Who Provides Medicare Coverage?

Medicare is a publicly funded health insurance program in the United States designed to provide individuals over 65, and certain others with disabilities, affordable health insurance. The need for the Medicare program arose during the 1950s and 1960s as senior citizens, many of whom had limited income in their retirement, struggled to find affordable health insurance from private insurance providers. The government created Medicare in 1965 to help ease this problem.

As a publicly funded program controlled by the government, Medicare needed to provide health coverage for millions of Americans in regions across the country from small rural towns to big cities like New York and Los Angeles. It is impossible for the government to set up its own hospitals or medical centers for individuals to collect their benefits at, instead providers all over the country may provide individuals with their health coverage and receive payment from the Medicare system.

Medicare providers can be found all over the United States. Individuals who collect their Medicare benefits through Original Medicare, that is Part A and Part B, can go to any hospital or medical center they wish as long as that provider accepts Medicare’s payment system. Individuals who collect their benefits through Part C, or a Medicare Advantage Plan, essentially have a private insurance plan and can only visit the hospitals and doctors their plan allows them to see.

Individuals who collect their benefits through Original Medicare have greater freedom to see a wide variety of hospitals, doctors, and other medical providers. As long as the individual provider is willing to accept Medicare’s payment system then they can become a Medicare provider. The Medicare program has an established billing and coding system that determines the amount that the program will pay to any provider for a given service, such as hospital stays, exams, laboratory and diagnostic tests, and so on. When a beneficiary goes in to see a doctor, the provider will bill Medicare for the services rendered based upon the coding system.

Medical providers, physicians, practitioners, and medical suppliers must register with the Centers for Medicare and Medicaid Services in order to become an approved Medicare provider. The CMS has an extensive online resource center where providers, physicians, and suppliers can submit online, or download and mail in, their application forms to receive a National Provider Identifier. There are separate forms for each of the following:

- Institutional providers
- Clinics, group practices, and certain other suppliers
- Physicians and non-physician practitioners
- Durable medical equipment, Prosthetics, and Orthotics suppliers

Once Medicare providers are listed on the National Provider Identifier it is much easier for Medicare beneficiaries to locate providers near them and receive services from local hospitals and clinics.

Because Medicare is accepted by providers in regions all over the country, beneficiaries have the benefit of reliable coverage no matter where they live. Those individuals living in densely populated areas will naturally have more providers to choose from, but even those living in rural areas will be able to easily find a provider courtesy of the National Provider Identifier list.