated monthly adjustment amounts to 

be paid by beneficiaries with modified 

adjusted gross income above certain 

threshold amounts. The monthly 

actuarial rates for 2024 are $343.40 for 

aged enrollees and $427.20 for disabled 

enrollees. The standard monthly Part B 

premium rate for all enrollees for 2024 

is $174.70, which is equal to 50 percent 

of the monthly actuarial rate for aged 

enrollees (or approximately 25 percent 

of the expected average total cost of Part 

B coverage for aged enrollees) plus the 

$3.00 repayment amount required under 

current law. (The 2024 premium is 5.9 

percent or $9.80 higher than the 2023 

standard premium rate of $164.90, 

which included the $3.00 repayment 

amount.) The Part B deductible for 2024 

is $240.00 for all Part B beneficiaries. If 

a beneficiary has to pay an incomerelated monthly adjustment amount, 

that individual will have to pay a total 

monthly premium of about 35, 50, 65, 

80, or 85 percent of the total cost of Part 

B coverage plus a repayment amount of 

$4.20, $6.00, $7.80, $9.60, or $10.20, 

respectively. Beginning in 2023, certain 

Medicare enrollees who are 36 months 

post kidney transplant, and therefore are 

no longer eligible for full Medicare 

coverage, can elect to continue Part B 

coverage of immunosuppressive drugs 

by paying a premium. For 2024, the 

immunosuppressive drug premium is 

$103.00. 

DATES: The monthly actuarial rates are 

effective on January 1, 2024. 

FOR FURTHER INFORMATION CONTACT: M. 

Kent Clemens, (410) 786–6391. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Part B is the voluntary portion of the 

Medicare program that pays all or part 

of the costs for physicians’ services; 

outpatient hospital services; certain 

home health services; services furnished 

by rural health clinics, ambulatory 

surgical centers, and comprehensive 

outpatient rehabilitation facilities; and 

certain other medical and health 

services not covered by Medicare Part 


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A, Hospital Insurance. Medicare Part B 

is available to individuals who are 

entitled to Medicare Part A, as well as 

to U.S. residents who have attained age 

65 and are citizens and to non-citizens 

who were lawfully admitted for 

permanent residence and have resided 

in the United States for 5 consecutive 

years. Part B requires enrollment and 

payment of monthly premiums, as 

described in 42 CFR part 407, subpart B, 

and part 408, respectively. The 

premiums paid by (or on behalf of) all 

enrollees fund approximately one-fourth 

of the total incurred costs, and transfers 

from the general fund of the Treasury 

pay approximately three-fourths of these 

costs. 

The Secretary of Health and Human 

Services (the Secretary) is required by 

section 1839 of the Social Security Act 

(the Act) to announce the Part B 

monthly actuarial rates for aged and 

disabled beneficiaries as well as the 

monthly Part B premium. The Part B 

annual deductible, income-related 

monthly adjustment amounts, and the 

immunosuppressive drug premium are 

included because their determinations 

are directly linked to the aged actuarial 

rate. 

The monthly actuarial rates for aged 

and disabled enrollees are used to 

determine the correct amount of general 

revenue financing per beneficiary each 

month. These amounts, according to 

actuarial estimates, will equal, 

respectively, one-half of the expected 

average monthly cost of Part B for each 

aged enrollee (age 65 or over) and onehalf of the expected average monthly 

cost of Part B for each disabled enrollee 

(under age 65). 

The Part B deductible to be paid by 

enrollees is also announced. Prior to the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) (Pub. L. 108–173), the Part 

B deductible was set in statute. After 

setting the 2005 deductible amount at 

$110.00, section 629 of the MMA 

(amending section 1833(b) of the Act) 

required that the Part B deductible be 

indexed beginning in 2006. The 

inflation factor to be used each year is 

the annual percentage increase in the 

Part B actuarial rate for enrollees age 65 

and over. Specifically, the 2024 Part B 

deductible is calculated by multiplying 

the 2023 deductible by the ratio of the 

2024 aged actuarial rate to the 2023 aged 

actuarial rate. The amount determined 

under this formula is then rounded to 

the nearest $1.00. 

The monthly Part B premium rate to 

be paid by aged and disabled enrollees 

is also announced. (Although the costs 

to the program per disabled enrollee are 

different than for the aged, the statute 

provides that the two groups pay the 

same premium amount.) Beginning with 

the passage of section 203 of the Social 

Security Amendments of 1972 (Pub. L. 

92–603), the premium rate, which was 

determined on a fiscal-year basis, was 

limited to the lesser of the actuarial rate 

for aged enrollees, or the current 

monthly premium rate increased by the 

same percentage as the most recent 

general increase in monthly Title II 

Social Security benefits. 

However, the passage of section 124 

of the Tax Equity and Fiscal 

Responsibility Act of 1982 (TEFRA) 

(Pub. L. 97–248) suspended this 

premium determination process. 

Section 124 of TEFRA changed the 

premium basis to 50 percent of the 

monthly actuarial rate for aged enrollees 

(that is, 25 percent of program costs for 

aged enrollees). Section 606 of the 

Social Security Amendments of 1983 

(Pub. L. 98–21), section 2302 of the 

Deficit Reduction Act of 1984 (DEFRA 

84) (Pub. L. 98–369), section 93130 of 

the Consolidated Omnibus Budget 

Reconciliation Act of 1985 (COBRA 85) 

(Pub. L. 99–272), section 4080 of the 

Omnibus Budget Reconciliation Act of 

1987 (OBRA 87) (Pub. L. 100–203), and 

section 6301 of the Omnibus Budget 

Reconciliation Act of 1989 (OBRA 89) 

(Pub. L. 101–239) extended the 

provision that the premium be based on 

50 percent of the monthly actuarial rate 

for aged enrollees (that is, 25 percent of 

program costs for aged enrollees). This 

extension expired at the end of 1990. 

The premium rate for 1991 through 

1995 was legislated by section 

1839(e)(1)(B) of the Act, as added by 

section 4301 of the Omnibus Budget 

Reconciliation Act of 1990 (OBRA 90) 

(Pub. L. 101–508). In January 1996, the 

premium determination basis would 

have reverted to the method established 

by the 1972 Social Security Act 

Amendments. However, section 13571 

of the Omnibus Budget Reconciliation 

Act of 1993 (OBRA 93) (Pub. L. 103–66) 

changed the premium basis to 50 

percent of the monthly actuarial rate for 

aged enrollees (that is, 25 percent of 

program costs for aged enrollees) for 

1996 through 1998. 

Section 4571 of the Balanced Budget 

Act of 1997 (BBA) (Pub. L. 105–33) 

permanently extended the provision 

that the premium be based on 50 

percent of the monthly actuarial rate for 

aged enrollees (that is, 25 percent of 

program costs for aged enrollees). 

The BBA included a further provision 

affecting the calculation of the Part B 

actuarial rates and premiums for 1998 

through 2003. Section 4611 of the BBA 

modified the home health benefit 

payable under Part A for individuals 

enrolled in Part B. Under this section, 

beginning in 1998, expenditures for 

home health services not considered 

‘‘post-institutional’’ are payable under 

Part B rather than Part A. However, 

section 4611(e)(1) of the BBA required 

that there be a transition from 1998 

through 2002 for the aggregate amount 

of the expenditures transferred from 

Part A to Part B. Section 4611(e)(2) of 

the BBA also provided a specific yearly 

proportion for the transferred funds. 

The proportions were one-sixth for 

1998, one-third for 1999, one-half for 

2000, two-thirds for 2001, and fivesixths for 2002. For the purpose of 

determining the correct amount of 

financing from general revenues of the 

Federal Government, it was necessary to 

include only these transitional amounts 

in the monthly actuarial rates for both 

aged and disabled enrollees, rather than 

the total cost of the home health 

services being transferred. 

