90002 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8088–N] 

RIN 0938–AV38 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rates, and Annual Deductible 

Beginning January 1, 2025 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Notice of 2025 Medicare Part B 

rates and amounts. 

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, 2025. In addition, this notice 

announces the monthly premium for 

aged and disabled beneficiaries, the 

deductible for 2025, 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 2025 are $368.10 for 

aged enrollees and $487.80 for disabled 

enrollees. The standard monthly Part B 

premium rate for all enrollees for 2025 

is $185.00, 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 

$0.90 repayment amount required under 

current law. (The 2025 premium is 5.9 

percent or $10.30 higher than the 2024 

standard premium rate of $174.70, 

which included a $3.00 repayment 

amount.) The Part B deductible for 2025 

is $257.00 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 

$1.30, $1.80, $2.30, $2.90, or $3.10, 

respectively. Beginning in 2023, certain 

Medicare enrollees who are 36 months 

post kidney transplant, and therefore no 

longer eligible for full Medicare 

coverage, can elect to continue Part B 

coverage of immunosuppressive drugs 

by paying a premium. For 2025, the 

standard monthly Part B 

immunosuppressive drug coverage only 

premium is $110.40. 

DATES: The Medicare Part B rates and 

amounts announced in this document 

are effective January 1, 2025. 

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 

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 (HHS) (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 

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 2025 Part B 

deductible is calculated by multiplying 

the 2024 deductible by the ratio of the 

2025 aged actuarial rate to the 2024 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 from those 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 9313 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 


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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 2025, 

$106,000 for a beneficiary filing an 

individual income tax return and 

$212,000 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 

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 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 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 the 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 

standard immunosuppressive drug 

coverage only 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 State 

Medicaid programs for the purpose of 

providing Medicare Part B premium 

assistance from 1998 through 2002 for 

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 


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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 

resulting from 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, 

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. (In the final 

repayment year, the repayment amount 

may be less than $3.00 to avoid an 

overpayment. The final repayment year 

will be 2025, and the repayment amount 

is $0.90.) The 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 

repayment amount plus an additional 

amount 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. (For 2025, 

high-income enrollees pay a $0.90 

repayment amount plus an additional 

$0.40, $0.90, $1.40, $2.00, or $2.20.) 

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 

$0.90 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. The balance due is 

expected to be zero by the end of 2025. 

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 2025 are 

$368.10 for enrollees age 65 and over 

and $487.80 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 2025 is $185.00. The Part 

B standard monthly 

immunosuppressive drug coverage only 

premium is $110.40. 

The following are the 2025 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. 


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For beneficiaries with Part B 

immunosuppressive drug coverage only 

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 2025 Part B monthly 

premium rates are shown below. 

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 Part B immunosuppressive drug 

coverage only 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: 


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Full Part B Coveraae 

IncomeRelated Total 

Monthly Monthly 

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

modified adjusted aross income: adjusted aross income: Amount Amount 

Less than or equal to $106,000 Less than or eaual to $212,000 $0.00 $185.00 

Greater than $106,000 and less than or equal to $133,000 Greater than $212,000 and less than or equal to $266,000 $74.00 $259.00 

Greater than $133,000 and less than or equal to $167,000 Greater than $266,000 and less than or equal to $334,000 $185.00 $370.00 

Greater than $167,000 and less than or equal to $200,000 Greater than $334,000 and less than or equal to $400,000 $295.90 $480.90 

Greater than $200,000 and less than $500,000 Greater than $400,000 and less than $750,000 $406.90 $591.90 

Greater than or equal to $500,000 Greater than or equal to $750,000 $443.90 $628.90 

Part B Immunosuppressive Drtt2 Cover32e Only 

IncomeRelated Total 

Monthly Monthly 

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

modified adjusted aross income: adjusted aross income: Amount Amount 

Less than or equal to $106,000 Less than or eaual to $212,000 $0.00 $110.40 

Greater than $106,000 and less than or CQual to $133,000 Greater than $212,000 and less than or equal to $266,000 $73.60 $184.00 

