Page 33 - FPGEE Management Q&A Book

www.pharmacyexam.com Krisman

The perfect example of a cost of illness study would income from a more recent tax year be used to
be a large multicenter survey conducted to obtain determine the premium, but the member must
data regarding healthcare utilization for people meet certain criteria. At the end of 2017, Social
suffering from diabetes. This example represents Security will send the member a letter if their Part B
the analysis that was conducted from the premium will increase based on the level of
perspective of the healthcare provider. The types of reported income and to tell them what they can do
costs included in this type of survey would be: if they disagree.

1. In-patient hospitalization costs. Part B Premium By Income
2. Home healthcare related services costs.
3. Prescription costs. If your yearly income in 2014 (for You pay
4. Long-term care costs. what you pay in 2016) was (in 2016)
5. Outpatient visits costs.
File File joint File
38. (d) All. The following factors affect the individual tax return married &
prescriber’s drug decision: tax return separate
tax return
1. Administrative programs
2. Formularies $85000 or $170,000 $85000 or $121.80
3. Prescribing restrictions less or less less
4. Financial incentives
5. Required specialty consultations for use of above above Not $170.50
particular drugs $85,000 up $170,000 applicable
6. Medical management protocols. to up to
$107,000 $214,000
39.(d) All. Most people will pay the standard
monthly Part B premium. However, some people above above Not $243.60
will pay a higher premium based on their modified $107,000 $214,000 applicable
adjusted gross income. The member monthly up to up to
premium will be higher if they file an individual tax $160,000 $320,000
return and their annual income is more than
$85,000, or if they are married (file a joint tax above above above $316.70
return) and their annual income is more than $160,000 $320,000 $85,000
$170,000. These amounts change each year. up to up to and up to
$214,000 $428,000 $129,000
If the member files an individual tax return and
their income is above $85,000, or if they are above above above $389.80
married and file a joint tax return and their income $214,000 $428,000 $129,000
is above $170,000, Social Security will use the
income reported two years ago on their IRS income
tax return to determine the premium (if Source: https://www.medicare.gov/your-medicare-
unavailable, SSA will use income from three years costs/part-b-costs/part-b-costs.html
ago).
40.(d) MLRs or Medical Loss Ratios are defined as
For example, the income reported on a 2016 tax the difference between the amount of premium
return will be used to determine the monthly Part B received by the HMO and amount of premium
premium in 2018. If the member income has actually spent on healthcare delivery.
decreased since 2016, he/she can ask that the

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