Section 4611(e)(3) of the BBA also 

specified, for the purpose of 

determining the premium, that the 

monthly actuarial rate for enrollees age 

65 and over be computed as though the 

transition would occur for 1998 through 

2003 and that one-seventh of the cost be 

transferred in 1998, two-sevenths in 

1999, three-sevenths in 2000, foursevenths in 2001, five-sevenths in 2002, 

and six-sevenths in 2003. Therefore, the 

transition period for incorporating this 

home health transfer into the premium 

was 7 years while the transition period 

for including these services in the 

actuarial rate was 6 years. 

Section 811 of the MMA, which 

amended section 1839 of the Act, 

requires that, starting on January 1, 

2007, the Part B premium a beneficiary 

pays each month be based on that 

individual’s annual income. (The MMA 

specified that there be a 5-year 

transition period to reach full 

implementation of this provision. 

However, section 5111 of the Deficit 

Reduction Act of 2005 (DRA) (Pub. L. 

109–171) modified the transition to a 3- 

year period, which ended in 2009.) 

Specifically, if a beneficiary’s modified 

adjusted gross income is greater than the 

legislated threshold amounts (for 2024, 

$103,000 for a beneficiary filing an 

individual income tax return and 

$206,000 for a beneficiary filing a joint 

tax return), the beneficiary is 

responsible for a larger portion of the 

estimated total cost of Part B benefit 

coverage. In addition to the standard 25- 

percent premium, these beneficiaries 

now have to pay an income-related 

monthly adjustment amount. The MMA 

made no change to the actuarial rate 

calculation, and the standard premium, 

which will continue to be paid by 


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beneficiaries whose modified adjusted 

gross income is below the applicable 

thresholds, still represents 25 percent of 

the estimated total cost to the program 

of Part B coverage for an aged enrollee. 

However, depending on income and tax 

filing status, a beneficiary can now be 

responsible for 35, 50, 65, 80, or 85 

percent of the estimated total cost of 

Part B coverage, rather than 25 percent. 

Section 402 of the Medicare Access and 

CHIP Reauthorization Act of 2015 

(MACRA) (Pub. L. 114–10) modified the 

income thresholds beginning in 2018, 

and section 53114 of the Bipartisan 

Budget Act of 2018 (BBA of 2018) (Pub. 

L. 115–123) further modified the income 

thresholds beginning in 2019. For years 

beginning in 2019, the BBA of 2018 

established a new income threshold. If 

a beneficiary’s modified adjusted gross 

income is greater than or equal to 

$500,000 for a beneficiary filing an 

individual income tax return and 

$750,000 for a beneficiary filing a joint 

tax return, the beneficiary is responsible 

for 85 percent of the estimated total cost 

of Part B coverage. The BBA of 2018 

specified that these new income 

threshold levels be inflation-adjusted 

beginning in 2028. The end result of the 

higher premium is that the Part B 

premium subsidy is reduced, and less 

general revenue financing is required, 

for beneficiaries with higher income 

because they are paying a larger share of 

the total cost with their premium. That 

is, the premium subsidy continues to be 

approximately 75 percent for 

beneficiaries with income below the 

applicable income thresholds, but it will 

be reduced for beneficiaries with 

income above these thresholds. 

The Consolidated Appropriations Act, 

2021 (Pub. L. 116–260) established a 

new basis for Medicare Part B eligibility 

for post-kidney-transplant 

immunosuppressive drug coverage only. 

Medicare eligibility due solely to endstage renal disease generally ends 36 

months after a successful kidney 

transplant. Beginning in 2023, postkidney-transplant individuals without 

certain types of insurance coverage can 

elect to enroll in Part B and receive 

coverage of immunosuppressive drugs 

only. The premium for this continuation 

of coverage is 15 percent of a different 

aged actuarial rate, which is equal to 

100 percent of costs for aged enrollees 

(rather than the standard aged actuarial 

rate, which is equal to one-half of the 

costs for aged enrollees). Enrollees 

paying the immunosuppressive 

premium are not subject to the late 

enrollment penalty and the $3.00 

repayment amounts, but they are subject 

to the hold-harmless provision 

(described later) and the income-related 

monthly adjustment amounts. The law 

requires transfers equal to the reduction 

in aggregate premiums payable that 

results from enrollees with coverage 

only for immunosuppressive drugs 

paying the immunosuppressive drug 

Part B premium rather than the standard 

Part B premium. These transfers are to 

be treated as premiums payable for 

general revenue matching purposes. 

Section 4732(c) of the BBA added 

section 1933(c) of the Act, which 

required the Secretary to allocate money 

from the Part B trust fund to the State 

Medicaid programs for the purpose of 

providing Medicare Part B premium 

assistance from 1998 through 2002 for 

the low-income Medicaid beneficiaries 

who qualify under section 1933 of the 

Act. This allocation, while not a benefit 

expenditure, was an expenditure of the 

trust fund and was included in 

calculating the Part B actuarial rates 

through 2002. For 2003 through 2015, 

the expenditure was made from the trust 

fund because the allocation was 

temporarily extended. However, 

because the extension occurred after the 

financing was determined, the 

allocation was not included in the 

calculation of the financing rates for 

these years. Section 211 of MACRA 

permanently extended this expenditure, 

which is included in the calculation of 

the Part B actuarial rates for 2016 and 

subsequent years. 

Another provision affecting the 

calculation of the Part B premium is 

section 1839(f) of the Act, as amended 

by section 211 of the Medicare 

Catastrophic Coverage Act of 1988 

(MCCA 88) (Pub. L. 100–360). (The 

Medicare Catastrophic Coverage Repeal 

Act of 1989 (Pub. L. 101–234) did not 

repeal the revisions to section 1839(f) of 

the Act made by MCCA 88.) Section 

1839(f) of the Act, referred to as the 

hold-harmless provision, provides that, 

if an individual is entitled to benefits 

under section 202 or 223 of the Act (the 

Old-Age and Survivors Insurance 

Benefit and the Disability Insurance 

Benefit, respectively) and has the Part B 

premium deducted from these benefit 

payments, the premium increase will be 

reduced, if necessary, to avoid causing 

a decrease in the individual’s net 

monthly payment. This decrease in 

payment occurs if the increase in the 

individual’s Social Security benefit due 

to the cost-of-living adjustment under 

section 215(i) of the Act is less than the 

increase in the premium. Specifically, 

the reduction in the premium amount 

applies if the individual is entitled to 

benefits under section 202 or 223 of the 

Act for November and December of a 

particular year and the individual’s Part 

B premiums for December and the 

following January are deducted from the 

respective month’s section 202 or 223 

benefits. The hold-harmless provision 

does not apply to beneficiaries who are 

required to pay an income-related 

monthly adjustment amount. 

A check for benefits under section 202 

or 223 of the Act is received in the 

month following the month for which 

the benefits are due. The Part B 

premium that is deducted from a 

particular check is the Part B payment 

for the month in which the check is 

received. Therefore, a benefit check for 

November is not received until 

December, but December’s Part B 

premium has been deducted from it. 

Generally, if a beneficiary qualifies for 

hold-harmless protection, the reduced 

premium for the individual for that 

January and for each of the succeeding 

11 months is the greater of either— 

• The monthly premium for January 

reduced as necessary to make the 

December monthly benefits, after the 

deduction of the Part B premium for 

January, at least equal to the preceding 

November’s monthly benefits, after the 

deduction of the Part B premium for 

December; or 

• The monthly premium for that 

individual for that December. 