Greater than $133,000 and less than or equal to $167,000 Greater than $266,000 and less than or equal to $334,000 $184.10 $294.50 

Greater than $167.000 and less than or equal to $200 000 Greater than $334 000 and less than or equal to $400.000 $294.50 $404.90 

Greater than $200.000 and less than $500 000 Greater than $400 000 and less than $750 000 $404.90 $515.30 

Greater than or equal to $500,000 Greater than or equal to $750,000 $441.70 $552.10 

Full Part B Coveraee 

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

time during the year, but who f'Ile separate tax returns from their Monthly Premium 

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

Less than or equal to $106,000 $0.00 $185.00 

Greater than $106,000 and less than $394,000 $406.90 $591.90 

Greater than or equal to $394,000 $443.90 $628.90 

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 f'Ile separate tax returns from their Monthly Premium 

spouses, with modified ad.iusted eross income: Ad.iustment Amount Amount 

Less than or equal to $106,000 $0.00 $110.40 

Greater than $106,000 and less than $394,000 $404.90 $515.30 

Greater than or equal to $394,000 $441.70 $552.10 
90006 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

The Part B annual deductible for 2025 

is $257.00 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 2025 

The actuarial assumptions and bases 

used to determine the monthly actuarial 

rates and the monthly premium rates for 

Part B are established by CMS’ 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 2025, the three most 

important of these factors are (1) the 

difference from prior years between the 

actual performance of the program and 

estimates made at the time financing 

was established; (2) the likelihood and 

potential magnitude of expenditure 

changes resulting from enactment of 

legislation affecting Part B costs in a 

year subsequent to the establishment of 

financing for that year; and (3) the 

expected relationship between incurred 

and cash expenditures. These 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 2023 

and 2024. 

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 2025 is 

determined by first establishing per 

enrollee costs by type of service from 

program data through 2023 and then 

projecting these costs for subsequent 

years. The projection factors used for 

financing periods from January 1, 2022, 

through December 31, 2025, 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 2025 is $371.36. Based on 

current estimates, the assets at the end 

of 2024 are sufficient to cover the 

amount of incurred, but unpaid, 

expenses, to provide for substantial 

variation between actual and projected 

costs. Thus, a near-zero contingency 

margin can be included to decrease 

assets to a more appropriate level. The 

monthly actuarial rate of $368.10 

provides an adjustment of ¥$0.01 for a 

contingency margin and ¥$3.25 for 

interest earnings. 

Starting in 2011, manufacturers and 

importers of brand-name prescription 

drugs pay a fee that is allocated to the 

Part B account of the SMI trust fund. For 

2025, the total of these brand-name drug 

fees is estimated to be $2.8 billion. The 

contingency margin for 2025 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 2024, 

the reserve ratio is expected to be 21.8 

percent. When the reserve ratio is higher 

than 20 percent, the typical approach in 

the premium determination is to target 

a gradual reduction in the reserve ratio 

over several years until 20 percent is 

reached. 

The actuarial rate of $368.10 per 

month for aged beneficiaries, as 


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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, 2023 $172,210 $35,304 $136,906 

December 31, 2024 $155,613 $34 477 $121136 . . 1 Includes remedy payments of$10.5 billion to 340B drug providers . 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. 89, No. 220 / Thursday, November 14, 2024 / Notices 90007 

announced in this notice for 2025, 

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 

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 onehalf of the total of benefits and 

administrative costs for disabled 

enrollees for 2025 is $471.73. The 

monthly actuarial rate of $487.80 also 

provides an adjustment of ¥$2.90 for 

interest earnings and $18.97 for a 

contingency margin, reflecting the same 

factors described previously for the aged 

actuarial rate at magnitudes applicable 

to the disabled rate determination. 

Based on current estimates, the assets 

associated with disabled Medicare 

beneficiaries at the end of 2024 are not 

sufficient to cover the amount of 

incurred, but unpaid, expenses and to 

provide for a significant degree of 

variation between actual and projected 

costs, and accordingly a positive margin 

is needed. 

