Medicare part b eligibility verification for providers

Need help with Medicare eligibility verification? Call our licensed insurance agents at this Medicare eligibility phone number: (800) 950-0608.

Just the essentials...

• The Medicare website provides information on eligibility at no cost

• The Medicare website provides a sign-up option at no cost

• The Social Security website provides information on eligibility

• The Social Security website provides a sign-up portal for Medicare as well as Social Security benefits at no cost

If you’re wondering how to verify Medicare coverage eligibility as well as how to  verify Medicare eligibility and benefits, we have answers! The best way to check eligibility and enroll in Medicare online is to use the Social Security or Medicare websites. They are government portals for signing up for Medicare, and they offer free information about eligibility.

Medicare is not part of Social Security, but they are connected: getting Social Security benefits is one way to become eligible for Medicare.

Once eligible and enrolled in Medicare, one can also choose an optional Medicare Advantage or supplemental Medigap plan to add benefits and reduce out-of-pocket costs.

These types of plans are offered by private insurance carriers, so comparison shopping is a great way to find the right health insurance coverage with Medicare Advantage or Medicare Supplement plans

Enter your zip code above to get help comparing all your Medicare plan options at no cost!

Determining Eligibility for Medicare: Who is eligible for Medicare?

The Medicare website is a good place to start. A button will say “Estimate my eligibility”. This link will lead to a page that asks a few questions that can affect your eligibility. There is no need to make an account to use this tool.

It assesses factors of age, U.S. citizenship, and whether a person or their spouse has paid Medicare taxes while working for 10 years.

Based on your responses, this tool then answers the questions of whether Medicare enrollment will be done automatically or if one needs to apply for it themselves, as well as explaining the best time to apply.

If eligible, the same page has a link to help estimate the premium amount one needs to pay to get covered under Part A and Part B of Medicare.

The below-listed items are the essential qualifications for Medicare.

• Age 65 U.S citizens or permanent residents who have lived in the U.S. for 5+ years consecutively.
• Age 64 or less, after receiving disability for twenty-four months
• Those diagnosed with End Stage Renal Disease

Those ages 65 and above with 10 years time working while paying Medicare taxes get Medicare Part A without any premium cost.

Information Needed to Verify Medicare Eligibility

One must provide identification, and this includes a full name, address, date of birth, and Social Security number.

Some questions may involve the work history of the spouse or partner to see if one or both may be eligible for Social Security benefits and Medicare.

The terms spouse and partner will also include divorced and separated couples because the work history of one spouse or partner can benefit the other.

Check Online for Free at Medicare.gov

The Medicare website lists the general qualifications to get and verify Medicare coverage. It also has resources to determine the applicant’s eligibility for Medicare.

Medicare has an online eligibility tool to determine status for benefits and can tell you the insurance premium for Medicare Part A, if you have to pay anything for it.

Check Eligibility through the Social Security Website

Social Security is an independent federal agency. Social Security helps people enroll in Medicare when they are ready to retire or whether they choose to continue working.

The SSA uses its website and offices to assist persons seeking information eligibility and in applying for benefits.

Open Enrollment Begins October 15 and Ends December 7

The government has enrollment periods; these are specific times when Medicare permits sign-ups. If one is eligible for Medicare, then the question may become when is the best time to enroll.

The below-listed information describes enrollment options.

• Initial Enrollment Period (IEP) encompasses the three full months before the 65th birthday month, the birthday month, and the three full months after the birthday month.
• The General Enrollment Period (GEP) runs from January 1 through March 31 of each year.  If the GEP is outside their IEP window, eligible persons that sign up for Part A and B get coverage beginning July 1 of that year..
• The annual open enrollment period (AEP) runs from October 15 through December 7 of each calendar year.

General Eligibility for Medicare: When am I eligible for Medicare?

Medicare eligibility goes hand-in-hand with Social Security eligibility.

Individuals in the below-listed categories can get Medicare coverage.

• Persons age 65 or older; eligibility begins four months before their 65th birthday
• Disabled persons 64 and under can qualify if receiving disability benefits from Social Security or the RRB for 24 months
• Persons with end-stage renal disease (needing kidney transplant or dialysis) can get premium-free Medicare Part A. Eligibility based on End-Stage Renal Disease (ESRD) requires current dialysis treatment, a kidney transplant, and filing an application for Medicare.