In determining the premium 

limitations under section 1839(f) of the 

Act, the monthly benefits to which an 

individual is entitled under section 202 

or 223 of the Act do not include 

retroactive adjustments or payments and 

deductions on account of work. Also, 

once the monthly premium amount is 

established under section 1839(f) of the 

Act, it will not be changed during the 

year even if there are retroactive 

adjustments or payments and 

deductions on account of work that 

apply to the individual’s monthly 

benefits. 

Individuals who have enrolled in Part 

B late or who have re-enrolled after the 

termination of a coverage period are 

subject to an increased premium under 

section 1839(b) of the Act. The increase 

is a percentage of the premium and is 

based on the new premium rate before 

any reductions under section 1839(f) of 

the Act are made. 

Section 1839 of the Act, as amended 

by section 601(a) of the Bipartisan 

Budget Act of 2015 (Pub. L. 114–74), 

specified that the 2016 actuarial rate for 

enrollees age 65 and older be 

determined as if the hold-harmless 

provision did not apply. The premium 

revenue that was lost by using the 

resulting lower premium (excluding the 

forgone income-related premium 

revenue) was replaced by a transfer of 

general revenue from the Treasury, 


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which will be repaid over time to the 

general fund. 

Similarly, section 1839 of the Act, as 

amended by section 2401 of the 

Continuing Appropriations Act, 2021 

and Other Extensions Act (Pub. L. 116– 

159), specified that the 2021 actuarial 

rate for enrollees age 65 and older be 

determined as the sum of the 2020 

actuarial rate for enrollees age 65 and 

older and one-fourth of the difference 

between the 2020 actuarial rate and the 

preliminary 2021 actuarial rate (as 

determined by the Secretary) for such 

enrollees. The premium revenue lost by 

using the resulting lower premium 

(excluding the forgone income-related 

premium revenue) was replaced by a 

transfer of general revenue from the 

Treasury, which will be repaid over 

time. 

Starting in 2016, in order to repay the 

balance due (which includes the 

transfer amounts and the forgone 

income-related premium revenue from 

the Bipartisan Budget Act of 2015 and 

the Continuing Appropriations Act, 

2021 and Other Extensions Act), the 

Part B premium otherwise determined 

will be increased by $3.00. These 

repayment amounts will be added to the 

Part B premium otherwise determined 

each year and will be paid back to the 

general fund of the Treasury, and they 

will continue until the balance due is 

paid back. 

High-income enrollees pay the $3.00 

repayment amount plus an additional 

$1.20, $3.00, $4.80, $6.60, or $7.20 in 

repayment as part of the income-related 

monthly adjustment amount (IRMAA) 

premium dollars, which reduce (dollar 

for dollar) the amount of general 

revenue received by Part B from the 

general fund of the Treasury. Because of 

this general revenue offset, the 

repayment IRMAA premium dollars are 

not included in the direct repayments 

made to the general fund of the Treasury 

from Part B in order to avoid a double 

repayment. (Only the $3.00 monthly 

repayment amounts are included in the 

direct repayments.) 

These repayment amounts will 

continue until the balance due is zero. 

(In the final year of the repayment, the 

additional amounts may be modified to 

avoid an overpayment.) The repayment 

amounts (excluding those for highincome enrollees) are subject to the 

hold-harmless provision. The original 

balance due was $9,066,409,000, 

consisting of $1,625,761,000 in forgone 

income-related premium revenue plus a 

transfer amount of $7,440,648,000 from 

the provisions of the Bipartisan Budget 

Act of 2015. The increase in the balance 

due in 2021 was $8,799,829,000, 

consisting of $946,046,000 in forgone 

income-related premium income plus a 

transfer amount of $7,853,783,000 from 

the provisions of the Continuing 

Appropriations Act, 2021 and Other 

Extensions Act. An estimated 

$14,624,044,000 will have been repaid 

to the general fund by the end of 2023, 

with an estimated $3,242,194,000 

remaining to be repaid. 

II. Provisions of the Notice 

A. Notice of Medicare Part B Monthly 

Actuarial Rates, Monthly Premium 

Rates, and Annual Deductible 

The Medicare Part B monthly 

actuarial rates applicable for 2024 are 

$343.40 for enrollees age 65 and over 

and $427.20 for disabled enrollees 

under age 65. In section II.B. of this 

notice, we present the actuarial 

assumptions and bases from which 

these rates are derived. The Part B 

standard monthly premium rate for all 

enrollees for 2024 is $174.70. The Part 

B immunosuppressive drug premium is 

$103.00. 

The following are the 2024 Part B 

monthly premium rates to be paid by (or 

on behalf of) beneficiaries with full Part 

B coverage who file either individual 

tax returns (and are single individuals, 

heads of households, qualifying widows 

or widowers with dependent children, 

or married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns. 

BILLING CODE 4120–01–P 

For beneficiaries with 

immunosuppressive drug only Part B 

coverage, who file either individual tax 

returns (and are single individuals, 

heads of households, qualifying widows 

or widowers with dependent children, 

or married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns, the 2024 Part B monthly 

premium rates are shown below. 


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Full Part B Coverae:e 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who file joint tax returns with modified Adjustment Premium 

modified adjusted l{ross income: adjusted l{ross income: Amount Amount 

Less than or equal to $103,000 Less than or equal to $206,000 $0.00 $174.70 

Greater than $103.000 and less than or equal to $129 000 Greater than $206 000 and less than or equal to $258.000 $69.90 $244.60 

Greater than $129.000 and less than or equal to $161 000 Greater than $258 000 and less than or equal to $322 000 $174.70 $349.40 

Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $279.50 $454.20 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $384.30 $559.00 

Greater than or equal to $500,000 Greater than or equal to $750,000 $419.30 $594.00 
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71559 

In addition, the monthly premium 

rates to be paid by (or on behalf of) 

beneficiaries with full Part B coverage 

who are married and lived with their 

spouses at any time during the taxable 

year, but who file separate tax returns 

from their spouses, are as follows: 

The monthly premium rates to be 

paid by (or on behalf of) beneficiaries 

with immunosuppressive drug only Part 

B coverage who are married and lived 

with their spouses at any time during 

the taxable year, but who file separate 

tax returns from their spouses, are as 

follows: 

BILLING CODE 4120–01–C 

The Part B annual deductible for 2024 

is $240.00 for all beneficiaries. 

B. Statement of Actuarial Assumptions 

and Bases Employed in Determining the 

Monthly Actuarial Rates and the 

Monthly Premium Rate for Part B 

Beginning January 2024 

Except where noted, the actuarial 

assumptions and bases used to 

determine the monthly actuarial rates 

and the monthly premium rates for Part 

B are established by the Centers for 

Medicare & Medicaid Services’ Office of 

the Actuary. The estimates underlying 

these determinations are prepared by 

actuaries meeting the qualification 

standards and following the actuarial 

standards of practice established by the 

Actuarial Standards Board. 

1. Actuarial Status of the Part B Account 

in the Supplementary Medical 

Insurance Trust Fund 

Under section 1839 of the Act, the 

starting point for determining the 

standard monthly premium is the 

amount that would be necessary to 

finance Part B on an incurred basis. This 

is the amount of income that would be 

sufficient to pay for services furnished 

during that year (including associated 

administrative costs) even though 

payment for some of these services will 

not be made until after the close of the 

year. The portion of income required to 

cover benefits not paid until after the 

close of the year is added to the trust 

fund and used when needed. 

