How to check Medicare eligibility
A portal or phone check takes a front-desk staffer 10–15 minutes per patient. A real-time 270/271 check returns Part A & B status, deductibles, QMB status, and Medicare Advantage enrollment in seconds.
CMSReal-time 270/271Enrollment required · hoursMedicare✓ Response verified July 2026Three ways to verify Medicare coverage
- Payer portal — free, but one patient at a time and 10–15 minutes each with logins.
- Phone (IVR) — hold times vary; no written record for the chart.
Automated 270/271 check
Full benefit detail in seconds, batched for your whole schedule — not one patient at a time.
From $0.50 per check, pay-as-you-go.
Medicare at a glance
What billers need before running a check.
CMSWhat a live Medicare check returns
Documented from real 271 eligibility responses. This is the actual level of detail — not a marketing summary.
Why this matters: The two most expensive Medicare billing mistakes — billing Original Medicare when the patient has a Medicare Advantage plan, and billing cost-sharing to a QMB patient — are both visible in this response before the visit happens.
Supported transactions
What can be exchanged electronically with Medicare today.
| Transaction | Status |
|---|---|
Eligibility (270/271) Real-time benefit and coverage checks | ENROLLMENT REQUIRED |
Claim status (276/277) Where a submitted claim stands | NOT AVAILABLE |
Professional claims (837P) Physician and outpatient claims | NOT AVAILABLE |
Institutional claims (837I) Facility claims | NOT AVAILABLE |
Dental claims (837D) Dental claims | NOT AVAILABLE |
Remittance (835 ERA) Electronic remittance advice | NOT AVAILABLE |
Coordination of benefits Secondary-payer routing | NOT AVAILABLE |
Claim attachments (275) Supporting documentation | NOT AVAILABLE |
Portal vs. phone vs. automated
The same verification, three ways.
| Payer portal | Phone / IVR | Automated check | |
|---|---|---|---|
| Time per patient | 10–15 min | 15–30 min | Seconds |
| Cost per check | ~$7.97 staff time* | ~$7.97+ staff time* | from $0.50 |
| Record for the chart | Screenshot | None | Full audit trail |
| Whole-day schedule | One at a time | One at a time | Batched overnight |
*CAQH Index benchmark for a manual eligibility verification.
FAQ
Frequently asked questions
Medicare uses payer ID CMS. It also appears as 10001, CMSMED, MAPMC, MEDICARE in some systems.
Yes. Medicare supports real-time 270/271 eligibility checks after a one-time enrollment that typically takes hours. Once enrolled, checks return in seconds.
A portal check takes 10–15 minutes of staff time per patient. An automated real-time check returns in seconds and can run for an entire day's schedule overnight.
Yes — this is one of the most valuable fields in the response. If the patient is enrolled in a Medicare Advantage plan, the check flags it and identifies the plan that should be billed instead of Original Medicare, preventing an automatic denial.
An MBI lookup can retrieve the patient’s Medicare Beneficiary Identifier from their name, date of birth, and SSN — then the eligibility check runs normally.
Run your first Medicare eligibility check
From $0.50 per check, pay-as-you-go. No annual contract, no implementation project.
Billing more than Medicare? — upload it and see which of your payers run automatically.
