Medicare Hospital Insurance

 

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.

General information about this opportunity
Last Known Status
Active
Program Number
93.773
Federal Agency/Office
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
C - Direct Payments For Specified Use; G - Insurance
Program Accomplishments
Not applicable.
Authorization
Affordable Care Act (Public Law 111-148)
American Recovery and Reinvestment Act of 2009, Public Law 111-5, Title XVIII of the Social Security Act, Health Care and Education Reconciliation Act (Public Law 111-152)
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
Persons age 65 or over and certain disabled persons are eligible to receive hospital insurance benefits. Nearly all individuals who had reached the age of 65 before 1968 are eligible for Part A, including people not eligible for cash Social Security benefits. A person reaching the age of 65 from 1968 to the present, and who is not eligible for social security benefits, needs to have accumulated work credits (amount dependent on age) to qualify for hospital insurance benefits. Hospital insurance (Medicare Part A) is also available to persons aged 65 and over through payment of a monthly premium, which is currently $437 per month, effective January 1, 2019. A reduced Part A premium of $240 per month is applied to persons with 30 to 39 quarters in which they have paid into the social security system. This reduced Part A premium applies to their spouse, surviving spouse or divorced spouse as well. Federal employees began contributing toward Medicare hospital insurance coverage in 1983. Employees who have worked in the federal government prior to this year are still eligible to receive credit for prior non-contributory quarters of Federal employment. State and local government employees not already in Social Security-covered positions and who were 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 the age of 65 who have been entitled to Social Security or Railroad Retirement disability benefits for at least 29 months are also eligible to receive hospital insurance benefits, as are any individuals who have been diagnosed with End Stage Renal Disease (ESRD).
Beneficiary Eligibility
Persons age 65 or over and qualified disabled persons.
Credentials/Documentation
Proof of age or disability.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is not applicable.
Application Procedure
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Telephone or visit the local Social Security Office. Individuals entitled to Social Security or railroad retirement are enrolled without application.
Award Procedure
The individual will be notified by mail of enrollment, whether automatic or applied for.
Deadlines
Not applicable.
Approval/Disapproval Decision Time
Not applicable.
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.
How are proposals selected?
Not applicable.
How may assistance be used?
Hospital insurance benefits are paid to participating hospitals, inpatient rehabilitation facilities ,skilled nursing facilities, home health agencies, and hospice agencies. Payments are made in order to cover the prospective payment amount or reasonable cost of medically necessary services furnished to individuals who are entitled under this program. In limited circumstances, Medicare will also pay for certain aspects of receiving care in an inpatient religious non-medical health care setting.
What are the requirements after being awarded this opportunity?
Reporting
Not applicable.
Auditing
Not applicable.
Records
None.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
None Claims-based payment to providers or monthly capitation payments to Medicare Advantage plans.
Who do I contact about this opportunity?
Regional or Local Office
Consult Appendix IV of the Catalog for a listing of Regional Offices.
Headquarters Office
Rob Ludwig
7500 Security Boulevard
Baltimore, MD 21244 US
Robert.Ludwig@cms.hhs.gov
Phone: 4107865407
Website Address
http://www.cms.hhs.gov
Financial Information
Account Identification
75-8005-0-7-571
Obligations
(Insurance) FY 18$298,824,000,000.00; FY 19 est $325,232,000,000.00; FY 20 est $346,847,000,000.00; FY 17$291,122,000,000.00; FY 16$291,248,000,000.00; - These figures represent benefit outlays, not including QIO or Health IT payments to medical providers.
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 2019 the beneficiary is responsible for $1,364 inpatient hospital deductible, a $341 per day coinsurance amount for 61 through 90 days of inpatient hospital care, a $682 per day coinsurance amount for inpatient hospital care during the 60 lifetime reserve days, and a $170.50 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 and You," SSA-79-10050, and other publications are available from any Social Security Office without charge.
Examples of Funded Projects
Not applicable.