Medicare Reimbursement

Last Updated : 06/12/20193 min read

You may be glad to learn that Medicare reimbursement is something most people won’t have to worry about. However, in certain situations, you might need to file a Medicare claim.

Who files claims for Medicare reimbursement?

Under traditional Medicare (Part A and Part B), your doctor or other health-care provider handles claims for Medicare reimbursement.

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You don’t typically have to file for Medicare reimbursement.

In fact, generally it’s the doctor, not you, who’s getting Medicare reimbursement. In most cases, you pay any applicable Medicare deductible amount or copayment/coinsurance. The doctor still needs to get paid, so the medical practice files with Medicare directly to get reimbursed, under Medicare Part A and Part B. It’s a little different with Medicare Advantage, which we’ll get to later.

When might I have to get Medicare reimbursement?

Again, in most cases you won’t have to file a claim for Medicare reimbursement. But here’s an example of when you may have to get Medicare reimbursement.

If you get services from a doctor who doesn’t accept Medicare assignment, generally that doctor still has to file the Medicare claim for you. The doctor can’t charge you for filing that claim.

Medicare assignment is an agreement that the provider will accept the Medicare-approved amount for payment in full for the service. This means the doctor won’t charge you anything beyond your Medicare deductible or coinsurance/copayment. You don’t have to get Medicare reimbursement when the doctor accepts Medicare assignment.

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If a doctor doesn’t take Medicare assignment, he or she may charge up to 15% over the Medicare-approved amount. Again, generally the provider should file the claim. But in some cases, you may have to pay the entire amount up front. You may have to file a claim to get Medicare reimbursement.

How do I get Medicare reimbursement if I have a Medicare Advantage plan?

If you have a Medicare Advantage plan, you probably already know that Medicare Advantage gives you a way to get your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. So how does Medicare reimbursement work?

You typically don’t have to deal with Medicare reimbursement when you have a Medicare Advantage plan. Medicare pays Medicare Advantage plans a certain monthly amount to provide health-care services to members.

What if I have to file a claim for Medicare reimbursement?

If you have to get Medicare reimbursement, you can fill out and file a Patient Request for Medicare Payment form. Here are some links to .

Want to learn more about Medicare Advantage plans? You can ask us your Medicare questions by reaching out to a licensed eHealth insurance agent. To begin comparing plans, enter your zip code into the box on this page.

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