Medicare-Hospital Insurance (93.773)
Program
93.773 Medicare-Hospital Insurance
Federal Agency
CENTERS FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Authorization
Social Security Act Amendments of 1965, Title XVIII, Part A, Public Law 89-97, as amended, Public Laws 90-248, 92-603, 93-233, 94-182, 94-437 and 95-292, 42 U.S.C. 1395 et seq.; Social Security Disability Amendments of 1980, Public Law 96-265; Public Law 97-248; Section 1, Public Law 98-21; Subtitle A, Public Law 98-369; Public Law 98-460, 99-177, 99-272, 99-509, and 100-203, 42 U.S.C. 1305 Note; Medicare Catastrophic Coverage Repeal Act of 1988, Title I, Subtitles A and B, and Title IV, Subtitle B and C, Public Law 100-360; Catastrophic Coverage Repeal Act of 1989, Public Law 101-234; Omnibus Budget Reconciliation Act of 1989, Title VI, Subtitle A, Public Law 101- 239; Omnibus Budget Reconciliation Act of 1990, Public Law 101-508; Omnibus Budget Reconciliation Act of 1993, Public Law 103-66; Social Security Act Amendments of 1994, Public Law 103-432; Contract with America Advancement Act of 1996, Public Law 104-121; Health Insurance Portability and Accountability Act of 1996, Public Law 104-191; Balanced Budget Act of 1997, Public Law 105-33; Balanced Budget and Refinement Act of 1999, Public Law 106-113; Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Public Law 106-554.
Program Number
93.773
Last Known Status
Active
Objectives
To provide hospital insurance protection for covered services to persons age 65 or above, to certain disabled persons and to individuals with chronic renal disease.
Types of Assistance
Direct Payments for Specified Use.
Uses and Use Restrictions
Hospital insurance benefits are paid to participating and emergency hospitals, skilled nursing facilities, home health agencies, and hospice agencies to cover the prospective payment amount or reasonable cost of medically necessary services furnished to individuals entitled under this program.
Eligibility Requirements
Applicant Eligibility
Persons age 65 or over and certain disabled persons are eligible for hospital insurance protection. Nearly everyone who reached 65 before 1968 is eligible for hospital insurance, including people not eligible for cash Social Security benefits. A person reaching age 65 in 1968 or after, who is not eligible for cash benefits, needs some work credit to qualify for hospital insurance benefits. The amount of work credit needed depends on age. Hospital insurance (Medicare Part A) is also available to persons, age 65 or over, not otherwise eligible through payment of a monthly premium which is currently $316. A reduced Part A premium of $174 per month in 2003 is available to persons with 30 or more quarters paid into the social security system, as well as to their spouse, surviving spouse or divorced spouse. The reduction in Part A premium payments would also apply to the surviving spouse, or divorced spouse of an individual who had at least 30 quarters of coverage under the social security system. Federal employees began contributing toward Medicare hospital insurance coverage beginning January 1983. Employees who worked prior to 1983 and who were employed during January 1983, can receive credit toward establishing Medicare eligibility, if necessary, for prior non-contributory quarters of Federal employment. State and local government employees not already in Social Security-covered positions and hired on or after April 1, 1986 also contribute toward Medicare hospital insurance coverage. Although States may request agreements to cover individuals employed prior to April 1, 1986, no credit is given toward establishing Medicare entitlement for prior employment. Persons under age 65 who have been entitled for at least 24 months to Social Security disability benefits, or for 29 consecutive months to railroad retirement benefits based on disability, are eligible for hospital insurance benefits.
Beneficiary Eligibility
Persons age 65 or over and qualified disabled persons.
Credentials/Documentation
Proof of age or disability. This program is excluded from coverage under OMB Circular No. A-87.
Application and Award Process
Preapplication Coordination
None. This program is excluded from coverage under E.O. 12372.
Application Procedure
Telephone or visit the local Social Security Office. Individuals entitled to Social Security or railroad retirement are enrolled without application. This program is excluded from coverage under OMB Circular Nos. A-102 and A-110.
Award Procedure
The individual will be notified by mail of enrollment, whether automatic or applied for.
Deadlines
None.
Range of Approval/Disapproval Time
Appeals
Telephone or visit the local Social Security Office or Medicare payment organization responsible for the initial determination. The appeal process ranges from reviews of the initial determinations to formal hearings and, in cases meeting certain criteria, reviews by Federal Courts.
Renewals
Not applicable.
Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula or matching requirements.
Length and Time Phasing of Assistance
Not applicable.
Post Assistance Requirements
Reports
None.
Audits
None.
Records
None.
Program Accomplishments
In fiscal year 2002, 40,070,000 persons were protected. In fiscal year 2003, we estimate that the number of persons protected will be 40,479,000. In fiscal year 2004, the number of persons protected is estimated to be 40,991,000.
Financial Information
Account Identification
20-8005-0-7-571.
Obligations
(Benefit Outlays) FY 02 $145,307,000; FY 03 est $150,000,000; and FY 04 est $159,418,000.
Range and Average of Financial Assistance
Benefits may be paid based on the prospective payment amount or the reasonable costs of covered inpatient hospital services and based on the reasonable costs of covered post-hospital extended care services which are incurred during a benefit period. For benefit periods beginning in calendar year 2003, the beneficiary is responsible for a $840 inpatient hospital deductible, a $210 per day coinsurance amount for sixty-one through ninety days of inpatient hospital care, a $420 per day coinsurance amount for inpatient hospital care during the 60 lifetime reserve days, and a $105.00 per day coinsurance amount for days 21 through 100 of care in a skilled nursing facility. Home health services are paid in full.
Regulations, Guidelines and Literature
Code of Federal Regulations, Title 20, Parts 401, 405 and 422; Title 42, Parts 400, 401, 405, 406, 409, 412, 417, and 418. " Medicare & You," SSA-79- 10050, and other publications are available from any Social Security Office without charge.
Related Programs
57.001, Social Insurance for Railroad Workers; 93.246, Health Centers Grants for Migrant and Seasonal Farmworkers; 93.774, Medicare_Supplementary Medical Insurance; 96.001, Social Security_Disability Insurance.
Information Contacts
Regional or Local Office
Consult Appendix IV of the Catalog for a listing of Regional Offices.
Headquarters Office
1-800-MEDICARE(1-800-633-4227).
Web Site Address
Examples of Funded Projects
Not applicable.
Criteria for Selecting Proposals
Not applicable.
