(Medicare General Information, Eligibility, and Entitlement)

As part of health insurance electronic data processing, Medicare cards are issued by CMS to individuals who have established entitlement to health insurance.   Below is an example of the Medicare card.   New Medicare Card           New Medicare Card  Front             New Medicare Card Back                                 The Medicare card is used to identify the individual as being entitled and also serves as a source of info rmation required to process Medicare claims or bills. It displays the beneficiary's name, Medicare number, and effective date of entitlement to hospital insurance and/or medical insurance. The Social Security Administration's Social Security Office assists  in replacing a lost or destroyed Medicare cards.   50.1 - Medicare Beneficiary Identifier (M BI) (Rev.  12046, Issued:05- 18-23, Effective:01-01-23, Implementation:06-21-23)  The term Medicare beneficiary identifier (M BI) is a general term describing a beneficiarys Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card tran sition period and after for certain business areas that will continue to use the HICN as part of their processes.   60 - Medicare Part C, Medicare+Choice  (Rev. 1, 09-11-02)  Medicare Part C, which is also known as Medicare+Choice, is a Medicare program that  gives beneficiaries more choices among health plans.  Everyone who has Medicare Parts A and B is eligible, except those who have end stage renal disease, and were not in a Medicare+Choice plan at the onset of this condition.  Public Law 105-33, the Balanced Budget Act of 1997, establishes a new authority permitting contracts between CMS and a variety of different managed care and fee -for-service entities.  The types of entities that may be granted contracts under this new authority include:   Coordinated care plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Provider-Sponsored Organizations  You may be asked to show this card when you get health care services. Only give your personal Medicare information to health care providers, your insurers, or people you trust who work with Medicare on your behalf. WARNING: Intentionally misusing this card  may be considered fraud and/or other violation of federal law and is punishable by law. Es posible que le pidan que muestre esta tarjeta cuando reciba servicios de cuidado mdico. Solamente d su informacin personal de Medicare a los proveedores de salud, sus aseguradores o personas de su confianza que trabajan con Medicare en su nombre.  ADVERTENCIA! El mal uso intencional de esta tarjeta puede ser considerado como fraude y/u otra violacin de la ley federal y es sancionada por la ley.  1-800- MEDICARE (1-800-633- 4227 /  TTY: 1 -877-486-2048); Medicare.gov  (PSOs).  A PSO is defined as a public or private entity established by health care providers, which provide a substantial proportion of health care items and services directly through affiliated providers who share, directly or indirectly, substantial financial risk.    Religious fraternal benefit society plans which may restrict enrollment to members of the church, convention or group with which the society is affiliated.  Payments to such plans may be adjusted, as appropriate to take into account the actuarial characteristics and experience of plan enrollees.    Private fee -for-service plans which reimburse providers on a f ee-for-service basis, and are authorized to charge enrolled beneficiaries up to 115 percent of the plan's payment schedule (which may be different from the Medicare fee schedule).   In addition to the Medicare+Choice contractors, beginning in January, 1999, up to 390,000 beneficiaries will have the choice (on a demonstration basis ending January 1, 2003) of enrolling in a Medical Savings Account (MSA) option.  Under this option, beneficiaries would obtain high deductible health policies that pay for at least  all Medicare- covered items and services after an enrollee meets the annual deductible of up to $6,000.  The difference between the premiums for such high deductible policies and the applicable Medicare+Choice premium amount would be placed into an account  for the beneficiary to use in meeting his or her deductible expenses.   Past 1876 Contracts  - HMO/CMP risk plans that remain in compliance with current contracting standards and comply with new requirements established under this statutory authority automa tically transitioned into the Part C Medicare+Choice program.  Section 1876 risk- based contractors were paid under a new Medicare+Choice payment methodology rather than the prior method in section 1876(a), and were subject to certain other Medicare+Choice provisions.  The Secretary no longer accepts new 1876 risk applications.  As of January 1, 1999, existing 1876 risk- based contracts were terminated, and plans in good standing transitioned to the Medicare+Choice program.   Repeal of Cost Option -  As of August 5, 1997, the Secretary is prohibited from entering into any new 1876 cost -based contracts, unless the plan is a Health Care Prepayment Plan with an agreement under section 1833 of the Social Security Act.  The 1876 cost -based payment authority is repeal ed and all cost contracts are terminated as of December 31, 2002.  Limited HCPP Option  - Beginning January 1, 1999, the Secretary may only contract with those HCPPs that are sponsored by Union or Employer groups, or HCPPs that do not "provide, or arrange f or the provision of, any inpatient hospital services ...."  This amendment will result in the termination of section 1833 agreements with any organization that does not meet the new definition.  CMS will establish transition rules for 1876 risk- based contr actors that currently receive reimbursement on a cost basis for enrollees remaining under a previous HCPP agreement.  For more information, see the Managed Care Manual.  Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#  R12046GI  05/18/2023  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-01, IOM Chapter 2 Hospital Insurance and Supplementary Medical Insurance  06/21/2023  13189  R11764BP  12/22/20 22 New Medicare Part B Immunosuppressant Drug Benefit (PBID) - Implementation  01/03/2023  12804  R11646GI  10/19/2022  New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation  Rescinded and Replaced by Transmittal 11764   01/03/2023  12804   07/28/2022  New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation  SENSITIVE/CONTOVERSIAL DO NOT POST - Rescinded and Replaced by Transmittal 11646  01/03/2023  12804  R124GI  05/17/2019  Update to Publication (Pub.) 100 -01 to Provide Language-Only Changes for the New Medicare Card Project   06/18/2019  11240  R01MGI  09/11/2002  Initial Publication of Manual  NA NA  Back to top of Chapter