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.

Active 93.774 Centers For Medicare and Medicaid Services, Department of Health and Human Services C - Direct Payments For Specified Use; G - Insurance Not applicable. Social Security Act Title XVIII, Section 1831. 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 2023 premiums range from $164.90 to $560.50 per month. The annual deductible is $226.00. 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. 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 Not applicable. 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. Not applicable. Not applicable. 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. Not applicable. Providers, suppliers, and Medicare Advantage plans are subject to audit requirements. None. 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. None Claims-based payments to providers and suppliers or monthly capitation payments to MA plans. Consult Appendix IV of the Catalog for listing of Regional Offices. Gary Davis
7500 Security Blvd
Baltimore, MD 21244 US
Gary.Davis2@cms.hhs.gov
Phone: 4107861000 http://www.cms.hhs.gov 75-8004-0-7-571 (Insurance) FY 22$467,732,000,000.00; FY 23 est $482,288,000,000.00; FY 24 est $505,853,000,000.00; FY 21$428,627,000,000.00; FY 20$414,044,000,000.00; FY 19$371,048,000,000.00; FY 18$323,097,000,000.00; FY 17$314,543,000,000.00; FY 16$301,506,000,000.00; - Generally, with exceptions of certain services, the beneficiary is responsible for meeting the annual $226 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. 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. Not applicable.