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
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
Fiscal Year 2016
In fiscal year 2016, the number of enrollees is estimated to be 56,646,000. The source for the number of Medicare beneficiaries is the FY 2017 MSR. In fiscal year 2016, the number of enrollees is estimated to be 56,482,000. The source for the number of Medicare beneficiaries is the FY 2018 MSR.Fiscal Year 2017
In fiscal year 2017, the number of enrollees is estimated to be 58,066,000. The source for the number of Medicare beneficiaries is the FY 2019 MSR.Fiscal Year 2018
Social Security Act Title XVIII, Section 1831.
Who is eligible to apply/benefit from this assistance?
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 2019 premiums range from $135.50 to $460.50 per month. The annual deductible is $185.00. Some States and other third parties may pay the SMI PART B premium on behalf of qualifying individuals.
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".
Proof of age, disability or lawful admission status.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable.
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. 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.
After review of the application is completed, the applicant will be notified by mail.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
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.
How are proposals selected?
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?
Providers, suppliers, and Medicare Advantage plans are subject to audit requirements.
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 payments to providers and suppliers or monthly capitation payments to MA plans.
Who do I contact about this opportunity?
Regional or Local Office
Consult Appendix IV of the Catalog for listing of Regional Offices.
7500 Security Blvd
Baltimore, MD 21244 US
(Insurance) FY 18$323,097,000,000.00; FY 19 est $360,873,000,000.00; FY 20 est $391,252,000,000.00; FY 17$314,543,000,000.00; FY 16$301,506,000,000.00; -
Range and Average of Financial Assistance
Generally, with exceptions of certain services, the beneficiary is responsible for meeting the annual $185 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.
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