Key Takeaways

  • In most instances, healthcare professionals and facilities must handle Medicare claims directly, but there may be some instances when you need to submit a Medicare claim yourself.
  • To file a claim, you’ll need to complete the Patient’s Request for Medical Payment form, gather itemized bills, and include any supporting documentation, such as doctor referrals.
  • You must mail your completed claim form and all supporting documents to Medicare within 1 year of receiving the service to avoid rejection. Currently, there is no option to submit a claim electronically.

Claims are bills sent to Medicare for services, items, or equipment that you’ve received. Typically, your doctor or another healthcare professional will file claims directly with Medicare, but there might be times you’ll need to file them yourself.

The claims process varies depending on which Medicare part you’re using. Claims for Original Medicare (parts A and B) are processed differently from claims for other Medicare parts, but in all cases, you’ll need to complete a claim form and send in documentation.

However, if you then need to cancel a claim that you made yourself, you can call Medicare to do so.

If you believe you made an error by submitting a Medicare claim, you might want to cancel it. The fastest way to do so is to call Medicare at 800-633-4227 (TTY: 877-486-2048).

You can tell the Medicare representative that you need to cancel a claim you previously filed. You might be transferred to a claim specialist or to your specific state’s Medicare claims department.

You’ll need to provide information about yourself and the claim, including:

  • your full name
  • your Medicare ID number
  • the date of your service
  • details about your service
  • the reason you’re canceling your claim

It can take 60 days or more for Medicare to process a claim. This means that if you call shortly after you submit one, you might be able to stop the claim before it has been processed.

Can I check the status of my own claims?

You can check the status of your claims by signing up for a Medicare account. You’ll need the following information to begin your sign-up:

  • your Medicare number
  • your birth month and year

You can find your Medicare number on your Medicare card. Once you have an account, you can see your claims as soon as they’re processed. You can call Medicare if you see any errors or mistakes with your claims.

You can also wait for Medicare to mail your Medicare Summary Notice (MSN), which you will receive every 4 months. The MSN will detail all recent claim information.

Filing a claim with Medicare requires a few simple steps. You can:

  1. Call Medicare at 800-633-4227 (TTY: 877-486-2048) to confirm the time limit on filing a claim for an item or service. Medicare will let you know if you still have time to make a claim.
  2. Complete the Patient’s Request for Medical Payment form. The form is also available in Spanish.
  3. Gather supporting documents for your claim, including the bill you received from your doctor, another healthcare professional, or facility.
  4. Ensure your supporting documents are clear. For example, if multiple doctors are listed on your bill, circle the one who treated you. If there are items on the bill that Medicare already paid for, cross them out.
  5. If you have another insurance plan alongside Medicare, include that plan’s information with your supporting documentation.
  6. Write a brief letter explaining why you’re filing the claim.
  7. Send your claim form, supporting documents, and letter to your state’s Medicare office. The address for each state office is listed on the payment request form.

Medicare will then process your claim, which you need to allow at least 60 days. You’ll then receive notice by mail of Medicare’s decision.

You can also check your Medicare account anytime to see the status of your claim.

Generally, your doctor or service provider must submit claims to Medicare for you. If a claim hasn’t been filed, you can ask your doctor or healthcare facility to file it for you.

Medicare claims must be filed within a year of receiving an item or service. So, if it’s getting close to the deadline and no claim has been filed, you might need to file on your own. This might occur because your doctor or healthcare facility:

  • does not participate in Medicare
  • refuses to file the claim
  • cannot file the claim
Medical Perspective

“A person may need to submit their own Medicare claim if their provider doesn’t accept Medicare, has opted out, or is unwilling or unable to file the claim directly. These situations are uncommon but can happen, especially with some specialists or out-of-network healthcare professionals and facilities.”

— Isabelle Phan, PharmD

Understanding Medicare Reimbursement and Claims

Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Can I file a complaint if a provider doesn’t file a claim for me?

You can file a complaint with Medicare if your doctor is refusing to file a claim on your behalf. You can do this in addition to filing the claim yourself. You can file a complaint by calling Medicare and explaining the situation.

Remember that filing a complaint with Medicare isn’t the same as filing an appeal. When you file an appeal, you’re asking Medicare to reconsider paying for an item or service. When you file a complaint, you’re asking Medicare to look into a doctor, another healthcare professional, or a facility.

