POMS Reference

HI 01001: Supplementary Medical Insurance

TN 31 (11-09)

A. Exhibit - Premiums and Surcharges - 1990 through 1994

 

1990

1991

1992

1993

1994

Base

28.60

29.90

31.80

36.60

41.10

10%

31.50

32.90

35.00

40.30

45.20

20%

34.30

35.90

38.20

43.90

49.30

30%

37.20

38.90

41.30

47.60

53.40

40%

40.00

41.90

44.50

51.20

57.50

           

50%

42.90

44.90

47.70

54.90

61.70

60%

45.80

47.80

50.90

58.60

65.80

70%

48.60

50.80

54.10

62.20

69.90

80%

51.50

53.80

57.20

65.90

74.00

90%

54.30

56.80

60.40

69.50

78.10

           

100%

57.20

59.80

63.60

73.20

82.20

110%

60.10

62.80

66.80

76.90

86.30

120%

62.90

65.80

70.00

80.50

90.40

130%

65.80

68.80

73.10

84.20

94.50

140%

68.60

71.80

76.30

87.80

98.60

           

150%

71.50

74.80

79.50

91.50

102.80

160%

74.40

77.70

82.70

95.20

106.90

170%

77.20

80.70

85.90

98.80

111.00

180%

80.10

83.70

89.00

102.50

115.10

190%

82.90

86.70

92.20

106.10

119.20

           

200%

85.80

89.70

95.40

109.80

123.30

210%

88.70

92.70

98.60

113.50

127.40

220%

91.50

95.70

101.80

117.10

131.50

230%

94.40

98.70

104.90

120.80

135.60

240%

 

101.70

108.10

124.40

139.70

250%

   

111.30

128.10

143.90

260%

       

148.00

270%

       

152.00

           

B. Exhibit - Premiums and Surcharges - 1995 through 2001

1995

1996

1997

and

1998

1999

and

2000

2001

Base

46.10

42.50

43.80

45.50

50.00

10%

50.70

46.80

48.20

50.10

55.00

20%

55.30

51.00

52.60

54.60

60.00

30%

59.90

55.30

56.90

59.20

65.00

40%

64.50

59.50

61.30

63.70

70.00

           

50%

69.20

63.80

65.70

68.30

75.00

60%

73.80

68.00

70.10

72.80

80.00

70%

78.40

72.30

74.50

77.40

85.00

80%

83.00

76.50

78.80

81.90

90.00

90%

87.60

80.80

83.20

86.50

95.00

           

100%

92.20

85.00

87.60

91.00

100.00

110%

96.80

89.30

92.00

95.60

105.00

120%

101.40

93.50

96.40

100.10

110.00

130%

106.00

97.80

100.70

104.70

115.00

140%

110.60

102.00

105.10

109.20

120.00

           

150%

115.30

106.30

109.50

113.80

125.00

160%

119.90

110.50

113.90

118.30

130.00

170%

124.50

114.80

118.30

122.90

135.00

180%

129.10

119.00

122.60

127.40

140.00

190%

133.70

123.30

127.00

132.00

145.00

           

200%

138.30

127.50

131.40

136.50

150.00

210%

142.90

131.80

135.80

141.10

155.00

220%

147.50

136.00

140.20

145.60

160.00

230%

152.10

140.30

144.50

150.20

165.00

240%

156.70

144.50

148.90

154.70

170.00

           

250%

161.40

148.80

153.30

159.30

175.00

260%

166.00

153.00

157.70

163.80

180.00

270%

170.60

157.30

162.10

168.40

185.00

280%

175.20

161.50

166.40

172.90

190.00

290%

 

165.80

170.80

177.50

195.00

           

300%

   

175.20

182.00

200.00

310%

   

179.60*

186.60

205.00

320%

     

191.10

210.00

330%

     

195.70**

215.00

340%

       

220.00

* Applies for 1998 only.

