If you have Original Medicare, the law requires doctors and suppliers to file Medicare claims for covered services and supplies you get. Find out which doctors in your area accept assignment.
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?
You should only need to file a claim in very rare cases
Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share. For example, if you see your doctor on March 22, 2016, your doctor must file the Medicare claim for that visit no later than March 22, 2017. Check the "Medicare Summary Notice" (MSN) you get in the mail every 3 months, or log into MyMedicare.gov to make sure claims are being filed timely.
If your claims aren't being filed timely:
- Contact your doctor or supplier, and ask them to file a claim.
- If they don't file a claim, call us at 1-800-MEDICARE (1-800-633-4227). 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 the time limit and your doctor or supplier still hasn't filed the claim, you should file the claim.
How do I file a claim?
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). Follow the instructions for the type of claim you're filing:
- Claims for Part B services -use these instructions [PDF, 205KB].
- Claims for durable medical equipment (DME) - use these instructions [PDF, 162KB].
- Claims for shipboard services (medical services you got aboard a ship) - use these instructions [PDF, 143KB].
- Claims for services you got in Canada or Mexico - use these instructions [PDF, 148KB].
- Claims for services you got in a foreign hospital - use these instructions [PDF, 149KB].
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 (Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB])
- 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 isn’t able to 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?
You can find the address for where to send your claim 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). To view an electronic version of your MSN, log into MyMedicare.gov.
You need to fill out an "Authorization to Disclose Personal Health Information" if:
- You want someone to be able to call 1-800-MEDICARE on your behalf
- You want Medicare to give your personal information to someone other than you