How to file a claim for Medicare reimbursement
Most people on Original Medicare will never need to file a claim—doctors, suppliers or healthcare providers typically submit claims directly to Medicare. However, there are rare cases where people may need to file their own claim.
Here’s some information to help you file a Medicare claim correctly.
When you may need to file a Medicare claim
Your doctor, supplier or healthcare provider:
Delayed filing a claim
Refused to file a claim
Can’t file a claim
Isn’t enrolled in Medicare
Original Medicare (Parts A and B) claims have to be submitted within 12 months of when you received care. If a claim isn't filed within 12 months, Medicare can't pay its share. Medicare Advantage plans (Part C) have different time limits for submitting claims which are shorter than Original Medicare. Contact your Medicare Advantage plan provider to find out the time limit for submitting claims.
How to file a Medicare claim
1. Fill out a Patient’s Request for Medical Payment form
Download, print and complete the Patient’s Request for Medical Payment (CMS-1490S) form. You can also pick up a form at your local Social Security office. Instructions are included with the form.
2. Get an itemized bill for your medical treatment
Your itemized bill is the evidence for the Medicare claim. Make sure the bill you receive from your healthcare provider or supplier includes all of the information Medicare requires, such as:
The date of your treatment
Where you received treatment (hospital, doctor’s office, etc.)
Description of each treatment or medical supply received
Itemized charge(s) for each treatment or medical supply
3. Write a letter and add supporting documents to your claim
Writing a letter can help explain why you (and not your doctor, supplier or healthcare provider) are filing the claim. Also, if you have supporting documents like referrals to specialists or details of your medical history, include them with your claim.
4. File your claim for Medicare reimbursement
Send your completed form, itemized bill, letter and supporting documents (if any) to the Medicare administrative contractor in your state. Medicare claims can’t be filed online—they must be submitted by mail.
The address for your state’s contractor can be found in the instructions for “How do I file a claim?” in the Patient’s Request for Medical Payment form. You can also find the address in your Medicare Summary Notice or by calling 800-MEDICARE (800-633-4227, TTY: 877-486-2048).
Note: It may take up to 60 days for Medicare to process and review your claim.
Check the status of a Medicare claim
Once you’ve submitted your paperwork, you can check the status of your claims.
For Medicare parts A and B claims:
Log into (or create) your secure Medicare account. You’ll usually be able to see a claim within 24 hours after Medicare processes it.
Check your Medicare Summary Notice (MSN). The MSN is a notice that people with Original Medicare get in the mail every 3 months. It shows:
All your Part A and Part B-covered services or supplies billed to Medicare during a 3-month period
What Medicare paid
The maximum amount you may owe the provider
Use Medicare's Blue Button by logging into your Medicare account to download and save your Part A and Part B claims information. Learn more about Medicare’s Blue Button.
For Medicare drug plan(part D), Medicare Advantage plan(part C), or other medicare health plan claims:
Check your Explanation of Benefits (EOB). Your Medicare drug plan will mail you an EOB each month you fill a prescription, visit a health care provider or file a claim. This notice gives you a summary of your claims and costs. Learn more about the EOB.
Use Medicare's Blue Button by logging into your secure Medicare account to download and save your claims information. Learn more about Medicare’s Blue Button.
For more up-to-date claims information, contact your plan.