Medicare has Four Parts

Medicare is split into parts, each identified by a letter: A, B, C, and D.

When a person has both Parts A and B, this is called having Original Medicare.Part D covers prescription drugs only.

Part C is slightly different; it combines the coverage of Parts A, B, and D under a type of plan called Medicare Advantage.

We explore all of these parts of Medicare below.

Medicare Part A: Hospital Insurance covers for inpatient services when admitted to the hospital, as well as home health care, skilled nursing care and Hospice. Part A may require a premium depending on work history while paying taxes, but typically beneficiaries are entitled to it at no cost. Individuals receiving at least four months of Railroad Retirement Board Benefits or Social Security benefits before they turned 65 will be automatically enrolled. Others must contact Social Security to enroll in Part A of Medicare.

Medicare Part B: Medical Insurance is outpatient physician care that includes doctor’s visits and other medical services as well as durable medical equipment for home use. Part B requires a premium in most cases. In 2021, this monthly premium is $148.50.

Medicare Part C: Medicare Advantage is available to anyone enrolled in Part A and Part B. Medicare Advantage plans are private insurance plans that cover at least what Parts A and B cover, but can cover more to include prescription drugs, dental, vision and hearing. Comparison shopping will ease the task of finding a plan to suit their situation and health needs by focusing on features one considers high priority.

Medicare Part D: Prescription Drug Coverage also depends on enrollment Parts A and B. If enrolled in either Part A or Part B, or both, a person can get their prescription drug coverage as either a stand-alone Part D plan or instead get prescription drug coverage through an all-in-one Medicare Advantage plan. Not all Medicare Advantage plans include prescription coverage, but most do.

You can start here and now; click here to compare Medicare costs and insurance options at no cost!

How to Get Premium-Free Part A

The system of eligibility for Medicare measures the working years in which the individual paid the Federal Insurance Contributions Act tax, or FICA tax.

With the exceptions of self-employment and certain government positions, most people have this included in the payroll taxes deducted from each paycheck.

These working years accrue what is known as Quarters of Coverage.

Quarters of Coverage each represent a three-month period of work while paying the FICA tax; about 4 Quarters of Coverage are earned in a single year.

The Quarters of Coverage are units of measuring eligibility for Medicare coverage and Social Security benefits. This measurement determines both the level of monthly Social Security income benefits and whether Part A is premium-free. 

To get Part A premium-free, one typically must have earned 40 quarters of coverage, or about 10 years of employment while paying payroll taxes. The 40 total Quarters of Coverage do not have to be earned over 10 consecutive years.

These quarters of coverage can be earned through one’s own work history or the work history of a spouse, parent, or child.

Those who have not quite accrued 40 Quarters of Coverage can still join Medicare Part A at age 65, but it will require paying a premium.

Earning 30-39 credits sets the monthly premium for Part A in 2021 at $259, and having earned less than 30 credits sets the Part A premium at $471.

For Medicare and Social Security beneficiaries who have to pay for Part A, they must also have and pay for Medicare Part B.

In 2021, the Medicare Part B premium for most people is $148.50. 

The number of fully-taxed covered quarters of work will also affect the monthly amount received for Social Security or Railroad Retirement Board pension benefits. 

The number of quarters needed varies on the bases of age, disability, or kidney disease.

Those Age 65 Typically Get Premium-Free Medicare Part A

Medicare Part A is premium-free to those 65 and older who are also eligible for monthly Railroad Retirement Board or Social Security retirement payments because they worked and paid taxes during all 40 Quarters of Coverage.

This is one basis of eligibility for premium-free Medicare Part A. However, some people receive Social Security benefits before they turn 65. 

The Social Security system automatically enrolls in Part A those individuals who receive Social Security or disability benefits for at least four months before the month of their 65th birthday. When this is the case, Part A coverage begins on the first day of their 65th birthday month.

Those Age 65 Can Apply for Medicare Parts A and Medicare Part B eligibility

Most eligible persons must apply for Medicare Benefits through the Social Security administration if they do not yet claim Social Security or Railroad retirement benefits.

