How Do I File A Medicare Claim
Medicare beneficiaries occasionally have to submit their own healthcare claims instead of relying on a provider to submit them. | Photo credit: Helloquence | Unsplash
Q: How do I file a healthcare claim with Medicare or my insurer?
A: Medicare beneficiaries occasionally have to submit their own healthcare claims instead of relying on a provider to submit them. Heres what you need to know about filing a Medicare claim.
How To Apply For Medicaid
If you are 18 or older, you can apply for Medicaid through your local Home and Community Services office or online.
There are three main parts to the application process:
How To Enroll In The Various Medicare Plans
There are three types of Medicare plans that all have different ways of signing up. Each of these plans also has different enrollment periods. Delaying your Medicare Enrollment could result in various penalties and fees. Its helpful to set reminders for these important dates, especially when signing up for Medicare for the first time.
|Original Medicare||Automatic or three months before the month you turn 65 and extends three months after.||10 percent of the monthly premium|
|Medicare Advantage Plans||None|
|Six months after the month youre 65 and enrolled in Medicare Part B.||None|
|It depends on how long you went without Part D|
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Check The Status Of An Application
The Division of Family Resources provides tools to strengthen families through services that focus on prevention, early intervention, self-sufficiency, family support, and preservation.
You can check the status of your application online by clicking on your county of residence or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.
Please remember that your application must be completed and all required documentation submitted before DFR can begin processing your application.
Pursuant to HIPAA and other applicable federal regulations, DFR is committed to respecting the privacy of each client. For that reason, DFR will not share or disclose information about your case without a signed release. You may download the DFR online.
Apply For Medicare Online Through Social Security
To apply online, go to the Social Security web site. Once at the Social Security Web page, a person will see Sign In/Sign Up, and after clicking it, you will choose mySocialSecurity account to continue.
In order to apply for Medicare online, you will first need:
- Your Social Security number
- A valid email address
From the account creation, youll be walked through an email verification process.
After you create your mySocial Security account, you can apply online for Medicare Part A and Part B. This online account will be helpful when updating your address, or replacing a lost Medicare card.
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How To Qualify For Automatic Enrollment
Some people dont have to follow any of the above steps and are enrolled in Original Medicare automatically. If any of the following situations apply to you, youll automatically be enrolled in Original Medicare, and youll get your card in the mail:
- If youre already receiving retirement benefits from Social Security or the Railroad Retirement Board , and youre approaching 65
- If your employer benefits allow you to delay Medicare past 65, but you decide to draw retirement benefits through Social Security or the RRB
- If you have a disability that qualifies you for Medicare, even if youre under 65
When To Apply For Medicare Supplement Insurance
The earliest time that you can enroll in a Medicare Supplement Insurance policy is during your Medigap Open Enrollment Period.
If you sign up for a Medigap policy outside of your Medigap Open Enrollment Period, insurance companies can charge you higher premiums or deny your application due to your age and health.
You may not have a Medicare Advantage plan and a Medicare Supplement Insurance plan at the same time.
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How And When Can You Switch Medicare Plans
If you want to make a change to your plan or switch to another plan, such as changing from a Medicare Supplement plan to a Medicare Advantage plan, you can do so during the Annual Election Period 2. The AEP lasts from October 15 to December 7 each year.
Outside of the AEP, if you have certain life events such as moving or your plan changes, you may be eligible for a Special Enrollment Period 1. You may also be able to switch your Medicare Supplement plans if you have guaranteed issue rights3 or are within your 6-month initial enrollment period.
Do I Need An Application Form For Medicare Part D Prescription Drug Coverage
Since Original Medicare, Part A and Part B, includes only limited prescription drug coverage, many beneficiaries sign up for Medicare prescription drug coverage. You can get this coverage through certain Medicare Advantage plans , or you can sign up for a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage.
Medicare Prescription Drug Plans are available from private, Medicare-approved insurance companies. To qualify, you need to be enrolled in Medicare Part A and/or Part B and live in the plans service area. Plan availability, costs, and benefit details may vary. Read about enrollment periods for Medicare Prescription Drug Plans.
As with Medicare Advantage plans, there are a few different ways you can enroll in a stand-alone Medicare Part D Prescription Drug Plan. You can contact the insurance company that offers the plan enroll through one of Medicare.coms licensed insurance agents or enroll through Medicare .
To compare plans, as noted above, just click Compare Plans or Find Plans on this page.
What if I have questions about Medicare forms?
If you have questions about Medicare enrollment or eligibility, you can call Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM . You can also visit the Social Security office nearest you.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
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When To Enroll In Original Medicare
You will typically be automatically enrolled in Medicare at age 65 if youre already receiving Social Security retirement benefits at least four months before you turn 65. If not, you can sign up for Medicare Part A and/or Part B during your initial enrollment period, which begins three months before your 65th birthday, includes the month you turn 65, and ends three months after your birthday month.
It Pays To Enroll On Time
If you miss your initial enrollment window to sign up for Medicare, you can do so later on. But know this: For each 12-month period youre eligible for coverage but dont apply, youll risk a 10% surcharge on your Part B premiums.
