Blue Button API query that returns current Medicare cardholder?

[Sarah Henry]

Hi everyone, I’m working on an application that gives users transit benefits based on their qualifications (e.g. older adult, veteran). We’re currently adding support to our app for Medicare users and I was wondering if anyone knew how best to query the Blue Button API in order to ascertain if a user a) has been issued a Medicare card and b) if that person is currently alive?

I’m concerned that medicare accounts remain active after someone’s death—in the case there are still financial obligations. I’m also not entirely certain as to which data point in the API verifies active account or cardholder status, and if I need to further parse out whether the account is enrolled in Medicare A or B. For example, I see there's coverage.status in the coverage file, but the definition doesn't seem clear to me.

Any suggestions or help is appreciated!

[Developer Group for CMS Blue Button API]

Hi Sarah,
Please note that the Blue Button 2.0 API is not a source of truth for Medicare eligibility. Eligibility is handled by the HIPAA Eligibility Transaction System (HETS). However, there are several fields that we do offer which may support qualification decisions. Our upstream data provider, the Beneficiary FHIR Database, releases a data dictionary with each release. This is the best place to see all the fields supported and their definitions. The latest data dictionary can be found here: https://github.com/CMSgov/beneficiary-fhir-data/releases/tag/2.141.0 (click the first link under ‘assets’ to download the data dictionary).

Note that there is a deceasedDateTime field, and the /coverage endpoint may give you some of the information you are looking for. We do not supply any data about if an enrollee has been issued a Medicare card. If you have additional questions feel free to email us at bluebuttonapi@ cms.hhs.gov
Thanks,

The Blue Button 2.0 Team