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Grant Community.com Catalog of Federal Domestic Assistance Program Descriptions |
CATALOG OF FEDERAL DOMESTIC
ASSISTANCE
93.774: Medicare: Supplementary Medical Insurance
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| PROGRAM AND AWARD | FINANCIAL AND INFORMATION CONTACTS |
| ELIGIBILITY REQUIREMENTS | FINANCIAL AND ADMINISTRATIVE INFO. |
| APPLICATION AND AWARD PROCESS | INFORMATION CONTACTS |
| RELATED PROGRAMS | ASSISTANCE CONSIDERATIONS |
| PROGRAM ACCOMPLISHMENTS | POST ASSISTANCE REQUIREMENTS |
Applicant Eligibility: All persons who are eligible for 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 the application for enrollment is filed, may voluntarily enroll for supplementary medical insurance (SMI). The beneficiary pays a monthly premium. In calendar year 2000, the base premium is $45.50. Some States and other third-party buy-ins pay the premium on behalf of qualifying individuals.
Beneficiary Eligibility: Persons age 65 and over, and persons under age 65 who qualify for hospital insurance benefits.
Credentials/Documentation: Proof of age, disability or lawful admission status. This program is excluded from coverage under OMB Circular No. A-87.
Preapplication Coordination: None. This program is excluded from coverage under E.O. 12372.
Application Procedure: Phone or visit the local Social Security Office. Most persons entitled to hospital insurance 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. This program is excluded from coverage under OMB Circular Nos. A-102 and A-110.
Award Procedure: After review of the application is completed, the applicant will be notified by mail.
Deadlines: Certain individuals may enroll during a special enrollment period (SEP) if they are covered under a group health plan (GHP) when first eligible to get Medicare: (1) individuals age 65 or older who are covered under a GHP based on their own or a spouse's current employment; and (2) disabled individuals under age 65 who are covered under a GHP based on their own or any family member's current employment. If the coverage of disabled individuals under age 65 was not through a large group health plan (LGHP), that is, a plan that covers employees of a least one employer that normally employs at least 100 employees, no family member other than a spouse qualifies for a special enrollment period. An SEP enrollment may occur during any month the individual is covered under the GHP based on current employment or, during the eight month period that begins the first month after employment or GHP coverage ends, whichever occurs first. Months of coverage under the GHP based on current employment are excluded from the calculation of the premium surcharge.
Range of Approval/Disapproval Time: Not applicable.
Appeals: Phone 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.
Criteria for Selecting Proposals: Not applicable.
Examples of Funded Projects: Not applicable.
Range and Average of Financial Assistance: The beneficiary is responsible for meeting an annual $100 deductible before benefits may begin. Thereafter, Medicare pays 80 percent of the fee schedule amount or the reasonable costs for covered services.
In fiscal year 1999, 36,932 persons were enrolled for supplementary medical insurance. In fiscal year 2000, the number of enrollees is estimated to be 37,280,000. In fiscal year 2001, the number of enrollees is estimated to be 37,651,000.
Federal Agency: HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Type of Assistance: Direct Payments for Specified Use.
Obligations: (Benefit Outlays) FY 99 $79,150,655,000; FY 00 est $90,574,000,000; and FY 01 est $100,273,000,000.
Budget Account Number: 20-8004-0-7-571.
Authorization: Social Security Act Amendments of 1965, Title XVIII, Part B, Public Law 89-97, as amended; Public Laws 90-248, 92-603, 93-233, 94-182, 95-210 and 95-292, 42 U.S.C. 1395 et seq.; Social Security Disability Amendments of 1980, Public Laws 96-265 and 97-248; Section 1, Public Law 98-21; Subtitle A, Public Law 98-369, as amended; Public Laws 98-460, 99-272, 99-509, and 100-203, 42 U.S.C. 1305 Note; Medicare Catastrophic Coverage Repeal Act of 1988, Title I, Subtitle B, Title II, Subtitles A and B, Title IV, Subtitle B and C, Public Law 100-360; Medicare Catastrophic Coverage Repeal Act of 1989, Title II, Public Law 101-234; Omnibus Budget Reconciliation Act of 1989, Public Law 101-239; Omnibus Budget Reconciliation Act of 1990, Public Law 101-508; Omnibus Budget Reconciliation Act of 1993, Public Law 103-66; Social Security Act Amendments of 1994, Public Law 103-432; Health Insurance Portability and Accountability Act of 1996, Public Law 104-191; Contract with America Advancement Act of 1996, Public Law 104-121; Balanced Budget Act of 1997, Public Law 105-33; Balanced Budget Refinement Act of 1999, Public Law 106-113.
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.
Regional or Local Office: Consult Appendix IV of the Catalog for listing of Regional Offices.
Headquarters Office: Mrs. Carol Cronin, Director, Center for Beneficiary Services, Health Care Financing Administration, Room C5-19-07, 7500 Security Blvd., Baltimore, MD 21244. Phone: (410) 786-2744.
(See Appendix IV for more contact info.)
Formula and Matching Requirements: This program has no statutory formula or matching requirements.
Length and Time Phasing of Assistance: Not applicable.
Uses and Use Restrictions: Benefits are paid on the basis of fee schedules or reasonable charges for covered services furnished by physicians and other suppliers of medical services to aged or disabled enrollees. Benefits are paid on the basis of reasonable costs for covered services furnished by participating providers such as hospitals and home health agencies.
Reports: None.
Audits: None.
Records: None.
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