MedicareEligibility

Medicare eligibility. Original Reason for Medicare Entitlement. In CMS’ calculation of the MA payment, CMS includes an additional factor in the risk score based on the original reason the beneficiary became eligible for Medicare. The following code outlines the application of the factor based on original reason for entitlement.The Monthly Membership Report reflects the OREC identified in MARx. Originally been entitled to Medicare as disabled is diagnosed with End-Stage Renal Disease(ESRD)

Possible enumeration values:

Name	Value	Description
Aged	0	Beneficiary insured due to age. Not Concurrently ESRD, Not Originally Disabled.
Disabled	1	Beneficiary insured due to disability. Originally Disabled, Not Concurrently ESRD. Originally Disabled terms refer to beneficiaries originally entitled to Medicare for reasons of disability other than ESRD. In this model, Originally Disabled is defined only for beneficiaries age 65 and over.
ESRD	2	Beneficiary insured due to ESRD. Concurrently ESRD, Not Originally Disabled. Medicare for those with End-Stage Renal Disease (ESRD Medicare) provides you with health coverage if you have permanent kidney failure that requires dialysis or a kidney transplant. ESRD Medicare covers a range of services to treat kidney failure. Originally ESRD indicates beneficiary originally entitled to Medicare due to ESRD. Beneficiaries who are Originally ESRD cannot be Originally Disabled.
DisabledESRD	3	Beneficiary insured due to disability and current ESRD. Originally Disabled, Concurrently ESRD. You can have Medicare for those with End-Stage Renal Disease (ESRD Medicare) at the same time you have Medicare based on disability or age. Whether or not you need to enroll in ESRD Medicare at the same time you are enrolled in Medicare based on age or disability depends on which you had first.