How to Read a Medicare Card and Check Eligibility
Reading a Medicare card and checking eligibility might sound a bit daunting, but it's actually pretty straightforward once you know what to look for. Whether you're a Medicare recipient or helping someone navigate the Medicare system, here's a simple guide to help you understand and use a Medicare card.
When you enroll in Medicare, you will be given a red, white, and blue Medicare card. This card contains your name and the start dates of your Original Medicare hospital insurance (Part A) and medical insurance (Part B). It will also display your Medicare number, which functions as a unique identifier in the Medicare system.
Understanding the Format of the Medicare ID Number
A Medicare MBI number consists of 11 random characters with no underlying meaning. The MBI number is a string of numbers and upper-case letters that can contain any combination of digits (1-9) and letters from the alphabet except B, I, L, O, S, and Z.
An MBI, for instance, will display on a Medicare card as 1EG4-TE5-MK73. The first, fourth, seventh, tenth, and eleventh characters are always letters, whereas the second, fifth, eighth, and ninth characters are always numbers.
How to Check Medicare Eligibility?
Verifying your patients' eligibility is a crucial step in ensuring a smooth healthcare billing and treatment process. Here's a quick guide on how to go about it:
You must first verify that the patient's Medicare card is active for those types of insurance.
The Medicare card provides information such as the patient's name, member ID, and the kind of insurance (Medicare Type A and Medicare Type B), so we only need to look for Type B coverage. Once activated, we may review the patient's coverage and other perks.
1. Gather Patient Information
Start by collecting all the necessary patient information. You'll typically need the patient's name, date of birth, and their insurance information, including their policy or member ID number.
2. Contact the Insurance Provider
Reach out to the patient's insurance provider. This can often be done by calling the customer service number on the back of the insurance card. Be prepared to provide the patient's information and explain that you're verifying their eligibility.
3. Provide Patient Details
When you get in touch with the insurance company, be ready to provide the patient's name, date of birth, and insurance details. You may also need the patient's social security number or a unique identifier, depending on the insurance company's requirements.
4. Ask the Right Questions
During your call with the insurance company, ask specific questions to ensure you have all the necessary information.
Inquire about:
Policy Effective Date
Confirm when the patient's coverage began. This will help determine if they are currently eligible for benefits.
Coverage Status
Find out if the patient's coverage is active and up-to-date. This includes checking for any pending or upcoming changes to their coverage.
Co-Pay and Deductible Information
Understand the patient's financial responsibilities, such as co-pays, deductibles, coinsurance with a patient insurance carrier and check if any have been met.
5. Record Information
Keep detailed records of your conversation with the insurance provider. Note down the date and time of the call, the name of the representative you spoke with, and a summary of the information you received.
6. Verify Special Conditions
If your patient has specific healthcare needs or conditions, ensure that their insurance covers the necessary treatments or medications. Some plans have restrictions or requirements for certain procedures or medications.
7. Communicate with the Patient
After verifying eligibility, inform the patient about the results. Clearly explain what their insurance covers, any out-of-pocket costs, and any restrictions or pre-authorizations required.
8. Document Everything
It's essential to maintain detailed records of eligibility verifications for future reference and billing purposes. This documentation can help in cases of disputes or discrepancies.
Remember that insurance coverage can change, so it's a good practice to verify eligibility before each appointment or significant healthcare service. By following these steps, you'll ensure a smoother and more transparent experience for both your patients and your healthcare facility.
Note that Medi-Dental has both single and bulk "EV" (Eligibility & Verification) options, which are really helpful for dentists who want to check all of their patients' coverage status every day. Three days before the appointment, we contact the front office or dentist to collect all the patient information.
We'll send the coverage status, right along with the benefits report to the dentist or front office. After the benefits are verified, our portal will automatically add all the patient's information to the patient demographics screen.
