Filing a claim

You should only need to file a claim in very rare cases.

• Original Medicare: If you have Original Medicare , the law requires your doctor, provider, or supplier to file Medicare claims for covered services and supplies you get.
• Medicare drug plans: If you have a separate Medicare drug plan (Part D) , the pharmacy will file a claim directly with your plan.
• Medicare health plans: If you have a Medicare Advantage (Part C) plan (with or without drug coverage), and use in-network doctors, suppliers, and pharmacies, they’ll usually submit a claim directly to your plan.

How do I file a claim?

What do I submit with the claim?

Follow the instructions on the form for the type of claim you're filing. Generally, you’ll need to submit:

• The completed claim form (Patient Request for Medical Payment form (CMS-1490S)
• The itemized bill from your doctor, supplier, or other health care provider
• A letter explaining why you’re submitting the claim (like if your provider or supplier isn’t able to file the claim, refuses to file the claim, or isn’t enrolled in Medicare)
• Any supporting documents related to your claim (like notes from your doctor)

Where do I send the claim?

If you have Original Medicare, you'll need to mail your claim form, itemized bill and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form.

Who can help me file a claim?

• State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling. SHIPs are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare.
• Medicare: You can also contact us for help. Talk or live chat with a real person, 24 hours a day, 7 days week (except some federal holidays) by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048 .
• Representative: If you have a family member or friend helping you with a complaint, you can appoint them as a representative. Download and share your claims with trusted sources.
  How do I appoint a representative?

What are the timeframes for filing a claim?

Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided unless an exception applies. If a claim isn't filed within this time, Medicare won't pay its share. How can I check the status of a claim once I've filed it?

Example: If you see your doctor on March 22, 2019, your doctor must have filed the Medicare claim for that visit by March 22, 2020. Check the "Medicare Summary Notice" (MSN) you get in the mail, log into your secure Medicare account, or check your plan's claims statements to make sure claims are being filed in a timely way.

Why did I get a bill, and what do I do with it?

If you get a bill, it could be because your doctor, provider, or supplier:

• Doesn’t accept assignment
• Opted-out of Medicare and entered into a private contract with you
• Gave you services that aren’t covered by Medicare
• Didn’t collect the Medicare deductible and coinsurance amounts you owe when you got services

You might have to either pay the bill or, in rare cases, submit your own claim.

If claim hasn’t been filed on your behalf, contact your doctor, provider, or supplier, and ask them to file a claim for the service or supply you got.

If you have contacted your doctor, provider, or supplier, and they haven’t filed your claim, call us at 1-800-MEDICARE. Ask for the exact time limit for filing a Medicare claim for the service or supply you got. If it's close to the end of that time limit and your doctor, provider, or supplier still hasn't filed a claim, you should file the claim.

Can I submit a claim if I already paid out-of-pocket?

Yes. If you had to pay out of pocket for services or supplies because your doctor, provider, or supplier refused to submit a claim, you’ll have to submit your own claim.

If you had to pay out of pocket for a vaccine or prescription that was covered by Medicare recently, but hasn’t been added to your plan’s formulary yet, you may need to file a claim if you want to be paid back.

What if I disagree with a coverage or payment decision?

If you disagree with a decision by Medicare or your Medicare plan, you can file an appeal. Learn more about filing an appeal.