The actuarial rate of $487.80 per 

month for disabled beneficiaries, as 

announced in this notice for 2025, 

reflects the combined net effect of the 

factors 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 $127,119 

million by the end of December 2025 

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 19.8 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 

$80,649 million by the end of December 

2025 under current law, which amounts 

to 11.2 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 $175,715 

million by the end of December 2025, or 

31.0 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 2025, together with existing Part B 

account assets, would be adequate to 

cover estimated Part B costs for 2025 

under current law, should actual costs 

prove to be somewhat greater than 

expected. 

BILLING CODE 4120–01–P 


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EN14NO24.017</GPH>ddrumheller on DSK120RN23PROD with NOTICES1

TABLE 2-PROJECTION FACTORS1 

12-MONTH PERIODS ENDING DECEl\iIBER 31 OF 2022-2025 (IN PERCENT) 

Durable Physician- Other 

Calendar Physician Fee Medical Practitioner Administered Practitioner Outpatient 

Year Schedule Equiument Lab2 Drues Senrices3 Hosuital 

Aged: 

2022 1.9 12.9 -5.8 10.8 17.9 4.3 2023 3.9 38.3 4.7 24.4 20.6 8.7 

2024 2.7 -13.4 7.3 20.4 -3.6 9.1 

2025 0.2 6.8 5.4 7.7 5.4 8.5 

Disabled: 

2022 -1.1 8.0 -6.7 14.8 12.3 1.0 2023 5.6 16.4 1.9 32.3 18.9 8.1 

2024 4.8 11.0 5.6 23.1 --0.3 9.1 

2025 1.5 11.3 6.7 9.0 9.3 10.0 

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 

-1.2 

0.9 

8.4 

5.6 

0.5 

5.3 

6.1 

9.6 

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

Hospital 

Lab4 

-2.3 -3.6 

2.9 

3.6 

-2.5 

-8.2 

2.0 

5.0 

EN14NO24.018</GPH>ddrumheller on DSK120RN23PROD with NOTICES1

TABLE 3-DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES A

FOR FINANCING PERIODS ENDING DECEMBER 31, 2022, THROUGH DECEM

CY2022 I CY2023 

Covered services (at level recognized): 

Physician fee schedule $66.97 $65.99 

Durable medical eauioment 6.56 8.61 Practitioner lab1 4.61 4.58 

Physician-administered drugs 19.03 22.45 

ervices2 9.81 11.22 

52.73 54.36 

Home health agencv 7.46 7.14 Hospital lab3 2.17 1.99 

Other institutional services4 16.57 17.11 

Managed care 158.34 180.05 

Total services 344.25 373.49 

Cost sharing: 

Deductible -8.90 -8.65 

Coinsurance -26.18 -25.15 

Sequestration of benefits -3.86 -6.79 

Total benefits 305.30 332.89 

'4.79 5.00 

310.09 337.88 

Value of interest -2.54 -3.01 

ro • ection error and to amortize the s lus or deficit 26.65 -11.17 

rate 

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 psychiatri

EN14NO24.019</GPH>ddrumheller on DSK120RN23PROD with NOTICES1

TABLE 4-DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED 

FOR FINANCING PERIODS ENDING DECEMBER 31, 2022, THROUGH DECEM

CY2022 I CY2023 I 

Covered services (at level reco_gni.zed): 

Phvsician fee schedule $56.45 Durable medical eQuipment 9.98 Practitioner lab1 5.04 Phvsician-administered drugs 16.86 

Other practitioner services2 10.90 Ou 52.94 

5.77 

2.42 

Other institutional services4 36.79 

Managed care 213.24 

Total services 410.40 

Cost sharing: 

Deductible -8.36 

Coinsurance -29.24 

SeQuestration of benefits -4.66 

Total benefits 368.14 

5.67 

373.81 

-3.32 

Contingency marcin for projection error and to amortize the s ilus or deficit I -1.59 

Monthly actuarial rate 

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. 