If youre still working during your initial enrollment period and have group health coverage, youll get a special enrollment period to sign up for Medicare later on, and you wont have to worry about that penalty. But otherwise, enrolling on time can not only save you money, but ensure that you have coverage when you need it.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
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Signing Up For A Medicare Part D Plan
Medicare Part D drug coverage is optional and available to anyone with Medicare Part A and Part B.
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In both cases, you must already be enrolled in Original Medicare.
You can explore and compare available Part D plans on the Medicare website.
You can also call your local State Health Insurance Assistance Program for free help.
Once you find a plan that meets your needs, there are a few ways to sign up.
Four Ways to Sign Up for a Part D Drug Plan
To sign up for a Medicare Part D plan, you will need your Medicare number and the date your Part A and Part B coverage started. You can find this information on your Medicare card or on MyMedicare.gov.
Other Information You Need to Provide
- Your primary mailing address
- Whether you had or have other drug coverage
- How you want to pay your premiums
Coverage usually begins the first day of the month after enrollment.
If you switch plans during the open enrollment period , your new coverage will start Jan. 1.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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Be Aware Of Other Enrollment Periods
Most people sign up for Medicare during the seven-month initial enrollment period around their 65th birthday.
But what if you missed your initial enrollment period and want to make changes or add additional coverage?
There are specific times each year when you can do this.
Alternate Medicare Enrollment Periods
How Do I Apply For Medicare Online
Applying for your Medicare benefits online is a simple 10-minute process for most people, and you wont need to send in any documents or other information to apply. In order to use the online application process, you must:
- Be at least 64 years and 9 months old.
- Want to enroll in Medicare and not currently receiving any Medicare benefits, including premium-free Part A.
- Not be receiving any Social Security retirement, survivor, or disability benefits.
You can complete the online application through the Social Security Administration website. If you have any questions or problems completing the online Medicare application, you can contact the Social Security office at 1-800-772-1213 TTY users should call 1-800-325-0778.You can speak to a representative Mon-Fri 7am-7pm.
Please note that if you worked for a railroad, you must apply for Medicare through the Railroad Retirement Board. You can contact them at 772-5772 751-4701).You may reach a representative Mon-Fri 9am-3:30pm
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Before You Apply For Medicare: What Youll Need
Before applying by any of these methods, its handy to have personal information and identifying documents ready.1 Which documents you need depends on your situation, so there is no one-size-fits-all answer. You may be asked to physically provide any of the following documents:
- Your original birth certificate or certified copy: This provides proof of your age.
- Proof of US citizenship or lawful alien status : You can do this with a US passport, Certificate of Citizenship, Green Card, etc.
- Copy of your US military service papers : The most commonly used is the DD Form 214.
- Copy of your W-2 form: A copy from the previous year is sufficient. This verifies the wages you received from your employer.
Applying For Medicare Over The Phone
Applying by phone is another good option that works for many. Just follow these simple steps.
If you apply over the phone, you will need to send in documents such as your original birth certificate to verify your identity. If this makes you nervous, applying in person is probably your best bet.
When Can You Enroll In Medicare
You can apply for Medicare during three distinct enrollment periods: your Initial Enrollment Period, the General Enrollment Period and a Special Enrollment Period when youre getting off your employers health coverage.
Medicare Enrollment Dates
|Change to a 5-star Medicare Advantage or Part D prescription drug plan.|
How Should I Ensure My Claims Are Also Filed With Medicaid
Many Medicare beneficiaries also qualify for Medicaid due to having limited incomes and resources. Medicaid pays for Medicare co-pays, deductibles and coinsurance for enrollees who see providers that accept both Medicare and Medicaid.
Show your health care provider your Medicare and Medicaid I.D. cards when you check in for your office visit. You should also show the provider your Medicaid managed care plan card .
Read more here about Medicaid benefits for Medicare enrollees.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients.
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How To Apply For Medicare: The Basics
Original Medicare is made up of two parts: Part A and Part B.
Part A is known as hospital insurance and covers services like a room, meals, nursing services, and treatment in a hospital or skilled nursing facility. Most people do not have to pay premiums for Part A because of the payroll taxes paid during their working career.
Part B is known as medical insurance and covers services like tests, services performed by doctors , preventive services like flu shots, and much more. Part B is covered by a monthly premium, set by law each year.
Although Medicare is its own entity, all applications for Original Medicare go through the United States Social Security Administration. You can apply for Medicare in one of three ways:
- Online: This method is the easiest and quickest way to apply, taking ten to thirty minutes.
- : If you want to talk to a human but from the convenience of your home.
- In person: If your situation is complicated, you dont wish to mail important documents, or you prefer speaking to someone face-to-face.
Enrolling Your Newborn Baby
You can enrol your newborn baby by using the Newborn Child Declaration. Youll get the declaration from the hospital. Find out how to enrol your baby.
If youve adopted a child or your child was born overseas, youll need to give us extra documents. Read more about what to do:
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Monthly Medicare Premiums For 2021
The standard Part B premium for 2021 is $148.50. If youre single and filed an individual tax return, or married and filed a joint tax return, the following chart applies to you:
|Modified Adjusted Gross Income||Part B monthly premium amount||Prescription drug coverage monthly premium amount|
|Individuals with a MAGI of less than or equal to $88,000 Married couples with a MAGI of $176,000 or less||2021 standard premium = $148.50|
|Your plan premium + $77.10|