Medicare_Supplementary Medical Insurance

 

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.

General information about this opportunity
Last Known Status
Active
Program Number
93.774
Federal Agency/Office
Agency: Department of Health and Human Services
Office: Centers for Medicare and Medicaid Services
Type(s) of Assistance Offered
DIRECT PAYMENTS FOR A SPECIFIED USE
Program Accomplishments
Fiscal Year 2014: In fiscal year 2014, the number of enrollees is estimated to be 53,502,000. The source for the number of Medicare beneficiaries is the FY 2016 MSR. Fiscal Year 2015: In fiscal year 2015, the number of enrollees is estimated to be 55,340,000. The source for the number of Medicare beneficiaries is the FY 2016 MSR. Fiscal Year 2016: No current data available.
Authorization
Social Security Act Title XVIII, Section 1831.
Who is eligible to apply/benefit from this assistance?
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 2015 premiums range from $104.90 to $335.70 per month. The annual deductible is $147.00. Some States and other third parties may pay the SMI PART B premium on behalf of qualifying individuals.
Beneficiary Eligibility
All persons who qualify for hospital insurance, and those who do not qualify for hospital insurance but meet eligibility requirements and choose to purchase Part "B".
Credentials/Documentation
Proof of age, disability or lawful admission status. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.
What is the process for applying and being award this assistance?
Pre-Application Procedure
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 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. 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.
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.
Approval/Disapproval Decision 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.
How are proposals selected?
Not Applicable.
How may assistance be used?
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 certain covered services furnished by participating providers such as hospitals and home health agencies.
What are the requirements after being awarded this opportunity?
Reporting
No program reports are required. No cash reports are required. No progress reports are required. No expenditure reports are required. No performance monitoring is required.
Auditing
This program is excluded from coverage under 2 CFR 200, Subpart F - Audit Requirements. Providers, suppliers, and Medicare Advantage plans are subject to audit requirements.
Records
None.
Other 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. See the following for information on how assistance is awarded/released: Claims-based payments to providers and suppliers or monthly capitation payments to MA plans.
Who do I contact about this opportunity?
Regional or Local Office
See Regional Agency Offices. Consult Appendix IV of the Catalog for listing of Regional Offices.
Headquarters Office
Inga Feldmanayte, 7500 Security Boulevard, Baltimore, Maryland 21207 Email: Inga.Feldmanayte@cms.hhs.gov Phone: (410) 786-5995.
Website Address
http://www.cms.hhs.gov
Financial Information
Account Identification
75-8004-0-7-571.
Obligations
(Insurance) FY 14 $262,595,000,000; FY 15 est $278,226,000,000; and FY 16 est $303,410,000,000
Range and Average of Financial Assistance
Generally, with exceptions of certain services, the beneficiary is responsible for meeting the annual $147 deductible before you may begin. Thereafter, Medicare pays a percent of the approved amount of the covered service. This percentage is 80 percent for most services.
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.
Examples of Funded Projects
Not Applicable.