$52.83 

10.32 

4.41 

19.80 11.47 

50.92 

5.42 

2.00 

35.12 

253.91 

446.21 

-8.13 

-26.28 

-8.23 

403.56 

6.06 

409.62 

-3.29 

-48.43 

4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric h
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, 2025. 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, 


EN14NO24.020</GPH>ddrumheller on DSK120RN23PROD 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, 2023 2024 

Actuarial status (in millions): 

Assets $172,210 $155,613 

Liabilities $35,304 $34,477 

Assets less liabilities $136,906 $121,136 

Ratio1 25.4% 20.8% 

Low-cost projection: 

Actuarial status (in millions): 

Assets $172,210 $167,565 

Liabilities $35,043 $33,160 

Assets less liabilities $137,167 $134,404 

Ratio1 26.2% 24.8% 

High-cost projection: 

Actuarial status (in millions): Assets $172,210 $147,042 

Liabilities $35,841 $35,407 

Assets less liabilities $136,369 $111,635 

Ratio1 24.6% 17.9% 

1 Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the following year, exp
90012 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

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 impacts of this 

rule 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 titled 

‘‘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 

titled ‘‘Modernizing Regulatory Review’’ 

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 rule 

that may: (1) have an annual effect on 

the economy of $200 million or more, 

(adjusted every 3 years by the 

Administrator of OMB’s Office of 

Information and Regulatory Affairs 

(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) create 

a serious inconsistency or otherwise 

interfere with an action taken or 

planned by another agency; (3) 

materially alter 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 this Executive order, as 

specifically authorized in a timely 

manner by OIRA in each case. 

An RIA must be prepared for rules 

with significant regulatory action/s as 

per section 3(f)(1) of Executive Order 

12866 ($200 million or more in any 1 

year). 

Based on our estimates, OIRA has 

determined that this rulemaking is 

significant per section 3(f)(1) as 

measured by the $200 million or more 

in any 1 year. The 2025 standard Part 

B premium of $185.00 is $10.30 higher 

than the 2024 premium of $174.70. We 

estimate that the total premium 

increase, for the approximately 64 

million Part B enrollees in 2025, will be 

$7.9 billion, which is an annual effect 

on the economy of $200 million or 

more. Accordingly, we have prepared an 

RIA that to the best of our ability 

presents the costs and benefits of this 

notice. OMB has reviewed this notice 

and HHS has provided the following 

assessment of its impact. 

C. Detailed Economic Analysis 

As discussed earlier, this notice 

announces that the monthly actuarial 

rates applicable for 2025 are $368.10 for 

enrollees age 65 and over and $487.80 

for disabled enrollees under age 65. It 

also announces the 2025 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. 

For beneficiaries with Part B 

immunosuppressive drug coverage only 

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 2025 Part B monthly 

premium rates are announced and 

shown in the following table. 


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Full Part B Coveraee 

IncomeRelated Total 

Monthly Monthly 

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

modified adjusted eross income: adjusted eross income: Amount Amount 

Less than or equal to $106,000 Less than or equal to $212,000 $0.00 $185.00 

Greater than $106.000 and less than or eaual to $133 000 Greater than $212 000 and less than or eaual to $266 000 $74.00 $259.00 

Greater than $133.000 and less than or equal to $167 000 Greater than $266 000 and less than or equal to $334 000 $185.00 $370.00 

Greater than $167,000 and less than or equal to $200,000 Greater than $334,000 and less than or equal to $400,000 $295.90 $480.90 

Greater than $200,000 and less than $500,000 Greater than $400,000 and less than $750,000 $406.90 $591.90 

Greater than or equal to $500,000 Greater than or equal to $750,000 $443.90 $628.90 
Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 90013 

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 Part B immunosuppressive drug 

coverage only 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 2025. 