** Applies for 2000 only.

C. Exhibit - Premiums and Surcharges - 2002 through 2009

 

2002

2003

2004

2005

2006

2007

2008

2009

Base

54.00

58.70

66.60

78.20

88.50

93.50

96.40

96.40

10%

59.40

64.60

73.30

86.00

97.40

102.90

106.00

106.00

20%

64.80

70.40

79.90

93.80

106.20

112.20

115.70

115.70

30%

70.20

76.30

86.60

101.70

115.10

121.60

125.30

125.30

40%

75.60

82.20

93.20

109.50

123.90

130.90

135.00

135.00

                 

50%

81.00

88.10

99.90

117.30

132.80

140.30

144.60

144.60

60%

86.40

93.90

106.60

125.10

141.60

149.60

154.20

154.20

70%

91.80

99.80

113.20

132.90

150.50

159.00

163.90

163.90

80%

97.20

105.70

119.90

140.80

159.30

168.30

173.50

173.50

90%

102.60

111.50

126.50

148.60

168.20

177.70

183.20

183.20

                 

100%

108.00

117.40

133.20

156.40

177.00

187.00

192.80

192.80

110%

113.40

123.30

139.90

164.20

185.90

196.40

202.40

202.40

120%

118.80

129.10

146.50

172.00

194.70

205.70

212.10

212.10

130%

124.20

135.00

153.20

179.90

203.60

215.10

221.70

221.70

140%

129.60

140.90

159.80

187.70

212.40

224.40

231.40

231.40

                 

150%

135.00

146.80

166.50

195.50

221.30

233.80

241.00

241.00

160%

140.40

152.60

173.20

203.30

230.10

243.10

250.60

250.60

170%

145.80

158.50

179.80

211.10

239.00

252.50

260.30

260.30

180%

151.20

164.40

186.50

219.00

247.80

261.80

269.90

269.90

190%

156.60

170.20

193.10

226.80

256.70

271.20

279.60

279.60

                 

200%

162.00

176.10

199.80

234.60

265.50

280.50

289.20

289.20

210%

167.40

182.00

206.50

242.40

274.40

289.90

298.80

298.80

220%

172.80

187.80

213.10

250.20

283.20

299.20

308.50

308.50

230%

178.20

193.70

219.80

258.10

292.10

308.60

318.10

318.10

240%

183.60

199.60

226.40

265.90

300.90

317.90

327.80

327.80

                 

250%

189.00

205.50

233.10

273.70

309.80

327.30

337.40

337.40

260%

194.40

211.30

239.80

281.50

318.60

336.60

347.00

347.00

270%

199.80

217.20

246.40

289.30

327.50

346.00

356.70

356.70

280%

205.20

223.10

253.10

297.20

336.30

355.30

366.30

366.30

290%

210.60

228.90

259.70

305.00

345.20

364.70

376.00

376.00

                 

300%

216.00

234.80

266.40

312.80

354.00

374.00

385.60

385.60

310%

221.40

240.70

273.10

320.60

362.90

383.40

395.20

395.20

320%

226.80

246.50

279.70

328.40

371.70

392.70

404.90

404.90

330%

232.20

252.40

286.40

336.30

380.60

402.10

414.50

414.50

340%

237.60

258.30

293.00

344.10

389.40

411.40

424.20

424.20

                 

350%

243.00

264.20

299.70

351.90

398.30

420.80

433.80

433.80

360%

 

270.00

306.40

359.70

407.10

430.10

443.40

443.40

370%

   

313.00

367.50

416.00

439.50

453.10

453.10

380%

     

375.40

424.80

448.80

462.70

462.70

390%

       

433.70

458.20

472.40

472.40

400%

         

467.50

482.00

482.00

410%

           

491.60

501.30

420%

               

D. Premiums and Surcharges – 2010 Through 2018

Surcharge Amounts (on Part B standard premium amount) for 2010 through 2018.

