Medicare, a health care program funded by the federal government is aimed at providing affordable services to the eligible US residents. It’s necessary for Medicare recipients to visit a Medicare provider in addition to meeting certain criterion, to be eligible for the benefits. These Medicare providers later get reimbursed for the services they offer to the recipients. Before we move on to the procedure to become a Medicare Provider, let’s try to know who is or can be a Medicare Provider. A Medicare Provider, also termed as a Provider of services is defined as a skilled nursing facility, CORF (Comprehensive Outpatient Rehabilitation Facility), hospice, home health agency or a hospital such as rural primary care hospital. A Medicare Provider can also be a public health agency, rehabilitation agency or a clinic meeting the criterion for participation for the purpose of delivering outpatient occupational therapy services, outpatient speech pathology and outpatient physical therapy. The term further extends to CMHC (Community Mental Health Center), just for the purpose of delivering partial hospitalization services.

A participating provider must comply with applicable provisions of the 1964 civil rights act, title VI. The provider must sign an agreement under social security act §1866 that states:

• The provider doesn’t charge any persons for services and items covered by the health insurance program except for coinsurance amount and deductibles.
• The provider returns any amount incorrectly charged on any individual on his/her behalf as dictated by statue.

For becoming a qualified participating provider, you must meet all criteria for certification on your onsite survey date. If you fail to meet any criterion on your onsite survey date, your effective date of agreement commences on:

• The date you meet all criteria.
• The date you submit correction plan accepted by HCFA.
• The date you provide an acceptable waiver request.

For the reimbursement to the provider for services and items delivered to the beneficiary, it must have the required record-maintaining facility to determine the cost of services offered.

Mentioned below is the procedure on becoming a Medicare Provider. Although Medicare providers have to submit a lengthy application, the procedure is quite simple once you complete the documentation.

• You need to be aware of both; federal regulations and regional policies devised by the state applicable to you. Review the guidelines given by Medicare.
• Identify the differences between various Medicare policies. For instance, if you are working in a hospital or nursing home, you will need Medicare part A, whereas group practices and private doctors will more than likely need Medicare part B.
• You should have a 10 digit number called an NPI number that ensures HIPA (Health Insurance Portability and Accountability) compliance.
• You can receive an application for a Medicare provider from the Medicare carrier in your area. The carrier is the point of contact for all your Medicare concerns. The carrier also helps you out regarding any queries on the enrollment procedure.
• You will need to submit an entirely completed application along with a copy of DEA (Drug Enforcement & Administration) certificate, Medicare provider letter, form W-9 from the IRS and a copy of state business license.
• Reread the Medicare certification terms. For becoming a Medicare provider, you need to possess a valid business license in addition to agreeing for a non-discrimination standard. You should also abide by all the other terms dictated in the program.
• Mail copies of all the documents and forms to a Medicare carrier in your area. It may take up to 7 weeks for your application to be processed.

Medicare medicine coverage plan, also referred to as Medicare Part D, is a type of insurance that provides Medicare coverage for a portion of your prescription drugs costs. Anyone who is eligible for Medicare is able to enroll for this plan. The plan covers both brand-name medications as well as generic medications. Although the plans are sponsored by Medicare, they are sold by private insurance companies and therefore the costs will vary.

Part D or Medicine Coverage Plan is obtained through private insurance companies. There are specific times during the year when you can enroll in a plan or perhaps switch from one plan to another. These plans are approved by Medicare and have a monthly premium. However, there is help available for people with limited incomes.

According to the FDA (Food and Drug Administration), generic medicines are similar in strength, safety, quality and function as compared to its brand-name counterpart. Generic medicines make use of the same active ingredients that are used in brand-name medicines and function in the same manner. Generic drug manufactures need to prove to the FDA that their medications function and perform in the same way as their corresponding brand-name medication. Since the active ingredients in both generic and brand name medications are same, they have the same benefits and risks involved. Researching and then manufacturing a medication costs a lot of money and since generic drug manufacturers do not develop a drug from scratch, the costs of the medications are far less. However, generic medications need to prove that they perform in the same way as a brand-name medication.

In order to have lower costs, Medicare plans place prescription drugs into different tiers. Each of these tiers cost a different amount. Each plan can divide the tiers in different ways. A medication in a lower tier would cost less as compared to a medication in a higher tier.

For example, generic drugs are placed in tier 1 as they cost the least. Tier 2 includes preferred brand-name medications and therefore would cost more than tier 1 medications. Tier 3 includes non-preferred brand-name medications and would cost more than both tier 1 and 2.

Any category of medicines under Medicare coverage is also covered under the drug coverage plan. However, there are specific categories of medications which are not covered under Medicare. These categories include fertility medications, barbiturates, benzodiazepines and over-the-counter smoking cessation medications. Since these plans are issued by private insurance companies, certain companies might offer to cover some medications which are not covered by Medicare, as an added benefit to the customers.

A Medicare drug coverage plan can be purchased as a single plan, or as a part of the Medicare Advantage Plan. The single plans are known as PDP or Prescription Drug Plans and provide coverage for medicine costs only. Medicare Advantage Plans which is also known as Medicare Part C, usually include a prescription plan in addition to health insurance coverage. Eligible individuals should enroll in a drug coverage plan to be covered. For people covered under the traditional Medicare model, the enrollment in both Medicare Part A and B is essential to be eligible for the drug coverage plan. In addition to the premium paid under Medicare Part B, participants would need to pay a monthly premium for Part D.

Since these plans for medicine coverage are issued by private insurance companies, certain brands of medications might or might not be covered depending upon which company you decide to go with. Some insurance companies might cover only certain brand name medications whereas others companies might mostly cover generic medications.