Medicare Application - Do Both You And Your Provider Have To Apply?

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Medicare Application - Do Both You And Your Provider Have To Apply?

Medicare is a health insurance program provided by the United States government. The Medicare Program covers citizens who are 65 years old or older, or those meeting other specific criteria.

The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS) department. In order for you to take advantage of Medicare, and for your physician to accept your coverage, you must both complete a Medicare application.

Medicare coverage and information is subject to change without notice. You should always check with your local Social Security agency before relying solely on this article.

Individual Coverage

Most people qualify for Medicare when they reach 65 years old or if certain medical conditions apply. Anyone already receiving Social Security benefits will automatically enrolled in Medicare Parts A and B. Because you must pay a premium for Part B coverage, you have the choice not to include Part B coverage on your Medicare application. Persons who are automatically eligible will be notified several months prior to their eligibility birthdate with the proper information.

Individuals who are not automatically enrolled must complete the Medicare application CMS 40B, Application for Enrollment in Medicare. To obtain this form, you must either visit your local Social Security Administration office or arrange for a Medicare application appointment at 1-800-772-1213.

For convenience, an application for monthly benefits for retirement, disability, or a spouse is often submitted with the Medicare application. It is possible to apply for these monthly benefits online at https://s044a90.ssa.gov/apps6z/ISBA/main.html Your local Social Security office can also help you with this application.

Provider Coverage

Medical providers desiring to participate in the Medicare health insurance program must submit a Medicare application. One example applicable to doctors, hospitals, and ambulance is Form CMS 10115, Section 1011 Provider Enrollment Application. This relatively short form requires basic contact information as well as the applicant's Medicare Identification Number, Federal Tax Identification Number, and, for hospitals only, lists of physicians with hospital privileges and their provider numbers.

Examples of a Medicare application for different providers include:

Form CMS 855A, Medical Enrollment Application - Institutional Providers applies to: Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, End-Stage Renal Disease Facilities, Federally Qualified Health Centers, and other facilities specifically listed on the application. This Medicare application is available for download from http://www.cms.hhs.gov/cmsforms/downloads/cms855a.pdf

Form CMS 855B is entitled Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers. It applies to Ambulance Service Suppliers, Ambulatory Surgical Centers, Clinic/Group Practices, Independent Clinical Laboratories, and other facilities specifically listed on the application. It is available for download from http://www.cms.hhs.gov/CMSforms/downloads/cms855b.pdf

The Beginning of the Medicare Paper Trail

There are many more Medicare application forms available than can be discussed or even listed here. Whether you are a doctor or a patient, the enrollment process begins with the Medicare application.



 

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