Because the premium rates are 

established prospectively, they are 

subject to projection error. Additionally, 

legislation enacted after the financing 

was established, but effective for the 

period in which the financing is set, 

may affect program costs. As a result, 

the income to the program may not 

equal incurred costs. Trust fund assets 

must therefore be maintained at a level 

that is adequate to cover an appropriate 

degree of variation between actual and 

projected costs, and the amount of 

incurred, but unpaid, expenses. 

Numerous factors determine what level 

of assets is appropriate to cover 

variation between actual and projected 

costs. For 2024, the four most important 

of these factors are (1) the impact of 

expected additional payments from the 

Part B account to 340B providers in 

response to a judicial remand order; (2) 

the difference from prior years between 

the actual performance of the program 

and estimates made at the time 

financing was established; (3) the 

likelihood and potential magnitude of 

expenditure changes resulting from 

enactment of legislation affecting Part B 

costs in a year subsequent to the 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.015</GPH> EN17OC23.016</GPH> EN17OC23.017</GPH>

Part B Immunosuooressive D~ Cover~e Only 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who file joint tax returns with modified Adjustment Premium 

modified adjusted ~ross income: adjusted ~ross income: Amount Amount 

Less than or equal to $l03,000 Less than or eaual to $206,000 $0.00 $l03.00 

Greater than $l03,000 and less than or equal to $129,000 Greater than $206,000 and less than or equal to $258,000 $68.70 $171.70 

Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $171.70 $274.70 

Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $274.70 $377.70 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $377.70 $480.70 

Greater than or eaual to $500,000 Greater than or equal to $750,000 $412.IO $515.IO 

Full Part B Covera2e 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who me separate tax returns from their Monthly Premium 

spouses, with modified ad_justed 2ross income: Ad_justment Amount Amount 

Less than or equal to $103,000 $0.00 $174.70 

Greater than $103,000 and less than $397,000 $384.30 $559.00 

Greater than or equal to $397,000 $419.30 $594.00 

Part B Immunosuooressive Dru2 Covera2e Only 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who me separate tax returns from their Monthly Premium 

spouses, with modified adjusted 2ross income: Adjustment Amount Amount 

Less than or equal to $103,000 $0.00 $103.00 

Greater than $103,000 and less than $397,000 $377.70 $480.70 

Greater than or equal to $397,000 $412.10 $515.10 
71560 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

establishment of financing for that year; 

and (4) the expected relationship 

between incurred and cash 

expenditures. The projected costs have 

a somewhat higher degree of uncertainty 

for 2024 due to the impact of the 

judicial remand order resulting in 

additional 340B drug payments. The 

other three factors are analyzed on an 

ongoing basis, as the trends can vary 

over time. 

Table 1 summarizes the estimated 

actuarial status of the trust fund as of 

the end of the financing period for 2022 

and 2023. 

2. Monthly Actuarial Rate for Enrollees 

Age 65 and Older 

The monthly actuarial rate for 

enrollees age 65 and older is one-half of 

the sum of monthly amounts for (1) the 

projected cost of benefits and (2) 

administrative expenses for each 

enrollee age 65 and older, after 

adjustments to this sum to allow for 

interest earnings on assets in the trust 

fund and an adequate contingency 

margin. The contingency margin is an 

amount appropriate to provide for 

possible variation between actual and 

projected costs and to amortize any 

surplus assets or unfunded liabilities. 

The monthly actuarial rate for 

enrollees age 65 and older for 2024 is 

determined by first establishing per 

enrollee costs by type of service from 

program data through 2021 and then 

projecting these costs for subsequent 

years. The projection factors used for 

financing periods from January 1, 2021 

through December 31, 2024 are shown 

in Table 2. 

As indicated in Table 3, the projected 

per enrollee amount required to pay for 

one-half of the total of benefits and 

administrative costs for enrollees age 65 

and over for 2024 is $349.10. Based on 

current estimates, the assets at the end 

of 2023 are sufficient to cover the 

amount of incurred, but unpaid, 

expenses, to provide for substantial 

variation between actual and projected 

costs. Thus, a negative contingency 

margin can be included to decrease 

assets to a more appropriate level. The 

monthly actuarial rate of $343.40 

provides an adjustment of ¥$3.30 for a 

contingency margin and ¥$2.40 for 

interest earnings. 

The contingency margin for 2024 is 

affected by several factors. Additional 

payments to 340B drug providers from 

Part B are expected as a result of a 

judicial remand order. In the unique 

context of a pending rulemaking on 

remand from a court, we anticipate that 

additional 340B payments will reduce 

the surplus in 2024, resulting in a 

higher contingency margin. We also 

anticipate that, should we finalize 

proposed payment decreases in future 

years to providers, that would result in 

correspondingly lower Part B financing 

rates in those years. Another factor 

affecting Part B costs is the broader 

coverage for certain newly-approved 

drugs that treat Alzheimer’s disease 

starting in July 2023. The broader 

coverage of these drugs results in a 

somewhat higher contingency margin. 

The Part B projected program costs were 

developed based on these assumptions 

and were included in the margin 

development. 

In addition, starting in 2011, 

manufacturers and importers of brandname prescription drugs pay a fee that 

is allocated to the Part B account of the 

SMI trust fund. For 2024, the total of 

these brand-name drug fees is estimated 

to be $2.8 billion. The contingency 

margin for 2024 has been reduced to 

account for this additional revenue. 

The traditional goal for the Part B 

reserve has been that assets minus 

liabilities at the end of a year should 

represent between 15 and 20 percent of 

the following year’s total incurred 

expenditures. To accomplish this goal, a 

17-percent reserve ratio, which is a fully 

adequate contingency reserve level, has 

been the normal target used to calculate 

the Part B premium. At the end of 2023, 

the reserve ratio is expected to be 25.3 

percent. When the reserve ratio is 

considerably higher than 20 percent, the 

typical approach in the premium 

determination is to target a gradual 

reduction in the reserve ratio to 20 

percent over a number of years. The 

Secretary, who determines the Part B 

premium each year under section 1839 

of the Act, directed the Office of the 

Actuary to use a 2024 premium increase 

of 5.9 percent, which targets a reserve 

ratio for the Part B premium 

determination of 22.6 percent by the 

end of 2024. 

The actuarial rate of $343.40 per 

month for aged beneficiaries, as 

announced in this notice for 2024, 

reflects the combined effect of the 

factors and legislation previously 

described and the projected 

assumptions listed in Table 2. 

3. Monthly Actuarial Rate for Disabled 

Enrollees 

Disabled enrollees are those persons 

under age 65 who are enrolled in Part 

B because of entitlement to Social 

Security disability benefits for more 

than 24 months or because of 

entitlement to Medicare under the endstage renal disease (ESRD) program. 

Projected monthly costs for disabled 

enrollees (other than those with ESRD) 

are prepared in a manner parallel to the 

projection for the aged using 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.018</GPH>

TABLE I-ESTIMATED ACTUARIAL STATUS OF THE PART B ACCOUNT 

IN THE SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND 

AS OF THE END OF THE FINANCING PERIOD 

Assets less 

Assets1 Liabilities2 Liabilities1 

Financine: Period Endine: (in millions) (in millions) (in millions) 

December 31 2022 $194,215 $34,152 $160 063 

December 31, 2023 $165,586 $34,708 $130,878 .. 1 In the umque context of a pendmg rulemaking on remand from a court, we have assumed remedy payments of $10.5 billion based on the 

amount we have proposed to pay providers (88 FR 44093), but that number is subject to any changes made in the fmal policy or by future, 

subsequent events, per our previous discussion of projection error. We also anticipate that, should we finalize proposed payment decreases in 

future years to providers, we will account for those savings in those future years. 2 These amounts include only items incurred but not paid. They do not include the amounts that are to be paid back to the general fund of the 

Treasury overtime as specified by section 1839 of the Act as amended by section 601(a) of the Bipartisan Budget Act of2015 and further 

amended by section 2401 of the Continuing Appropriations Act, 2021 and Other Extensions Act, nor do they include the Accelerated and 

Advance Payments Program amounts that are to be repaid by providers and returned to the general fund of the Treasury. 
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71561 

appropriate actuarial assumptions (see 

Table 2). Costs for the ESRD program are 

projected differently because of the 

different nature of services offered by 

the program. 