You might also need to file your own claims if you received healthcare when traveling outside the United States. Remember that Medicare will only cover care you receive in foreign countries in very specific circumstances, including:

  • You’re on a ship and it’s within 6 hours of leaving or arriving in the United States: If you’re more than 6 hours from a United States port, your medical emergency must have started when you were still within the 6-hour window. You also need to be closer to a foreign port and hospital than to one in the United States, and the doctor you use must be fully licensed in that country.
  • You’re in the United States and having a medical emergency, but the closest hospital is in another country.
  • You live in the United States, but the closest hospital to your home that can treat your condition is in another country: For example, you might live very close to the Canadian or Mexican border, and the nearest foreign hospital might be much closer to you than the nearest domestic one.
  • You’re traveling through Canada to or from Alaska and another state, and you have a medical emergency: For this rule to apply, you need to be on a direct route between Alaska and another state, and the Canadian hospital you’re taken to must be closer than any United States hospital. You also need to be traveling without what Medicare calls an “unreasonable delay.”

You can submit a claim to Medicare if you received care in one of the above situations.

You need to follow the same steps as a regular claim, and include proof that you were unable to be treated in a United States hospital or that the foreign hospital was closer. On the standard form, you’d mark that your service provider didn’t participate in Medicare, then you’d provide a detailed explanation in your letter.

If you travel often, you might consider a Medigap plan or a specific Medicare Advantage plan, as these can include coverage for healthcare costs while traveling outside the United States.

Generally, if you’re filing your own claim, it’ll be for Original Medicare’s Part B services, unless you’re filing for hospital care in a foreign country.

Original Medicare comprises parts A and B. Part A covers inpatient hospital care, and Part B covers outpatient medical services like medical equipment, doctors’ visits, therapy appointments, preventive care, and emergency services.

Coverage will not come from Part A unless you’re admitted to a hospital, another healthcare facility, or you’re receiving home healthcare. For example, if you visit the ER, Part B would cover your visit. If you were admitted to the hospital following the ER visit, Part A would cover your hospital stay.

The claims process is the same for both parts of Original Medicare.

Tips for filing a Medicare claim yourself
  • Ensure you include your original bill.
  • Provide supporting evidence or additional information.
  • Fill out the form with as much detail as you can.
  • Submit your claims within a year of receiving the item or service.

Medicare Advantage (Part C)

As with Original Medicare, you don’t typically need to file your own claims for Medicare Advantage, also called Medicare Part C.

However, if you do, Medicare Advantage plans don’t use the same claim forms as Original Medicare, as private insurance companies administer the plans on Medicare’s behalf. You can contact your plan provider for information on how to submit claims.

Most plan providers offer claim forms online or by mail. If you’re unsure, you can call the phone number on your Medicare Advantage card for advice. You’ll file the claim directly with your Advantage plan.

Medicare Part D prescription drug plans

Medicare Part D covers take-home prescription medications. You can use stand-alone Part D plans alongside Original Medicare, and many Medicare Advantage plans include Part D coverage.

You shouldn’t have to file your own Part D claims if you fill your prescriptions using an in-network pharmacy. However, if you use an out-of-network pharmacy, you might have to pay for your medications and submit a claim for reimbursement. There are a few other cases when you might need to file your own Part D claim, including:

  • You had to stay in the hospital for observation and weren’t permitted to bring your daily medications along: Medicare Part D can cover these medications during your stay if you submit a claim.
  • You forgot your Medicare Part D card while purchasing a prescription: If you forgot your card and paid full price at the counter, you can submit a claim to your Part D plan for coverage.

Just like Medicare Advantage plans, claims to Medicare Part D go directly to your Part D plan provider. You can often get claim forms on your plan’s website or by mail. You can also call your plan to request more details about the claims process.

Medigap

Medigap plans help you pay the out-of-pocket costs of Medicare, such as coinsurance payments and deductibles. In most cases, Medicare will send claims directly to your Medigap plan provider for you.

However, some Medigap plans require you to make your own claims. Your plan will inform you whether or not you need to submit your own claims.

If you need to submit your own claims, you’ll have to send your Medicare Summary Notice directly to your Medigap plan along with your claim. After your plan receives the summary notice, it will pay some or all of the charges that Medicare didn’t cover.

If you’re unsure about how to submit your own claims or need more information on the process, call your Medigap plan.

You should not need to file your own Medicare claims for most services you receive.

However, if you do need to file your own claim, you’ll need to submit as much information about the service as you can to Medicare, along with the claim form.

You can check the status of your claims at any time by visiting the Medicare website. To cancel an Original Medicare claim, you can call Medicare directly.

For claims outside of Original Medicare — such as Medigap, Medicare Part D, or Medicare Advantage — you’ll need to submit them to your plan directly.