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.



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 listing of Regional Offices.
Website Address

http://www.cms.hhs.gov




Program Accomplishments

Fiscal Year 2016: 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 58,165,000. The source for the number of Medicare beneficiaries is the FY 2018 MSR. Fiscal Year 2018: N/A.

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 certain covered services furnished by participating providers such as hospitals 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 2016 premiums range from $134.00 to $428.60 per month.

The annual deductible is $183.00.

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.

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. 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 Procedures

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.

Authorization

Social Security Act Title XVIII, Section 1831.

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. 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.

Post Assistance Requirements

Reports

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.

Audits

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.

Financial Information

Account Identification

75-8004-0-7-571.

Obigations

(Insurance) FY 16 $301,506,000,000; FY 17 est $309,423,000,000; and FY 18 est $325,058,000,000

Range and Average of Financial Assistance

Generally, with exceptions of certain services, the beneficiary is responsible for meeting the annual $166 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.

Information Contacts

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.

Criteria for Selecting Proposals

Not Applicable.



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