As shown in Table 4, the projected 

per enrollee amount required to pay for 

one-half of the total of benefits and 

administrative costs for disabled 

enrollees for 2024 is $436.36. The 

monthly actuarial rate of $427.20 also 

provides an adjustment of ¥$2.39 for 

interest earnings and ¥$6.77 for a 

contingency margin, reflecting the same 

factors and legislation described 

previously for the aged actuarial rate at 

magnitudes applicable to the disabled 

rate determination. Based on current 

estimates, the assets associated with the 

disabled Medicare beneficiaries at the 

end of 2023 are sufficient to cover the 

amount of incurred, but unpaid, 

expenses and to provide for a significant 

degree of variation between actual and 

projected costs. 

The actuarial rate of $427.20 per 

month for disabled beneficiaries, as 

announced in this notice for 2024, 

reflects the combined net effect of the 

factors and legislation described 

previously for aged beneficiaries and the 

projection assumptions listed in Table 

2. 

4. Sensitivity Testing 

Several factors contribute to 

uncertainty about future trends in 

medical care costs. It is appropriate to 

test the adequacy of the rates using 

alternative cost growth rate 

assumptions, the results of which are 

shown in Table 5. One set represents 

increases that are higher and, therefore, 

more pessimistic than the current 

estimate, and the other set represents 

increases that are lower and, therefore, 

more optimistic than the current 

estimate. The values for the alternative 

assumptions were determined from a 

statistical analysis of the historical 

variation in the respective increase 

factors. 

As indicated in Table 5, the monthly 

actuarial rates would result in an excess 

of assets over liabilities of $128,583 

million by the end of December 2024 

under the cost growth rate assumptions 

shown in Table 2 and under the 

assumption that the provisions of 

current law are fully implemented. This 

result amounts to 21.9 percent of the 

estimated total incurred expenditures 

for the following year. 

Assumptions that are somewhat more 

pessimistic (and that therefore test the 

adequacy of the assets to accommodate 

projection errors) produce a surplus of 

$64,240 million by the end of December 

2024 under current law, which amounts 

to 9.7 percent of the estimated total 

incurred expenditures for the following 

year. Under fairly optimistic 

assumptions, the monthly actuarial rates 

would result in a surplus of $212,701 

million by the end of December 2024, or 

41.0 percent of the estimated total 

incurred expenditures for the following 

year. 

The sensitivity analysis indicates that, 

in a typical year, the premium and 

general revenue financing established 

for 2024, together with existing Part B 

account assets, would be adequate to 

cover estimated Part B costs for 2024 

under current law, should actual costs 

prove to be somewhat greater than 

expected. 

5. Premium Rates and Deductible 

As determined in accordance with 

section 1839 of the Act, the following 

are the 2024 Part B monthly premium 

rates to be paid by (or on behalf of) 

beneficiaries with full Part B coverage 

who file either individual tax returns 

(and are single individuals, heads of 

households, qualifying widows or 

widowers with dependent children, or 

married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns. 

BILLING CODE 4120–01–P 

For beneficiaries with 

immunosuppressive drug only Part B 

coverage who file either individual tax 

returns (and are single individuals, 

heads of households, qualifying widows 

or widowers with dependent children, 

or married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns, the 2024 Part B monthly 

premium rates are shown below. 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.019</GPH>

Full Part B Coveraee 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who file joint tax returns with modified Adjustment Premium 

modified adjusted eross income: adjusted eross income: Amount Amount 

Less than or equal to $103,000 Less than or equal to $206,000 $0.00 $174.70 

Greater than $103,000 and less than or CQual to $129,000 Greater than $206,000 and less than or equal to $258,000 $69.90 $244.60 

Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $174.70 $349.40 

Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $279.50 $454.20 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $384.30 $559.00 

Greater than or equal to $500,000 Greater than or equal to $750,000 $419.30 $594.00 
71562 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

In addition, the monthly premium 

rates to be paid by (or on behalf of) 

beneficiaries with full Part B coverage 

who are married and lived with their 

spouses at any time during the taxable 

year, but who file separate tax returns 

from their spouses, are as follows: 

The monthly premium rates to be 

paid by (or on behalf of) beneficiaries 

with immunosuppressive drug only Part 

B coverage who are married and lived 

with their spouses at any time during 

the taxable year, but who file separate 

tax returns from their spouses, are as 

follows: 

The Part B annual deductible for 2024 

is $240.00 for all beneficiaries. 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.020</GPH> EN17OC23.021</GPH> EN17OC23.022</GPH>

Part B Immunosuooressive Dru2 Covertt2e Only 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who file joint tax returns with modified Adjustment Premium 

modified adjusted 2ross income: adjusted 2ross income: Amount Amount 

Less than or equal to $l03,000 Less than or eaual to $206,000 $0.00 $l03.00 

Greater than $l03,000 and less than or equal to $129,000 Greater than $206,000 and less than or equal to $258,000 $68.70 $171.70 

Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $171.70 $274.70 

Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $274.70 $377.70 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $377.70 $480.70 

Greater than or equal to $500,000 Greater than or equal to $750,000 $412.IO $515.IO 

Full Part B Covera2e 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who file separate tax returns from their Monthly Premium 

spouses, with modified ad_iusted 2ross income: Ad_iustment Amount Amount 

Less than or equal to $103,000 $0.00 $174.70 

Greater than $103,000 and less than $397,000 $384.30 $559.00 

Greater than or equal to $397,000 $419.30 $594.00 

Part B Immunosuooressive Dru2 Covera2e Only 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who file separate tax returns from their Monthly Premium 

spouses, with modified adiusted 2:ross income: Adiustment Amount Amount 

Less than or eQual to $103,000 $0.00 $103.00 

Greater than $103,000 and less than $397,000 $377.70 $480.70 

Greater than or eQual to $397,000 $412.10 $515.10 

EN17OC23.023</GPH>lotter on DSK11XQN23PROD with NOTICES1

TABLE 2-PROJECTION FACTORS1 

12-MONTH PERIODS ENDING DECEl\iIBER 31 OF 2021-2024 (IN PERCENT) 

Durable Physician- Other 

Calendar Physician Fee Medical Practitioner Administered Practitioner Outpatient 

Year Schedule Equiument Lab2 Drues Senrices3 Hosuital 

Aged: 

2021 18.6 5.8 20.5 10.8 5.4 19.7 

2022 3.7 15.1 -4.3 11.8 19.9 5.9 

2023 3.5 14.9 1.0 12.9 12.3 16.0 

2024 2.0 -0.8 6.2 8.1 -20.8 9.0 

Disabled: 

2021 15.8 4.0 18.2 15.2 2.7 12.7 

2022 -0.3 11.2 -5.9 18.2 13.0 3.5 

2023 5.8 12.9 2.3 25.1 16.9 14.1 

2024 3.0 -0.3 7.3 9.1 -1.5 10.5 

1 All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee. 

2 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab. 

3 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. 

' Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

Home 

Health 

Aeencv 

3.9 

-3.0 

12.6 

3.4 

4.7 

0.5 

11.5 

7.2 

' Includes services furnished in dialysis facilities, rural health cliuics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc. 

