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.
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This Medicare application is available for
download from
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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.
-
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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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