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. Most hospitals and most 

other providers and suppliers are small 

entities, either by being nonprofit 

organizations or by meeting the Small 

Business Administration’s (SBA) 

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 notice announces 

the monthly actuarial rates for aged (age 

65 and over) and disabled (under age 


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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 $106,000 Less than or equal to $212,000 $0.00 $110.40 

Greater than $106,000 and less than or equal to $133,000 Greater than $212,000 and less than or equal to $266,000 $73.60 $184.00 

Greater than $133,000 and less than or equal to $167,000 Greater than $266,000 and less than or equal to $334,000 $184. IO $294.50 

Greater than $167,000 and less than or equal to $200,000 Greater than $334,000 and less than or equal to $400,000 $294.50 $404.90 

Greater than $200,000 and less than $500,000 Greater than $400,000 and less than $750,000 $404.90 $515.30 

Greater than or equal to $500,000 Greater than or equal to $750,000 $441.70 $552.10 

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_iusted 2ross income: Ad_iustment Amount Amount 

Less than or equal to $106,000 $0.00 $185.00 

Greater than $106,000 and less than $394,000 $406.90 $591.90 

Greater than or equal to $394,000 $443.90 $628.90 

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 adiusted 2:ross income: Adiustment Amount Amount 

Less than or eQual to $106,000 $0.00 $110.40 

Greater than $106,000 and less than $394,000 $404.90 $515.30 

Greater than or eQual to $394,000 $441.70 $552.10 

TABLE 6: ACCOUNTING STATEMENT: THE ESTIMATED AGGREGATE PART B 

PREMIUM INCREASE FOR ALL ENROLLEES FOR 2025 

Estimated Airn:re2ate Part B Premium Increase for All Enrollees for 2025 

Cate2ory 

Annualized Monetized Transfers $7.9 billion 

From Whom to Whom? Beneficiaries to Federal Government 
90014 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

65) beneficiaries enrolled in Part B of 

the Medicare SMI program beginning 

January 1, 2025. 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 

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. 

F. Unfunded Mandates Reform Act 

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 1 year of $100 

million in 1995 dollars, updated 

annually for inflation. In 2024, that 

threshold is approximately $183 

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 2025 

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. 

G. 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. 

H. Congressional Review 

This notice is subject to the 

Congressional Review Act and has been 

transmitted to the Congress and the 

Government Accountability Office’s 

Comptroller General for review. 

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 the time frame in which 

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 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 90015 

with the statute, for CY 2025. 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. 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 31, 

2024. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2024–26474 Filed 11–8–24; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8087–N] 

RIN 0938–AV37 

Medicare Program; CY 2025 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 of 2025 Medicare Part A 

premium for uninsured enrollees. 

SUMMARY: This notice announces 

Medicare’s Hospital Insurance Program 

(Medicare Part A) premium for 

uninsured enrollees in calendar year 

(CY) 2025. This premium is paid by 

enrollees aged 65 and over who are not 

otherwise eligible for benefits under 

Medicare Part A (hereafter known as the 

‘‘uninsured aged’’) and by certain 

individuals with disabilities who have 

exhausted other entitlement. The 

monthly Medicare Part A premium for 

the 12 months beginning January 1, 

2025, for these individuals will be $518. 

The premium for certain other 

individuals as described in this notice 

will be $285. 

DATES: The premium announced in this 

notice is effective on January 1, 2025. 

FOR FURTHER INFORMATION CONTACT: 

Yaminee Thaker, (410) 786–7921. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1818 of the Social Security 

Act (the Act) provides for voluntary 

enrollment in Medicare Part A, subject 

to payment of a monthly premium, of 

certain persons aged 65 and older who 

are uninsured under the Old-Age, 

Survivors, and Disability Insurance 

(OASDI) program or the Railroad 

Retirement Act and do not otherwise 

meet the requirements for entitlement to 

Medicare Part A. These ‘‘uninsured 

aged’’ individuals are uninsured under 

the OASDI program or the Railroad 

Retirement Act, because they do not 

have 40 quarters of coverage under Title 

II of the Act (or are/were not married to 

someone who did). (Persons insured 

under the OASDI program or the 

Railroad Retirement Act and certain 

others do not have to pay premiums for 

Medicare Part A.) 

