Eagle Eye Publishers, Inc.

Centers for Medicare and Medicaid Services, Department of Health and Human Services

AUTHORIZATION

American Recovery and Reinvestment Act of 2009, Public Law 111-5.

OBJECTIVES

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.

TYPES OF ASSISTANCE

DIRECT PAYMENTS FOR A SPECIFIED USE

USES AND USE RESTRICTIONS

Hospital insurance benefits are paid to participating and emergency hospitals, skilled nursing facilities, home health agencies, and hospice agencies to cover the prospective payment amount or reasonable cost of medically necessary services furnished to individuals entitled under this program.

ELIGIBILITY REQUIREMENTS

Applicant Eligibility

Persons age 65 or over and certain disabled persons are eligible for hospital insurance protection. Nearly everyone who reached 65 before 1968 is eligible for hospital insurance, including people not eligible for cash Social Security benefits. A person reaching age 65 in 1968 or after, who is not eligible for cash benefits, needs some work credit to qualify for hospital insurance benefits. The amount of work credit needed depends on age. Hospital insurance (Medicare Part A) is also available to persons, age 65 or over, not otherwise eligible through payment of a monthly premium which is currently $393. A reduced Part A premium of $216 per month in 2006 is available to persons with 30 or more quarters paid into the social security system, as well as to their spouse, surviving spouse or divorced spouse. The reduction in Part A premium payments would also apply to the surviving spouse, or divorced spouse of an individual who had at least 30 quarters of coverage under the social security system. Federal employees began contributing toward Medicare hospital insurance coverage beginning January 1983. Employees who worked prior to 1983 and who were employed during January 1983 can receive credit toward establishing Medicare eligibility, if necessary, for prior non-contributory quarters of Federal employment. State and local government employees not already in Social Security-covered positions and 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 age 65, who have been entitled for at least 24 months to Social Security disability benefits, or for 29 consecutive months to railroad retirement benefits based on disability, are eligible for hospital insurance benefits.

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 OMB Circular No. A-87. This program is excluded from coverage under OMB Circular No. A-87.

APPLICATION 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 Procedure

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Telephone or visit the local Social Security Office. Individuals entitled to Social Security or railroad retirement are enrolled without application.

Award Procedure

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

Deadlines

Range of Approval/Disapproval Time

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

ASSISTANCE CONSIDERATION

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. Method of awarding/releasing assistance: lump sum.

POST ASSISTANCE REQUIREMENTS

Reports

Audits

No audits are required for this program.

Records

FINANCIAL INFORMATION

Account Identification

Obligations

(Insurance) FY 08 $223,304,091,000; FY 09 est $241,866,000,000; FY 10 est $251,203,000,000 - These figures represent benefit outlays.

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 2009 the beneficiary is responsible for $1,068 inpatient hospital deductible, a $267 per day coinsurance amount for 61 through 90 days of inpatient hospital care, a $534 per day coinsurance amount for inpatient hospital care during the 60 lifetime reserve days, and a $133.50 per day coinsurance amount for days 21 through 100 of care in a skilled nursing facility. Home health services are paid in full.

Program Accomplishments

Fiscal Year 2009: No Current Data Available Fiscal Year 2010: In fiscal year 2010, the number of persons protected is estimated to be 46,248,000. Fiscal Year 2011: No Current Data Available

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

Center for Beneficiary Choices 7500 Security Boulevard, Baltimore, Maryland 21244 Phone: 4107863418

93.773 Medicare_Hospital Insurance

(Medicare Part A)

FEDERAL AGENCY