Remember when all you had to show at the doctor’s office or hospital was your Medicare card and no questions were asked? Now you have different cards for different services, and your original Medical card. So, which card do you use and when do you use it?

First, you should always have your original Medicare card with you. If you did not receive your original Medicare card or you have lost your original Medicare card, you can get a replacement card by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week.

What cards do I use if I have Medicare A and B?

  • Your original Medicare card

Your Medicare card provides proof that you Medicare eligible and enrolled in the Medicare program. Your Medicare card is red, white and blue. The card also shows your effective dates of coverage and which parts of Medicare you are enrolled in (i.e., Medicare Parts A and/or Part B). This is the only card you will need to provide when checking in for a doctor’s appointment, medical facility or hospital if the only coverage you have is original Medicare Part A and/or Part B. Typically, since original Medicare does not cover but a select few prescription medications, your original Medicare card is not needed when you go to a pharmacy to get prescriptions. Most prescriptions that are covered under original Medicare Part B are for medications administered in a medical facility or doctor’s office, such as injections. (For more information see “What prescriptions are covered under original Medicare Part B?”)

What cards do I use if I have a Medicare Supplement or a Medigap plan?

If you have a Medicare Supplement plan (also known as “Medigap”), you also have a card from the carrier of the plan indicating your active enrollment dates in the Medicare Supplement plan. You will also need to show your Medicare card.

What cards do I use if I have a Medicare Advantage plan?

If you have a Medicare Advantage plan (also known as “Medicare Part C” or “Part C”) you will have a card from the carrier of your plan. The Medicare Advantage card is the only card you will need to present when you go to the doctor, a medical facility or the hospital. Your original Medicare card is not needed if you have a Medicare Advantage plan because the doctor’s office, medical facility or hospital will not bill Medicare for services rendered because original Medicare is no longer administering your claims. A Medicare Advantage plan, or Medicare Part C, takes the place of original Medicare Part A and Part B and all payments made to your medical providers are issued from your Medicare Advantage plan insurance carrier. You still have to be enrolled in original Medicare Part A and Part B to qualify for a Medicare Advantage plan even though you will no longer be utilizing Medicare for payment of medical services. The medical services provided must still be Medicare approved services in order to be covered by your Medicare Advantage plan.

What cards do I use at the pharmacy?

When you go to the pharmacy to get your prescription medications, if you have a “stand-alone” Prescription Drug Plan (also known as “PDP”), you will present the card provided by the carrier of your Prescription Drug Plan. This card provides proof of eligibility and coverage and the dates of coverage, as well as telephone numbers for the pharmacist to call if there is a problem with coverage of one or more of your medications.

If you have a Medicare Advantage plan with a “built-in” Prescription Drug Plan (also known as a “MAPD”), then you would present the card from your Medicare Advantage plan insurance carrier at the pharmacy.

 

It is possible have up to three different cards which relate to Medicare coverage. If you need assistance in determining which card to use, simply contact your Medicare or your agent/benefit specialist. Do not cheat yourself out of the coverage you have purchased by not having or producing the appropriate card when receiving medical services or obtaining prescriptions medications. Failure to present the proper Medicare related insurance card may result in denial of payment of medical services at the time, unnecessary out-of-pocket expenses, or delay in payment of medical services to your medical provider.

 

Medicare Pathways, Inc.  1-866-466-9118