Section 1818A of the Act provides for 

voluntary enrollment in Medicare Part 

A, subject to payment of a monthly 

premium for certain individuals with 

disabilities who have exhausted other 

entitlement. These are individuals who 

were entitled to coverage due to a 

disabling impairment under section 

226(b) of the Act, but who are no longer 

entitled to disability benefits and 

premium-free Medicare Part A coverage 

because they have gone back to work 

and their earnings exceed the statutorily 

defined ‘‘substantial gainful activity’’ 

amount (section 223(d)(4) of the Act). 

Section 1818A(d)(2) of the Act 

specifies that the provisions relating to 

premiums for the aged under section 

1818(d) through section 1818(f) of the 

Act will also apply to certain 

individuals with disabilities as 

described above. 

Section 1818(d)(1) of the Act requires 

us to estimate, on an average per capita 

basis, the amount to be paid from the 

Federal Hospital Insurance Trust Fund 

for services incurred in the upcoming 

calendar year (CY) (including the 

associated administrative costs) on 

behalf of individuals aged 65 and over 

who will be entitled to benefits under 

Medicare Part A. We must then 

determine the monthly actuarial rate for 

the following year (the per capita 

amount estimated above divided by 12) 

and publish the dollar amount for the 

monthly premium in the succeeding CY. 

If the premium is not a multiple of $1, 

the premium is rounded to the nearest 

multiple of $1 (or, if it is a multiple of 

50 cents but not of $1, it is rounded to 

the next highest $1). 

Section 13508 of the Omnibus Budget 

Reconciliation Act of 1993 (Pub. L. 103– 

66) amended section 1818(d) of the Act 

to provide for a reduction in the 

premium amount for certain voluntary 

enrollees (sections 1818 and 1818A of 

the Act). The reduction applies to an 

individual who is eligible to buy into 

the Medicare Part A program and who, 

as of the last day of the previous month: 

• Had at least 30 quarters of coverage 

under Title II of the Act; 

• Was married, and had been married 

for the previous 1-year period, to a 

person who had at least 30 quarters of 

coverage; 

• Had been married to a person for at 

least 1 year at the time of the person’s 

death if, at the time of death, the person 

had at least 30 quarters of coverage; or 

• Is divorced from a person and had 

been married to the person for at least 

10 years at the time of the divorce if, at 

the time of the divorce, the person had 

at least 30 quarters of coverage. 

Section 1818(d)(4)(A) of the Act 

specifies that the premium that these 

individuals will pay for CY 2025 will be 

equal to the premium for uninsured 

aged enrollees reduced by 45 percent. 

Section 1818(g) of the Act requires the 

Secretary of the Department of Health 

and Human Services (the Secretary), at 

the request of a state, to enter into a 

Medicare Part A buy-in agreement with 

a state to pay Medicare Part A premiums 

for Qualified Medicare Beneficiaries 

(QMBs). Under the QMB program, state 

Medicaid agencies must pay the 

Medicare Part A premium for those not 

eligible for premium-free Medicare Part 

A if those individuals meet all of the 

eligibility requirements for the QMB 

program under the state’s Medicaid state 

plan. (Entering into a Medicare Part A 

buy-in agreement would permit a state 

to avoid any Medicare Part A late 

enrollment penalties that the individual 

may owe and would allow states to 

enroll persons in Medicare Part A at any 

time of the year, without regard to 

Medicare enrollment periods.) Other 

individuals may be eligible for the 

Qualified Disabled Working Individuals 

program, through which state Medicaid 

programs provide coverage of Medicare 

Part A premiums for individuals eligible 

to enroll in Medicare Part A by virtue 

of section 1818A of the Act who meet 

certain financial eligibility criteria. 

II. Monthly Premium Amount for CY 

2025 

The monthly premium for the 

uninsured aged and certain individuals 

with disabilities who have exhausted 

other entitlement for the 12 months 

beginning January 1, 2025, is $518. The 

monthly premium for the individuals 

eligible under section 1818(d)(4)(B) of 

the Act, and therefore, subject to the 45 


ddrumheller on DSK120RN23PROD with NOTICES1