- You will likely never need to file your own Medicare claim.
- You have 1 year to file your Medicare claim after receiving services covered by Medicare.
- You’ll need to fill out the Patient’s Request for Medical Payment form found on the CMS.com website.
- You can log into your MyMedicare account to check the status of your claim.
Most people may never need to file a Medicare claim themselves. In some circumstances, though, it might be required. If so, the process is simple and straightforward.
We’ve broken it down step by step below. Continue reading to learn more.
Medicare-approved providers usually send claims directly to Medicare so that you won’t need to. And people with Medicare Advantage (Part C) don’t need to file claims at all because the private insurance companies that offer these plans are paid by Medicare each month.
People with original Medicare (parts A and B) may need to file their own claims if their healthcare provider:
- can’t file a claim
- won’t file a claim
- isn’t enrolled in Medicare
If you have original Medicare, you’ll receive a Medicare summary notice in the mail every 3 months. This notice will detail your Medicare plans and costs.
You can check your Medicare summary notice each month for claims. If you think any claims are wrong, bring the form to your healthcare provider’s billing office.
In the rare case that you may need to file a Medicare claim yourself, follow this step-by-step guide to make sure yours is done correctly.
The first thing you’ll need to do when filing your claim is to fill out the Patient’s Request for Medical Payment form. If you’d prefer, you may fill out this form in Spanish.
With this form, you’ll provide most of the information that Medicare will need to process your claim. The form will ask you to include:
- the reasons why you saw your healthcare provider
- if you got treatment for a work-related illness or injury
- the details of your health insurance plan
There may be other requirements, too, depending on what the claim is for. You may need to provide additional details on certain claims, including those for:
- services covered under Medicare Part B
- durable medical equipment (such as wheelchairs, walkers, or feeding pumps)
- healthcare services received in Canada or Mexico
- treatment received in hospitals outside the United States, Canada, or Mexico
The next step in filing your own claim is to get an itemized bill for your medical treatment.
Itemized bills describe in detail exactly what you’re paying for. Your claim will be valid when you receive an itemized bill for your treatment. Ask your healthcare provider for an itemized bill if the one you initially get isn’t itemized.
Your itemized bill should include:
- the date of your medical treatment
- the hospital or doctor’s office you went to for treatment
- your doctor or healthcare provider’s name and address
- a description of each surgical or medical treatment received
- an itemized charge for each treatment
- your diagnosis
You’ll need to add any supporting documents to your claim after getting an itemized bill for your treatment.
Supporting documents may include doctor referrals or details of your medical history. You should fill out the Authorization to Disclose Personal Health Information form if:
- You want someone to call Medicare about your claim on your behalf.
- You want Medicare to give personal information about you and your claim to someone else.
The final step in filing your own Medicare claim is to mail all the completed forms and documents to Medicare. This includes the Patient’s Request for Medical Payment form, itemized bills, and any other supporting documents to your claim.
You must file your Medicare claim by mail. There isn’t an option to file your Medicare claim online.
According to Medicare.gov, you may find the address for where to send your claim in two places:
- on the second page of the instructions for filing a claim, listed as “How do I file a claim?”
- on your Medicare summary notice, which may be found in your personal MyMedicare account
- It’s important to follow the correct steps when you file your own Medicare claim.
- You have 1 year to file your Medicare claim after receiving services covered by Medicare as a beneficiary. Your claim may be rejected if you wait longer.
- Contact a Medicare representative if you have other questions regarding your claim.
- You can log into your MyMedicare account to check the status of your claim. You may need to wait 24 hours after Medicare processes your claim for it to show up.