| Medicare is a health insurance program provided by | | | | Security office can also help you with this application. |
| the United States government. The Medicare Program | | | | Provider Coverage |
| covers citizens who are 65 years old or older, or | | | | Medical providers desiring to participate in the Medicare |
| those meeting other specific criteria. | | | | health insurance program must submit a Medicare |
| The Medicare program is administered by the Centers | | | | application. One example applicable to doctors, |
| for Medicare and Medicaid Services (CMS) | | | | hospitals, and ambulance is Form CMS 10115, Section |
| department. In order for you to take advantage of | | | | 1011 Provider Enrollment Application. This relatively short |
| Medicare, and for your physician to accept your | | | | form requires basic contact information as well as the |
| coverage, you must both complete a Medicare | | | | applicant's Medicare Identification Number, Federal Tax |
| application. | | | | Identification Number, and, for hospitals only, lists of |
| Medicare coverage and information is subject to | | | | physicians with hospital privileges and their provider |
| change without notice. You should always check with | | | | numbers. |
| your local Social Security agency before relying solely | | | | Examples of a Medicare application for different |
| on this article. | | | | providers include: |
| Individual Coverage | | | | Form CMS 855A, Medical Enrollment Application - |
| Most people qualify for Medicare when they reach 65 | | | | Institutional Providersapplies to: Community Mental |
| years old or if certain medical conditions apply. Anyone | | | | Health Centers, Comprehensive Outpatient |
| already receiving Social Security benefits will | | | | Rehabilitation Facilities, Critical Access Hospitals, |
| automatically enrolled in Medicare Parts A and B. | | | | End-Stage Renal Disease Facilities, Federally Qualified |
| Because you must pay a premium for Part B | | | | Health Centers, and other facilities specifically listed on |
| coverage, you have the choice not to include Part B | | | | the application. This Medicare application is available for |
| coverage on your Medicare application. Persons who | | | | download from |
| are automatically eligible will be notified several months | | | | Form CMS 855B is entitled Medicare Enrollment |
| prior to their eligibility birthdate with the proper | | | | Application - Clinics/Group Practices and Certain Other |
| information. | | | | Suppliers. It applies to Ambulance Service Suppliers, |
| Individuals who are not automatically enrolled must | | | | Ambulatory Surgical Centers, Clinic/Group Practices, |
| complete the Medicare application CMS 40B, | | | | Independent Clinical Laboratories, and other facilities |
| Application for Enrollment in Medicare. To obtain this | | | | specifically listed on the application. It is available for |
| form, you must either visit your local Social Security | | | | download from |
| Administration office or arrange for a Medicare | | | | The Beginning of the Medicare Paper Trail |
| application appointment at 1-800-772-1213. | | | | There are many more Medicare application forms |
| For convenience, an application for monthly benefits | | | | available than can be discussed or even listed here. |
| for retirement, disability, or a spouse is often submitted | | | | Whether you are a doctor or a patient, the enrollment |
| with the Medicare application. It is possible to apply for | | | | process begins with the Medicare application. |
| these monthly benefits online at [ Your local Social | | | | |