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.



Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

Consult Appendix IV of the Catalog for a listing of Regional Offices.
Website Address

http://www.cms.hhs.gov




Program Accomplishments

Not Applicable.

Uses and Use Restrictions

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.

Eligibility Requirements

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 $413 per month, effective January 1, 2017.

A reduced Part A premium of $227 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. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.

Aplication 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 Procedures

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. Individuals entitled to Social Security or railroad retirement are enrolled without application.

Award Procedures

The individual will be notified by mail of enrollment, whether automatic or applied for.

Deadlines

Not Applicable.

Authorization

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); Affordable Care Act (Public Law 111-148).

Range of Approval/Disapproval Time

None.

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

None.

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 payment to providers or monthly capitation payments to Medicare Advantage plans.

Post Assistance Requirements

Reports

No reports are required.

Audits

No audits are required for this program.

Records

None.

Financial Information

Account Identification

75-8005-0-7-571.

Obigations

(Insurance) FY 16 $291,248,000,000; FY 17 est $293,284,000,000; and FY 18 est $298,434,000,000 - 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 2017 the beneficiary is responsible for $1,316 inpatient hospital deductible, a $329 per day coinsurance amount for 61 through 90 days of inpatient hospital care, a $658 per day coinsurance amount for inpatient hospital care during the 60 lifetime reserve days, and a $164.50 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.

Information Contacts

Regional or Local Office

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

Headquarters Office

Rob Ludwig 7500 Security Boulevard, Baltimore, Maryland 21244 Email: Robert.Ludwig@cms.hhs.gov Phone: (410) 786-5407

Criteria for Selecting Proposals

Not Applicable.



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