Medicare Reimbursement Explained

What is Medicare Reimbursement?

Medicare reimbursement ensures that you can be reimbursed for eligible healthcare expenses as a Medicare member. For eligible cases, this can include a portion of the amount you paid for approved services or medications that your Medicare plan should have paid.

Medicare beneficiaries who pay their entire healthcare bill upfront, rather than only their specified portion, may qualify for reimbursement.

Claiming Your Medicare Reimbursement

Original Medicare (Part A & Part B) - If you've had to pay the full amount for services upfront or have been billed for services by a provider who does not bill Medicare directly, you can submit a claim for reimbursement. Use Form CMS-1490S, also known as the "Patient's Request for Medical Payment," along with an itemized bill from your provider and a letter explaining in detail your reason for submitting the claim (e.g., your provider or supplier isn’t enrolled in Medicare or refuses to file the claim).

Medicare Advantage (Part C) - If you've chosen a plan through a private insurance company, you'll need to apply directly to the insurance company — rather than Medicare — for reimbursement for any costs incurred outside your plan's network. Your provider should have the necessary forms and guidelines.

Medicare Part D (Prescription Drug Plan) - If out-of-pocket costs arise for your covered medications — for instance, if you had to use an out-of-network pharmacy or incorrect billing occurred — you can submit a coverage determination request with your Part D sponsor for possible reimbursement.

As healthcare finance is subject to change, our team will keep you updated with the latest Medicare regulations. In the meantime, hang on to all receipts for services and Explanations of Benefits (EOBs) should you be eligible for reimbursements.