How To File a Claim (Medicare)
If you have original Medicare, the law requires doctors and suppliers to file Medicare claims for covered services and supplies you get.
If you have a Medicare Advantage Plan (Part C), these plans don’t have to file claims because Medicare pays these private insurance companies a set amount each month.
When do I Need to File a Claim?
Medicare claims must be filed no later than 12 months after the date when the services were provided. If not filed during this time, Medicare cannot pay its share. (i.e. if your appointment was September 1st, 2021, you must file the claim by September 1st, 2022.
How Do I File a Claim?
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). You can also fill out the CMS-1490S claim form in Spanish. [These forms will be attached in a separate file in this email]
What Do I Submit with the Claim?
Follow the instructions for the type of claim you’re filing (listed above under “How do I file a claim?”). Generally, you’ll need to submit these items:
- The completed claim form
- The itemized bill from your doctor, supplier, or other health care provider
- A letter explaining in detail your reason for submitting the claim, like your provider or supplier can’t file the claim, your provider or supplier refuses to file the claim, and/or your provider or supplier isn’t enrolled in Medicare
- Any supporting documents related to your claim
Where Do I Send the Claim?
The address for where to send your claim can be found in 2 places:
- On the second page of the instructions for the type of claim you’re filing (listed above under “How do I file a claim?”).
- On your “Medicare Summary Notice” (MSN). You can also log into your Medicare account to sign up to get your MSNs electronically and view or download them anytime.