Medicare-Supplementary Medical Insurance (93.774)

Program

93.774 Medicare-Supplementary Medical Insurance

Federal Agency

Agency: Department of Health and Human Services
Office: Centers For Medicare And Medicaid Services

Authorization

American Recovery and Reinvestment Act of 2009, Public Law 111-5.

Program Number

93.774

Last Known Status

Active

Objectives

To provide medical insurance protection for covered services to persons age 65 or over, to certain disabled persons and to individuals with end-stage renal disease. Enrollment in Part B is voluntary.

Types of Assistance

DIRECT PAYMENTS FOR A SPECIFIED USE

Uses and Use Restrictions

Managed care benefits are paid on the basis of Medicare capitation rates. Fee-for-service benefits are paid on the basis of fee schedules or other approved amounts for services furnished by physicians and other suppliers of medical services to aged or disabled enrollees. Benefits are paid on the basis of prospective payment systems for covered services furnished by participating providers such as hospitals, skilled nursing facilities and home health agencies.

Eligibility Requirements

Applicant Eligibility

All persons who are eligible for premium-free hospital insurance benefits (see 93.773), and persons age 65 and older who reside in the United States and are either citizens or aliens lawfully admitted for permanent residence who have resided in the United States continuously during the five years immediately preceding the month in which the application for enrollment is filed, may voluntarily enroll for Part B supplementary medical insurance (SMI). The beneficiary pays a monthly premium and an annual deductible. Beginning in calendar year 2008, the Part B premiums have been set based upon beneficiary income. The calendar year 2008 premiums range from $96.40 to $238.40 per month. The annual deductible is $135.00. Some States and other third parties may pay the SMI PART B premium on behalf of qualifying individuals.

Beneficiary Eligibility

Persons age 65 and over, and persons under age 65 who qualify for hospital insurance benefits.

Credentials/Documentation

Proof of age, disability or lawful admission status. This program is excluded from coverage under OMB Circular No. A-87. This program is excluded from coverage under OMB Circular No. A-87.

Application and Award Process

Preapplication Coordination

Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Telephone or visit the local Social Security Office. Most persons entitled to hospital insurance and already receiving benefits from Social Security or the Railroad Retirement Board are enrolled automatically for supplementary medical insurance. Since the program is voluntary, you may decline coverage. Persons not entitled to hospital insurance must file an application. This program is excluded from coverage under OMB Circular Nos. A-102 and A-110.

Award Procedure

After review of the application is completed, the applicant will be notified by mail.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time

Not Applicable.

Appeals

Telephone or visit the local Social Security Office or the 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.

This program has no matching requirements.

This program does not have MOE requirements.

Length and Time Phasing of Assistance

None. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements

Reports

Audits

No audits are required for this program.

Records

None.

Program Accomplishments

Fiscal Year 2008: In fiscal year 2008, 41,669,000 persons were enrolled for supplementary medical insurance. Fiscal Year 2009: In fiscal year 2009, the number of enrollees is estimated to be 42,340,000. Fiscal Year 2010: In fiscal year 2010, the number of enrollees is estimated to be 43,049,000.

Financial Information

Account Identification

20-8004-0-7-571.

Obligations

(Insurance) FY 08 $187,255,712,000; FY 09 est $200,277,000,000; FY 10 est $200,498,000,000 - The figures represent benefit outlays.

Range and Average of Financial Assistance

Generally, with exceptions of certain services, the beneficiary is responsible for meeting the annual $135 deductible before you may begin. Thereafter, Medicare pays a percent of the approved amount of the covered service. For many services, this percentage is 80 percent. For other services, the percentage that Medicare pays will vary from 100 percent to 50 percent depending upon the category of service.

Regulations, Guidelines and Literature

Code of Federal Regulations, Title 20, Parts 401, 405, and 422; Title 42, Parts 401, 405, 407, 408, 410, 413, 416, and 417. "Your Medicare Handbook," and other publications are available from any Social Security Office without charge.

Related Programs

57.001 Social Insurance for Railroad Workers; 64.012 Veterans Prescription Service; 64.013 Veterans Prosthetic Appliances; 93.770 Medicare_Prescription Drug Coverage; 93.773 Medicare_Hospital Insurance; 93.778 Medical Assistance Program; 96.001 Social Security_Disability Insurance

Information Contacts

Regional or Local Office

See Regional Agency Offices. Consult Appendix IV of the Catalog for listing of Regional Offices.

Headquarters Office

Kemuel Johnson, 7500 Security Boulevard
, Baltimore, Maryland 21207 Email: kemuel.johnson@cms.hhs.gov Phone: (410) 786-8200. Fax: (410) 786-7667

Web Site Address

http://www.cms.hhs.gov.

Examples of Funded Projects

Not Applicable.

Criteria for Selecting Proposals

Not Applicable.