Hospital 

Lab4 

15.1 

-2.5 -3.9 

3.3 

19.6 

-2.2 -6.4 

4.4 

EN17OC23.024</GPH>lotter on DSK11XQN23PROD with NOTICES1

TABLE 3-DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES A

FOR FINANCING PERIODS ENDING DECEMBER 31, 2021 THROUGH DECEM

CY2021 I CY2022 

Covered services (at level recognized): 

Physician fee schedule $69.38 $68.27 

Durable medical eauipment 6.14 6.71 

Practitioner lab1 5.16 4.69 

Physician-administered drugs 18.13 19.23 

Other practitioner services2 8.78 9.99 

Outoatient hospital 51.83 52.09 

Home health agencv 7.97 7.33 

Hospital lab3 2.35 2.17 

Other institutional services4 17.04 16.43 

Managed care 140.15 158.01 

Total services 326.92 344.91 

Cost sharing: 

Deductible -7.77 -8.90 

Coinsurance -27.27 -26.71 

Sequestration of benefits 0.00 -3.86 

Total benefits 291.88 305.42 

Administrative exoenses 4.74 4.74 

Incurred expenditures 296.61 310.16 

Value of interest -1.93 -2.54 

Contingency marn:in for proiection error and to amortize the surolus or deficit -3.68 26.58 

Monthly actuarial rate $291.00 $334.20 

1 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab. 

2 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. 

3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

I 

4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation, and psychiatr

EN17OC23.025</GPH>lotter on DSK11XQN23PROD with NOTICES1

TABLE 4---DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISA

ENROLLEES 

FOR FINANCING PERIODS ENDING DECEMBER 31, 2021, THROUGH DE

31,2024 

CY2021 I CY2022 I 

Covered services (at level recognized): 

Physician fee schedule $63.39 $56.88 

Durable medical eauipment 10.23 10.25 Practitioner lab1 5.88 5.06 

Physician-administered drugs 16.23 17.33 

Other practitioner services2 11.15 10.93 

Outpatient hospital 56.64 52.57 

Home health agencv 6.38 5.73 Hosoital lab3 2.70 2.41 

Other institutional services4 41.53 36.69 

Managed care 179.07 213.06 

Total services 393.19 410.90 

Cost sharing: 

Deductible -7.30 -8.36 

Coinsurance -35.02 -29.61 

Seauestration of benefits 0.00 -4.66 

Total benefits 350.87 368.27 

Administrative exnenses 5.71 5.71 

Incurred expenditures 356.57 373.98 

Value of interest -2.49 -3.34 

Contingency mar!!in for projection error and to amortize the surplus or deficit -4.18 -1.74 

Monthly actuarial rate $349.90 $368.90 

1 Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab. 

2 Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies

3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitati

psychiatric hospitals, etc. 
Requirements 

III. Collection of Information 

BILLING CODE 4120–01–C 

This document does not impose 

Consequently, there is no need for 

third-party disclosure requirements. 

that is, reporting, recordkeeping, or 

information collection requirements— 

U.S.C. 3501 

Paperwork Reduction Act of 1995 (44 

Budget under the authority of the 

review by the Office of Management and 

et seq.). 

A. Statement of Need 

IV. Regulatory Impact Analysis 

This notice announces the monthly 

actuarial rates and premium rates, as requires the Secretary to provide for 

section 1839(a)(1) of the Act, which 

January 1, 2024. It also responds to 

Insurance (SMI) program beginning 

Medicare Supplementary Medical 

beneficiaries enrolled in Part B of the 

by section 1833(b) of the Act, for 

and the annual deductible, as required 

required by section 1839(a) of the Act, 


EN17OC23.026</GPH>lotter on DSK11XQN23PROD with NOTICES1

TABLE 5--ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SMI 

UNDER THREE SETS OF ASSUMPTIONS FOR FINANCING PERIODS THROUGH 

As of December 31, 2022 2023 

Actuarial status (in millions): 

Assets $194,215 $165,586 

Liabilities $34,152 $34,708 

Assets less liabilities $160,063 $130,878 

Ratio1 31.7% 24.5% 

Low-cost projection: 

Actuarial status (in millions): 

Assets $194,215 $191,638 

Liabilities $34,152 $31,813 

Assets less liabilities $160,063 $159,826 

Ratio1 33.7% 32.9% 

High-cost projection: 

Actuarial status (in millions): 

Assets $194,215 $140,334 

Liabilities $34,152 $37,514 

Assets less liabilities $160,063 $102,820 

Ratio1 30.1% 17.6% 

1 Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the following year, exp
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71567 

publication of these amounts in the 

Federal Register during the September 

that precedes the start of each calendar 

year. As section 1839 prescribes a 

detailed methodology for calculating 

these amounts, we do not have the 

discretion to adopt an alternative 

approach on these issues. 

B. Overall Impact 

We have examined the impact of this 

notice as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), Executive Order 14094 entitled 

‘‘Modernizing Regulatory Review’’ 

(April 6, 2023), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, section 202 of 

the Unfunded Mandates Reform Act of 

1995 (March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999), and the Congressional 

Review Act (5 U.S.C. 804(2)). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). The Executive Order 14094 

entitled ‘‘Modernizing Regulatory 

Review’’ (hereinafter, the Modernizing 

E.O.) amends section 3(f)(1) of Executive 

Order 12866 (Regulatory Planning and 

Review). The amended section 3(f) of 

Executive Order 12866 defines a 

‘‘significant regulatory action’’ as an 

action that is likely to result in a notice/ 

rule: (1) having an annual effect on the 

economy of $200 million or more in any 

one year (adjusted every 3 years by the 

Administrator of OIRA for changes in 

gross domestic product), or adversely 

affect in a material way the economy, a 

sector of the economy, productivity, 

competition, jobs, the environment, 

public health or safety, or State, local, 

territorial, or tribal governments or 

communities; (2) creating a serious 

inconsistency or otherwise interfering 

with an action taken or planned by 

another agency; (3) materially altering 

the budgetary impacts of entitlement 

grants, user fees, or loan programs or the 

rights and obligations of recipients 

thereof; or (4) raise legal or policy issues 

for which centralized review would 

meaningfully further the President’s 

priorities, or the principles set forth in 

the Executive Order, as specifically 

authorized in a timely manner by the 

Administrator of OIRA in each case. 

A regulatory impact analysis (RIA) 

must be prepared for major rules with 

significant regulatory action/s and/or 

with significant effects as per section 

3(f)(1) ($200 million or more in any one 

year). Based on our estimates, OMB’s 

Office of Information and Regulatory 

Affairs has determined this rulemaking 

is significant per section 3(f)(1) as 

measured by the $200 million threshold 

or more in any one year, and hence also 

a major rule under Subtitle E of the 

Small Business Regulatory Enforcement 

Fairness Act of 1996 (also known as the 

Congressional Review Act). The 2024 

standard Part B premium of $174.70 is 

$9.80 higher than the 2023 premium of 

$164.90. We estimate that the total 

premium increase, for the 

approximately 62 million Part B 

enrollees in 2024, will be $7.3 billion, 

which is an annual effect on the 

economy of $200 million or more. 

Accordingly, we have prepared a 

Regulatory Impact Analysis that to the 

best of our ability presents the costs and 

benefits of the rulemaking. Therefore, 

OMB has reviewed these proposed 

regulations, and the Departments have 

provided the following assessment of 

their impact. 

