In most cases, your doctor is in charge of filing a Medicare claim for each health care service you receive. However, this is not always the case. Sometimes, you must fill out a Medicare claim yourself to collect Medicare reimbursement.
When to File Claims for Medicare Part A and Part B
Has your doctor delayed filing? Or have you worn out all efforts to get a claim filed? If the answer to the questions above is ‘yes’, then you will need to file a claim with Medicare only. This applies to Original Medicare (Part A for hospital coverage and Part B for Medical coverage). This circumstance is rare, but always stay prepared in case this does happen.
Medicare Part C and Part D – Filing Claims
There are no Medicare claims for Medicare Part C (Medicare Advantage) and Part D (prescription drug coverage). This is because Medicare pays your health insurance plan for Part C and Part D every month. What you will be liable for is the cost sharing (coinsurance, co-payments, and/or deductible) established by the Medicare Part C or Part D plan.
In some cases, you may need to file claims with your specific plan. The doctor will usually file the claim for you if they are a part of the network of health care providers in your plan.
You may have a plan that lets you go to any doctor who accepts Medicare no matter if they are outside the network. With cases like this, you probably have to file the claims yourself. Note that the filing of these claims are with the Medicare Advantage (Part C) or Prescription Drug (Part D) plan, not with Medicare.
Check your plan records to see when and how to file claims and which doctors you may visit.
The deadline for Medicare claims
All Medicare claims should be filed within 12 months of when the medical service(s) were provided. The claim must be filed within this timeframe so that Medicare can pay its share. For example, if your doctor provided service on August 1, 2018, you and your doctor have until August 1, 2019 to file the claim. Even if you have paid the doctor your portion of the costs directly, you’ll want to confirm that the doctor has submitted the claim within the allotted timeframe. Deductibles are credited only when the claimed are filed and processed.
To confirm claims are being submitted on time you can log into MyMedicare.gov to check the status. If for some reason it’s not being filed, you should follow-up with your doctor. If they are still unable to submit the claim, you’ll then want to submit it yourself so it’s done within the time allotted.
Medicare forms for filing a claim
The deadline for filing your Medicare claims is 12 months after the date of the provided service(s). For instance, if you received health care services on July 1, 2020, your Doctor must file the claim by July 1, 2021. Obviously, it’s better sooner than later.
Make sure that any deductibles are credited to you even if you’re not anticipating a reimbursement. This can only happen when you are able to file your Medicare claims.
If you need to remind your doctor to file a claim, then call the doctor’s office. Call if your doctor has not yet filed your medicare claims and you are responsible for a deductible, or you are waiting for reimbursement. If calling the doctor’s office doesn’t work then:
- Call 1–800 MEDICARE (1–800–633–4227; TTY users should call 1–877–486–2048). Medicare representatives are available 24 hours a day, seven days a week.
- If all attempts to have the doctor file the claim fail, then click here to file the Medicare claim yourself.
Medicare forms for filing a claim
The location for Medicare forms are on the cms.gov website.
Look for CMS 1490S, Patient’s Request for Medical Payment, then print and download this form. You can also visit your local Security office and pick up a form there. Look at the instructions on the back of the form for completion. Call 1–800–633–4227 (1–800-MEDICARE; TTY users should call 1–877–486–2048). You can call anytime as representatives are open 24/7 to find out where to mail the completed form.
What to know about Medicare reimbursement
In order to get Medicare reimbursements, find out if your doctor accepts Medicare assignments. You should only have to pay the amount that is your responsibility if your doctor does accept Medicare. This covers coinsurance, copays, and/or deductibles.
However, if the doctor does not accept Medicare, note that you may be responsible for all the invoices correlated with your visit.
You will receive a notice if the provider network changes. They may change at any time.