How to Verify Eligibility & Benefits of Medicare Patients

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Medicare is a health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) for elderly (age 65 and over) and certain disabled individuals. Eligibility for Medicare can be determined through the use of prescreening tools. Understanding the types of benefits offered by different Medicare plans can help determine which plans to enroll in after eligibility is determined.

Complete the Medicare Eligibility Tool, available on medicare.gov (see reference 1). This eligibility tool will provide you with detailed feedback regarding your Medicare eligibility. You may also call 1-800-MEDICARE.

Review coverage guidelines for Part A hospital and Part B outpatient medical benefits. You should receive a booklet stating your Part A and B benefits after you enroll in Medicare. If you have any specific questions regarding coverage for a specific medical procedure or require a replacement booklet, you may call 1-800-MEDICARE.

Review eligibility guidelines for Part D, Advantage and Medigap plans if you require prescription coverage or additional hospital and/or outpatient medical coverage. All these plans require enrollment in Medicare as the first eligibility requirement. However, unlike Part A and B, these plans also require that other eligibility requirements be met, including residing in a specific geographic region within the United States. You can determine eligibility requirements and explanation of benefits for these plans under "Plan Choices" on medicare.gov.

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