C. Detailed Economic Analysis 

As discussed earlier, this notice 

announces that the monthly actuarial 

rates applicable for 2024 are $343.40 for 

enrollees age 65 and over and $427.20 

for disabled enrollees under age 65. It 

also announces the 2024 monthly Part B 

premium rates to be paid by (or on 

behalf of) beneficiaries with full Part B 

coverage who file either individual tax 

returns (and are single individuals, 

heads of households, qualifying widows 

or widowers with dependent children, 

or married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns. 

BILLING CODE 4120–01–P 

For beneficiaries with 

immunosuppressive drug only Part B 

coverage, who file either individual tax 

returns (and are single individuals, 

heads of households, qualifying widows 

or widowers with dependent children, 

or married individuals filing separately 

who lived apart from their spouses for 

the entire taxable year) or joint tax 

returns, the 2024 Part B monthly 

premium rates are announced and 

shown below. 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.027</GPH>

Full Part B Coveral!e 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who tue joint tax returns with modified Adjustment Premium 

modified adjusted uoss income: adjusted l!ross income: Amount Amount 

Less than or equal to $103,000 Less than or equal to $206,000 $0.00 $174.70 

Greater than $103,000 and less than or caual to $129,000 Greater than $206,000 and less than or equal to $258,000 $69.90 $244.60 

Greater than $129.000 and less than or equal to $161 000 Greater than $258 000 and less than or equal to $322 000 $174.70 $349.40 

Greater than $161.000 and less than or equal to $193 000 Greater than $322 000 and less than or equal to $386.000 $279.50 $454.20 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $384.30 $559.00 

Greater than or equal to $500,000 Greater than or equal to $750,000 $419.30 $594.00 
71568 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

In addition, the monthly premium 

rates to be paid by (or on behalf of) 

beneficiaries with full Part B coverage 

who are married and lived with their 

spouses at any time during the taxable 

year, but who file separate tax returns 

from their spouses, are also announced 

and listed in the following table: 

The monthly premium rates to be 

paid by (or on behalf of) beneficiaries 

with immunosuppressive drug only Part 

B coverage who are married and lived 

with their spouses at any time during 

the taxable year, but who file separate 

tax returns from their spouses, are 

announced and listed in the following 

table: 

D. Accounting Statement and Table 

As required by OMB Circular A–4 

(available at www.whitehouse.gov/sites/ 

whitehouse.gov/files/omb/circulars/A4/ 

a-4.pdf), in Table 6 we have prepared an 

accounting statement showing the 

estimated aggregate Part B premium 

increase for all enrollees in 2024. 

BILLING CODE 4120–01–C 

E. Regulatory Flexibility Act (RFA) 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, if a rule or other regulatory 

document has a significant impact on a 

substantial number of small entities. For 

purposes of the RFA, small entities 

include small businesses, nonprofit 

organizations, and small governmental 

jurisdictions. Individuals and States are 

not included in the definition of a small 

entity. This notice announces the 

monthly actuarial rates for aged (age 65 

and over) and disabled (under 65) 

beneficiaries enrolled in Part B of the 

Medicare SMI program beginning 

January 1, 2024. Also, this notice 

announces the monthly premium for 

aged and disabled beneficiaries as well 

as the income-related monthly 

adjustment amounts to be paid by 

beneficiaries with modified adjusted 


lotter on DSK11XQN23PROD with NOTICES1EN17OC23.028</GPH> EN17OC23.029</GPH> EN17OC23.030</GPH> EN17OC23.031</GPH>

Part B Immunosuooressive D~ Cover~e Only 

IncomeRelated Total 

Monthly Monthly 

Beneficiaries who file individual tax returns with Beneficiaries who file joint tax returns with modified Adjustment Premium 

modified adjusted ~ross income: adjusted ~ross income: Amonnt Amount 

Less than or equal to $103,000 Less than or equal to $206,000 $0.00 $103.00 

Greater than $103,000 and less than or equal to $129,000 Greater than $206,000 and less than or equal to $258,000 $68.70 $171.70 

Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $171.70 $274.70 

Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $274.70 $377.70 

Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $377.70 $480.70 

Greater than or eaual to $500,000 Greater than or eaual to $750,000 $412.10 $515.10 

Full Part B Coverae:e 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who me separate tax returns from their Monthly Premium 

spouses, with modified ad_justed e;ross income: Ad_justment Amount Amount 

Less than or equal to $103,000 $0.00 $174.70 

Greater than $103,000 and less than $397,000 $384.30 $559.00 

Greater than or eaual to $397.000 $419.30 $594.00 

Part B Immunosuooressive Drue: Coverae:e Only 

Beneficiaries who are married and lived with their spouses at any Income-Related Total Monthly 

time during the year, but who me separate tax returns from their Monthly Premium 

spouses, with modified ad_justed e;ross income: Ad_justment Amount Amount 

Less than or equal to $103,000 $0.00 $103.00 

Greater than $103,000 and less than $397,000 $377.70 $480.70 

Greater than or eaual to $397 000 $412.10 $515.10 

TABLE 6: ACCOUNTING STATEMENT: THE ESTIMATED AGGREGATE PART B 

PREMIUM INCREASE FOR ALL ENROLLEES FOR 2024 

Estimated Aeere~ate Part B Premium Increase for All Enrollees for 2024 

Cate~ory 

Annualized Monetized Transfers $7.3 billion 

From Whom to Whom? Beneficiaries to Federal Government 
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71569 

gross income above certain threshold 

amounts. As a result, we are not 

preparing an analysis for the RFA 

because the Secretary has determined 

that this notice will not have a 

significant economic impact on a 

substantial number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule or other 

regulatory document may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Metropolitan Statistical Area and has 

fewer than 100 beds. As we discussed 

previously, we are not preparing an 

analysis for section 1102(b) of the Act 

because the Secretary has determined 

that this notice will not have a 

significant effect on a substantial 

number of small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 (UMRA) 

also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule whose mandates 

require spending in any one year of 

$100 million in 1995 dollars, updated 

annually for inflation. In 2023, that 

threshold is approximately $177 

million. Part B enrollees who are also 

enrolled in Medicaid have their 

monthly Part B premiums paid by 

Medicaid. The cost to each State 

Medicaid program from the 2024 

premium increase is estimated to be 

more than the threshold. This notice 

does not impose mandates that will 

have a consequential effect of the 

threshold amount or more on State, 

local, or tribal governments or on the 

private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it publishes a proposed 

rule or other regulatory document (and 

subsequent final rule or other regulatory 

document) that imposes substantial 

direct compliance costs on State and 

local governments, preempts State law, 

or otherwise has Federalism 

implications. We have determined that 

this notice does not significantly affect 

the rights, roles, and responsibilities of 

States. Accordingly, the requirements of 

Executive Order 13132 do not apply to 

this notice. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

V. Waiver of Proposed Rulemaking 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register and invite public comment 

prior to a rule taking effect in 

accordance with section 1871 of the Act 

and section 553(b) of the Administrative 

Procedure Act (APA). Section 1871(a)(2) 

of the Act provides that no rule, 

requirement, or other statement of 

policy (other than a national coverage 

determination) that establishes or 

changes a substantive legal standard 

governing the scope of benefits, the 

payment for services, or the eligibility of 

individuals, entities, or organizations to 

furnish or receive services or benefits 

under Medicare shall take effect unless 

it is promulgated through notice and 

comment rulemaking. Unless there is a 

statutory exception, section 1871(b)(1) 

of the Act generally requires the 

Secretary of the Department of Health 

and Human Services (the Secretary) to 

provide for notice of a proposed rule in 

the Federal Register and provide a 

period of not less than 60 days for 

public comment before establishing or 

changing a substantive legal standard 

regarding the matters enumerated by the 

statute. Similarly, under 5 U.S.C. 553(b) 

of the APA, the agency is required to 

publish a notice of proposed rulemaking 

in the Federal Register before a 

substantive rule takes effect. Section 

553(d) of the APA and section 

1871(e)(1)(B)(i) of the Act usually 

require a 30-day delay in effective date 

after issuance or publication of a rule, 

subject to exceptions. Sections 553(b)(B) 

and 553(d)(3) of the APA provide for 

exceptions from the advance notice and 

comment requirement and the delay in 

effective date requirements. Sections 

1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the 

Act also provide exceptions from the 

notice and 60-day comment period and 

the 30-day delay in effective date. 

