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.
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.
Note: To make sure your claims are being filed on time, check the Medicare Summary Notice (MSN) you get in the mail every 3 months.
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, PDF opens new window. 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.
Note: You may want to make a copy of all forms and documents to keep for your own records.
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.
Once you’ve submitted your paperwork, follow these tips to check the status of a claim, opens new window.
For more helpful information on Medicare, check out these 10 frequently asked questions about Medicare plans.