 

2010

2011

2012

2013

2014

2015

2016

2017 and 2018

Base

110.50

115.40

99.90

104.90

104.90

104.90

121.80

134.00

10%

121.60

126.90

109.90

$115.40

115.40

115.40

134.00

147.40

20%

132.60

138.50

119.90

$125.90

125.90

125.90

146.20

160.80

30%

143.70

150.00

129.90

$136.40

136.40

136.40

158.30

174.20

40%

154.70

161.60

139.90

$146.90

146.90

146.90

170.50

187.60

                 

50%

165.80

173.10

149.90

$157.40

157.40

157.40

182.70

201.00

60%

176.80

184.60

159.80

$167.80

167.80

167.80

194.90

214.40

70%

187.90

196.20

169.80

$178.30

178.30

178.30

207.10

227.80

80%

198.90

207.70

179.80

$188.80

188.80

188.80

219.20

241.20

90%

210.00

219.30

189.80

$199.30

199.30

199.30

231.40

254.60

                 

100%

221.00

230.80

199.80

$209.80

209.80

209.80

243.60

268.00

110%

232.10

242.30

209.80

$220.30

220.30

220.30

255.80

281.40

120%

243.10

253.90

219.80

$230.80

230.80

230.80

268.00

294.80

130%

254.20

265.40

229.80

$241.30

241.30

241.30

280.10

308.20

140%

265.20

277.00

239.80

$251.80

251.80

251.80

292.30

321.60

                 

150%

276.30

288.50

249.80

$262.30

262.30

262.30

304.50

335.00

160%

287.30

300.00

259.70

$272.70

272.70

272.70

316.70

348.40

170%

298.40

311.60

269.70

$283.20

283.20

283.20

328.90

361.80

180%

309.40

323.10

279.70

$293.70

293.70

293.70

341.00

375.20

190%

320.50

334.70

289.70

$304.20

304.20

304.20

353.20

388.60

                 

200%

331.50

346.20

299.70

$314.70

314.70

314.70

365.40

402.00

210%

342.60

357.70

309.70

$325.20

325.20

325.20

377.60

415.40

220%

353.60

369.30

319.70

$335.70

335.70

335.70

389.80

428.80

230%

364.70

380.80

329.70

$346.20

346.20

346.20

401.90

442.20

240%

375.70

392.40

339.70

$356.70

356.70

356.70

414.10

455.60

                 

250%

386.80

403.90

349.70

$367.20

367.20

367.20

426.30

469.00

260%

397.80

415.40

359.60

$377.60

377.60

377.60

438.50

482.40

270%

408.90

427.00

369.60

$388.10

388.10

388.10

450.70

495.80

280%

419.90

438.50

379.60

$398.60

398.60

398.60

462.80

509.20

290%

431.00

450.10

389.60

$409.10

409.10

409.10

475.00

522.60

                 

300%

442.00

461.60

399.60

$419.60

419.60

419.60

487.20

536.00

310%

353.10

473.10

409.60

$430.10

430.10

430.10

499.40

549.40

320%

464.10

484.70

419.60

$440.60

440.60

440.60

511.60

562.80

330%

475.20

496.20

429.60

$451.10

451.10

451.10

523.70

576.20

340%

486.20

507.80

439.60

$461.60

461.30

461.60

535.90

589.60

                 

350%

497.30

519.30

449.60

$472.10

472.10

472.10

548.10

603.00

360%

508.30

530.80

459.50

$482.50

482.50

482.50

560.20

616.40

370%

519.40

542.40

469.50

$493.00

493.00

493.00

572.40

629.80

380%

530.40

553.90

479.50

$503.50

503.50

503.50

584.70

643.20

390%

541.50

565.50

489.50

$514.00

514.00

514.00

596.80

656.60

                 

400%

552.50

577.00

499.50

$524.50

524.50

524.50

609.00

670.00

410%

563.60

588.50

509.50

$535.00

535.00

535.00

621.10

683.40

420%

574.60

600.10

519.50

$545.50

545.50

545.50

633.40

696.80

430%

585.70

611.60

529.50

$556.00

556.00

556.00

645.50

710.20

440%

 

623.20

539.50

$566.50

556.50

566.50

657.70

723.60

                 

450%

   

549.50

$577.00

 577.00

577.00

669.90

737.00

460%

     

$587.40

587.40

587.40

682.00

750.40

470%

       

597.90

597.90

694.20

763.80

480%

         

608.40

706.40

777.20