Section 553(b)(B) of the APA and 

section 1871(b)(2)(C) of the Act 

expressly authorize an agency to 

dispense with notice and comment 

rulemaking for good cause if the agency 

makes a finding that notice and 

comment procedures are impracticable, 

unnecessary, or contrary to the public 

interest. 

The annual updated amounts for the 

Part B monthly actuarial rates for aged 

and disabled beneficiaries, the Part B 

premium, and the Part B deductible set 

forth in this notice do not establish or 

change a substantive legal standard 

regarding the matters enumerated by the 

statute or constitute a substantive rule 

that would be subject to the notice 

requirements in section 553(b) of the 

APA. However, to the extent that an 

opportunity for public notice and 

comment could be construed as 

required for this notice, we find good 

cause to waive this requirement. 

Section 1839 of the Act requires the 

Secretary to determine the monthly 

actuarial rates for aged and disabled 

beneficiaries, as well as the monthly 

Part B premium (including the incomerelated monthly adjustment amounts to 

be paid by beneficiaries with modified 

adjusted gross income above certain 

threshold amounts), for each calendar 

year in accordance with the statutory 

formulae, in September preceding the 

year to which they will apply. Further, 

the statute requires that the agency 

promulgate the Part B premium amount, 

in September preceding the year to 

which it will apply, and include a 

public statement setting forth the 

actuarial assumptions and bases 

employed by the Secretary in arriving at 

the amount of an adequate actuarial rate 

for enrollees age 65 and older. We 

include the Part B annual deductible, 

which is established in accordance with 

a specific formula described in section 

1833(b) of the Act, because the 

determination of the amount is directly 

linked to the rate of increase in actuarial 

rate under section 1839(a)(1) of the Act. 

We have calculated the monthly 

actuarial rates for aged and disabled 

beneficiaries, the Part B deductible, and 

the monthly Part B premium as directed 

by the statute; since the statute 

establishes both when the monthly 

actuarial rates for aged and disabled 

beneficiaries and the monthly Part B 

premium must be published and the 

information that the Secretary must 

factor into those amounts, we do not 

have any discretion in that regard. We 

find notice and comment procedures to 

be unnecessary for this notice, and we 

find good cause to waive such 

procedures under section 553(b)(B) of 

the APA and section 1871(b)(2)(C) of the 

Act, if such procedures may be 

construed to be required at all. Through 

this notice, we are simply notifying the 

public of the updates to the monthly 

actuarial rates for aged and disabled 

beneficiaries and the Part B deductible, 

as well as the monthly Part B premium 

amounts and the income-related 

monthly adjustment amounts to be paid 

by certain beneficiaries, in accordance 

with the statute, for CY 2024. As such, 

we also note that even if notice and 

comment procedures were required for 

this notice, we would find good cause, 

for the previously stated reason, to 

waive the delay in effective date of the 

notice, as additional delay would be 

contrary to the public interest under 

section 1871(e)(1)(B)(ii) of the Act. 


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71570 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

Publication of this notice is consistent 

with section 1839 of the Act, and we 

believe that any potential delay in the 

effective date of the notice, if such delay 

were required at all, could cause 

unnecessary confusion for both the 

agency and Medicare beneficiaries. 

Chiquita Brooks-LaSure, 

Administrator of the Centers for 

Medicare & Medicaid Services, 

approved this document on October 11, 

2023. 

Dated: October 11, 2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–22823 Filed 10–12–23; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–576 and CMS– 

576A] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

Services (HHS). 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & 

Medicaid Services (CMS) is announcing 

an opportunity for the public to 

comment on CMS’ intention to collect 

information from the public. Under the 

Paperwork Reduction Act of 1995 

(PRA), federal agencies are required to 

publish notice in the Federal Register 

concerning each proposed collection of 

information, including each proposed 

extension or reinstatement of an existing 

collection of information, and to allow 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by November 16, 

2023. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, please access the CMS PRA 

website by copying and pasting the 

following web address into your web 

browser: https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (PRA) 

(44 U.S.C. 3501–3520), federal agencies 

must obtain approval from the Office of 

Management and Budget (OMB) for each 

collection of information they conduct 

or sponsor. The term ‘‘collection of 

information’’ is defined in 44 U.S.C. 

3502(3) and 5 CFR 1320.3(c) and 

includes agency requests or 

requirements that members of the public 

submit reports, keep records, or provide 

information to a third party. Section 

3506(c)(2)(A) of the PRA (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-day notice in the 

Federal Register concerning each 

proposed collection of information, 

including each proposed extension or 

reinstatement of an existing collection 

of information, before submitting the 

collection to OMB for approval. To 

comply with this requirement, CMS is 

publishing this notice that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Organ 

Procurement Organization (OPO) 

Request for Designation as an OPO, 

Health Insurance Benefits Agreement, 

and Supporting Regulations; Use: We 

are seeking reinstatement of a revised 

version of the CMS–576 form. We are 

also seeking reinstatement for the CMS– 

576A form. The CMS–576 and CMS– 

576A forms have been updated to a 

fillable .pdf format. In addition, 

multiple changes were made to the 

CMS–576 and CMS–576A forms. 

Organizations seeking designation 

from CMS as a qualified and approved 

Organ Procurement Organization (OPO), 

as per §§ 371(a) and 1138 of the Social 

Security Act (‘‘the Act’’) must complete 

and submit the CMS–576 form. After 

designation as an OPO, the organization 

must sign CMS–576A form in order to 

be reimbursed by Medicare for their 

services. The CMS–576A form requires 

the OPO ‘‘to maintain compliance with 

the requirements of titles XVIII and XIX 

of the Act, § 1138 of the Act, applicable 

regulations including the conditions set 

forth in Part 486, subpart G, title 42 of 

the Code of Federal Regulations, those 

conditions of the Organ Procurement 

and Transplantation Network 

established under § 372 of the Public 

Health Service Act that have been 

approved by the Secretary, and to report 

promptly to CMS. Form Number: CMS– 

576 and 576A (OMB Control Number: 

0938–0512); Frequency: Occasionally; 

Affected Public: Private Sector (Business 

or other for-profit and Not-for-profit 

institutions); Number of Respondents: 

16; Total Annual Responses: 16; Total 

Annual Hours: 32. (For policy questions 

regarding this collection contact 

Caroline Gallaher at 410–786–8705.) 

Dated: October 12, 2023. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2023–22892 Filed 10–16–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8084–N] 

RIN 0938–AV12 

Medicare Program; CY 2024 Part A 

Premiums for the Uninsured Aged and 

for Certain Disabled Individuals Who 

Have Exhausted Other Entitlement 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

monthly premium for uninsured 

enrollees under the Medicare Hospital 

Insurance (Part A) program in calendar 

year 2024. This premium is paid by 

enrollees aged 65 and over who are not 

otherwise eligible for benefits under 

Part A (hereafter known as the 

‘‘uninsured aged’’) and by certain 

individuals with disabilities who have 

exhausted other entitlement. The 

monthly Part A premium for the 12 

months beginning January 1, 2024 for 


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