The Government Accountability Office (GAO) has issued a report on Social Security's implementation of income-based Medicare Part B premiums. This is a big workload that Social Security does not need at a time when it is already struggling to cope with severely limited funding. Below is the cover letter to the Senate Finance Committee Chairman and Ranking Minority Member summarizing the report.
November 17, 2006
The Honorable Charles E. Grassley Chairman
The Honorable Max Baucus Ranking Minority Member
Committee on Finance United States Senate
Subject: Social Security Administration: Short Time Frame and Workload Challenges Could Affect Timely Implementation of Income-Based Medicare Part B Premiums
Beginning January 1, 2007, the premiums for the Medicare Part B Supplementary Medical Insurance program will be based on income, which will raise the premiums for approximately 1.65 million higher-income beneficiaries to as much as 80 percent of the full cost over the 3-year phase-in period. This change, which may be unknown to some beneficiaries, will affect single individuals with incomes over $80,000 and married couples who file jointly with incomes over $160,000. Medicare Part B is a voluntary program administered by the Centers for Medicare & Medicaid Services (CMS) that covers doctors’ services, certain outpatient services, and other care. Currently, Medicare Part B beneficiaries generally pay a flat premium of 25 percent (the standard monthly premium) of the cost of the program, with the remaining 75 percent subsidized by the federal government. While CMS administers the program, the Social Security Administration (SSA) is responsible for determining and assessing Medicare Part B income-based premiums once CMS has set the standard premium amount for the year. To better understand how SSA is implementing such premiums, the Senate Committee on Finance requested that we review the process that SSA has established to determine and assess the new premiums.
Enclosed (Enclosure I) is an updated version of the briefing that we provided to your staff on November 7, 2006 describing the status of SSA’s implementation efforts as of November 6, 2006. At this writing, SSA is still in the process of calculating premiums and expects to finish this task by mid-November. Once the calculations are completed, SSA will include the new premium in its cost of living adjustment notices, which will be mailed to affected beneficiaries in late November. Beneficiaries will have 60 days after receiving the notice of the premium increase to file an appeal. However, they may also request a new determination without filing an appeal if they have experienced a life changing event that results in a significant reduction in their income, or they have more recent, amended or corrected tax return information. Time frames for requesting new determinations vary depending on the reason that beneficiaries cite for making such a request. SSA is conducting a number of training efforts to assist staff in dealing with inquiries from affected beneficiaries. For field offices with a high volume of affected beneficiaries, SSA plans to move the resulting work as needed to offices with fewer affected beneficiaries. Despite SSA’s planning efforts, there are various issues that could affect its implementation of income-based premiums. For example, SSA has about a month to determine and assess the premiums, and faces an anticipated field office workload increase when beneficiaries contact them for help in understanding the higher premiums or challenging the premium assessment.
To address the Committee’s request, we reviewed relevant statutes and program regulations on income-based premiums, interviewed officials at SSA, the Internal Revenue Service (IRS), and CMS, and obtained supporting documentation on their plans for implementing the income-based premiums. We evaluated these plans based on the time frame established in the law for SSA’s receipt of income-based data from the IRS and SSA’s schedule to implement the income-based premiums by the effective date. We also interviewed managers and staff at various SSA field offices and spoke with Medicare advocacy groups. We did not assess the procedures used to test IRS and SSA systems for implementing the income-based premiums. We performed our work between May 2006 and November 2006 in accordance with generally accepted government auditing standards.
We provided a draft of the briefing to the Commissioner of the Social Security Administration on November 9, 2006. In response to our statement that beneficiaries might not be aware of the income-based premiums, SSA noted that this information was provided in the 2007 “Medicare and You” handbook, which was sent to all Medicare beneficiaries by the end of October 2006. SSA also noted that the current hiring freeze, which could affect SSA’s ability to respond to income-based premium inquiries, was a result of the continuing resolution under which SSA is currently operating. We considered these comments, as well as SSA’s technical comments, and made changes as appropriate. We have included the agency’s comments in Enclosure II. We are sending copies of this briefing to the Commissioner of Social Security, the Commissioner of Internal Revenue, and the Secretary of Health and Human Services, and other interested parties. Copies will also be made available to others upon request. In addition, the report will be available at no charge on GAO’s Web site at http://www.gao.gov. Please contact us at the number shown below if you or your staff have any questions about this report. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this briefing.
Sincerely yours,
Barbara D. Bovbjerg Director, Education, Workforce, and Income Security Issues
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