Medicare Refund and Reimbursement Policy
- Medicare may issue a refund or reimbursement in certain situations. Learn about Medicare refund policies and find out how to request the money you may be owed.
Medicare handles billions of dollars every year on behalf of beneficiaries, health care providers and other stakeholders. There may be situations in which someone may need to request a Medicare refund or reimbursement.
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When Can I Request a Medicare Refund?
Typically, beneficiaries won’t need to request refunds or reimbursements for Medicare Part A and Part B services because health care providers bill Medicare directly and will only bill patients for deductibles, copayments, coinsurance or for services or items that are not covered by Medicare.
In fact, federal law requires providers to file claims for covered services on behalf of Original Medicare beneficiaries within 12 months of the date of service.
But you may need to request Medicare reimbursement in a few types of circumstances.
Your Doctor or Provider Doesn’t Submit Your Medicare Claim
There may be instances in which a health care provider neglects to bill Medicare for the services they provided to you, or they might file an improper claim on your behalf.
If either of these circumstances happen to you, you may need to file a Medicare claim for Medicare reimbursement.
You Receive Care From a Doctor or Provider Who Doesn’t Accept Medicare Assignment
A provider who doesn’t accept Medicare assignment is someone who accepts Medicare insurance but does not accept the Medicare-approved amount as full payment.
The Medicare-approved amount is a predetermined cost that Medicare has set as the price for a covered health care service. A doctor or provider who doesn’t accept Medicare assignment may agree to treat Medicare beneficiaries, but they may potentially charge a higher cost than this predetermined Medicare-approved amount.
Instead, these providers reserve the right to charge up to 15% more than the Medicare rate for their services or items.
This extra charge is called a “Medicare Part B excess charge” and these providers may request that you pay upfront for their services, and then you’ll have to request reimbursement from Medicare for the portion of your cost that Medicare will cover (the Medicare-approved amount, minus your deductible and copay or coinsurance amounts).
If you have Medicare Part A and Part B, you may consider applying for a Medicare Supplement plan (also called a Medigap plan). Some Medicare Supplement plans pay for Part B excess charges as well as certain Medicare copays, coinsurance and deductibles.
You Receive Emergency Medical Care in a Foreign Country
You may also need to request a Medicare reimbursement or refund after receiving emergency care in a foreign country. Medicare generally does not provide coverage in these situations, but there are exceptions to the rule in which you may file for reimbursement.
What Is a Medicare Premium Refund?
There are certain cases in which Medicare may issue a refund on your monthly premium.
One such case is if you’re charged for a Medicare premium but you qualify for a Medicare discount or subsidy that was not applied to your account. Call 1-800-MEDICARE (1-800-633-4227) if you think you may be owed a refund on a Medicare premium.
Some Medicare Advantage (Medicare Part C) plans reimburse members for the Medicare Part B premium as one of the benefits of the plan. These plans are sometimes called Medicare buy back plans.
Who Qualifies for a Medicare Premium Refund?
Members of Medicare Advantage plans that offer Part B premium reimbursements can be eligible for a full or partial refund of their Medicare Part B premium. In addition, retirees of certain organizations such as a city fire department are sometimes eligible for subsidies that issue full or partial reimbursements of Medicare premiums.
Medicaid beneficiaries who also have Medicare may qualify for premium reimbursement through a Medicare Savings Program.
How Do I Get My Money Back from Medicare?
To get a refund or reimbursement from Medicare, you will need to complete a claim form and mail it to Medicare along with an itemized bill for the care you received. Medicare’s claim form is available in English and in Spanish.
Your itemized bill should display the date and location of service, a breakdown of charges, a description of your illness or injury that was being treated, the supplies and methods used to treat it and the name and address of the provider or supplier.
It also helps to include a letter detailing the reason for needing reimbursement. The Medicare claim form will include more detailed instructions along with the appropriate address to where you must send the documents.
Before filing for a refund, you may want to contact the health care provider or supplier to discuss the matter or call 1-800-MEDICARE (1-800-633-4227) for assistance.
If you need to file for reimbursement from a Medicare Advantage or Medicare Part D plan, contact your plan directly, as the claim process may vary from one insurance company to another. Generally speaking, you will not need to file any claims unless you seek care from an out-of-network provider or care that is not covered by the plan.