They can determine eligibility by reviewing the information on either the Social Security or Medicare websites.

Self-Enrollment for Premium-Paid Medicare Part A

Any person who has to pay a premium for Part A must also pay Part B premiums, and when this is the case they will not get automatic enrollment at age 65.

If a person has to pay a premium for Part A, they can choose not to buy it, yet that person is still able to buy Part B and pay its monthly premiums. 

When turning 65 and not yet receiving retirement benefits, one should apply for Medicare Parts A and B through Social Security. 

This should be done within the three full months before the 65th birthday month, the full month of their 65th birthday, and three full months afterward.

Waiting too long after turning 65 to get coverage may result in an unwanted penalty on the premium cost of Part A or Part B.

The Individual Mandate and Late Enrollment Penalties

Although most states have eliminated the tax penalty set by the Affordable Care Act for not having health insurance coverage each year, Medicare has its own requirements for qualified health insurance. 

Any of the below listed Medicare Parts will meet the requirements of the individual mandate for those age 65 and over:

• Original Medicare, consisting of Medicare Part A and Part B
• Medicare Part A has the Minimum Essential Coverage required by the Affordable Care Act.
• Medicare Part C Medicare Advantage plans meet the requirements of the individual mandate for qualified health insurance. These plans provide coverage equal to or better than Original Medicare.

Enrolling in Medicare Parts A and B on time is essential. For those who are eligible for Medicare, but who do not enroll, may face a penalty if they wait too long. 

Penalty amounts are calculated by the amount of time an eligible person went without coverage:

• For Part A, a 10% penalty added to the premium cost lasts for twice the number of full years the person was eligible, but did not enroll. 
• For Part B, the penalty adds 10% to the monthly Part B premium, multiplied by the number of full years the person was eligible, but did not enroll. It lasts for the entire duration of Part B coverage
• For Part D, the penalty adds 1% of the national average cost for a Part D plan, multiplied by the number of full uncovered months. The national average in 2021 is $33.06, so the penalty adds about $0.33 per full, uncovered month. This penalty begins when the person goes 63 days without prescription coverage  while eligible for Medicare.

Prescription coverage is offered through private insurance companies either in the form of stand-alone Part D plans or all-in-one Medicare Advantage plans. Eligibility for Part D requires having either Part A or Part B.

Understanding Medicare Based on Disability

Persons entitled to monthly Social Security or Railroad Retirement Board (RRB) benefits by disability are automatically entitled to Medicare Part A after twenty-four months of disability benefits.

If disabled government employees are not otherwise eligible for Social Security Benefits through their history of work or contribution to payroll taxes, they get automatic eligibility for Part A after twenty-nine months of receiving disability benefits.

There is a special rule for People with (ALS) Lou Gehrig’s disease. They get eligibility with no waiting period upon the first month of RRB or SSA benefits.

Child disability eligibility begins the month of the 20th birthday except for ALS which is set for age 18.

Those diagnosed with End-Stage Renal Disease (ESRD) are typically eligible to begin Medicare on the first day of the fourth month they receive dialysis treatments.

In addition, to get Part A premium-free, those with End-Stage Renal Disease must also meet one of three below-stated conditions:

1. Receiving Social Security or Railroad Retirement Board Benefits; or
2. Have worked enough quarters covered by Social Security, Railroad Retirement Board, or as a government employee; or
3. Be the spouse or child dependent of someone that has worked enough quarters covered by Social Security, Railroad Retirement Board, or in government employment.

How can I get a free Medicare eligibility checker? Is there a Medicare verification portal?

Medicare has free eligibility checks online. The Social Security website offers the same information.

Both websites offer a free-to-use online enrollment tool.

Once in Medicare, one will need to compare private plans to make the best selection to help with costs and provide additional benefits not normally covered by Medicare.

Comparison shopping is a great tool when considering private prescription drug plans, Medigap insurance plans, and Medicare Advantage plans.

You can start here and now; click here to compare Medicare costs and insurance options for free!

References:

How do I verify Medicare Part B?

How do I verify Medicare eligibility?

How does a provider check Medicare claim status?

How do I verify a Medicare number?