How To File a Reimbursement Claim with Medicare
How to File a Medicare
Reimbursement Claim
A step-by-step guide from DME Superstore to help you get reimbursed for your durable medical equipment purchases.
If you've paid out of pocket for medical equipment or services, you may be entitled to reimbursement from Medicare. This guide walks you through exactly what you need to do — whether you're on Original Medicare or a Medicare Advantage plan.
Jump to a Section
How Medicare Reimbursement Works
Normally, your doctor, hospital, or supplier bills Medicare directly. But sometimes you may pay out of pocket — and that's when you file a reimbursement claim yourself.
Provider Bills Medicare
Most of the time, your provider submits the claim directly to Medicare on your behalf.
You Pay Out of Pocket
If the provider doesn't bill Medicare, you pay upfront and file for reimbursement.
Medicare Pays You Back
After reviewing your claim, Medicare reimburses the approved amount directly to you.
To file a claim yourself, you'll use Form CMS-1490S — Patient's Request for Medical Payment. This is the standard form for Original Medicare reimbursement claims and is available directly from CMS (Centers for Medicare & Medicaid Services).
Documents to Include with Your Claim
Before you file, gather these documents. Missing items are the #1 reason claims are delayed or denied.
✅ Reimbursement Claim Checklist
Completed CMS-1490S Form
The official Patient's Request for Medical Payment form. Download from CMS.gov. Choose the packet based on whether your claim is for medical, DME, or hospital services.
Itemized Bill from DME Superstore
Must include patient name, date(s) of service, HCPCS codes, products purchased, and total charges. DME Superstore will provide this for you.
Proof of Payment
Receipts, canceled checks, or credit card statements showing you paid. DME Superstore will provide documentation to support this.
Medical Necessity Documentation
Doctor's notes or a Letter of Medical Necessity showing why the equipment or service was needed.
Diagnosis & Procedure Codes (for Advantage plans)
ICD-10 diagnosis codes and CPT/HCPCS procedure codes from your provider's bill.
Important Deadline: For Original Medicare, you generally have 12 months from the date of service to file your claim. For Medicare Advantage plans, the deadline is typically 90–180 days — always confirm with your specific plan.
Filing with Original Medicare (Part A & B)
Original Medicare doesn't have networks the way private insurance does. This process applies when you paid out of pocket because your provider didn't bill Medicare directly.
💡 Good to Know
Before filing, confirm your provider is Medicare-enrolled. If a provider has completely opted out of Medicare, Medicare typically won't reimburse you — even if you paid out of pocket.
Confirm Provider Medicare Status
Verify that your provider or supplier is enrolled in Medicare (not opted out completely). You can check at Medicare.gov or call 1-800-MEDICARE.
Get an Itemized Bill
Request a detailed bill from DME Superstore or your provider listing patient name, service dates, diagnosis codes (ICD-10), procedure codes (CPT/HCPCS), and total charges.
Complete Form CMS-1490S
Download the Patient's Request for Medical Payment form from CMS.gov. Choose the correct packet based on your claim type (medical, DME, or hospital).
Attach All Supporting Documents
Include your proof of payment (receipt, bank statement, or credit card statement) and any doctor's notes establishing medical necessity.
Mail to Your Medicare Administrative Contractor (MAC)
The correct mailing address depends on your state. It's listed in the CMS-1490S instruction packet. Send everything together via certified mail to keep a record.
Wait for Your Medicare Summary Notice (MSN)
Medicare reviews your claim and sends you an MSN explaining what was covered and how much you'll be reimbursed. Reimbursement typically goes directly to you since you paid out of pocket.
Filing with Medicare Advantage (Part C)
Medicare Advantage plans have networks similar to private insurance. Out-of-network coverage — and how to claim reimbursement — depends on your specific plan type.
Health Maintenance Org.
- Usually no out-of-network coverage
- Exceptions for emergencies & urgent care
- Must use in-network providers for reimbursement
- Contact your plan to confirm before purchasing
Preferred Provider Org.
- Often covers out-of-network care
- Typically at a higher cost to you
- You may need to file your own claim
- Each plan has its own claim form & process
Check Your Plan's Rules
Call the member services number on the back of your insurance card and ask specifically whether your plan covers out-of-network DME purchases and what the reimbursement process is.
Request Your Plan's Claim Form
Ask for their official "Medical Claim Form." This is different from the CMS-1490S — each Medicare Advantage plan has its own form. It may also be available on your plan's member portal.
Collect Your Documents
Gather your itemized bill from DME Superstore (with diagnosis and procedure codes), proof of payment, and any required medical necessity documentation.
Complete & Submit the Claim Form
Fill out your plan's claim form and send it along with your documents to your plan's claims department. The mailing address will be on the claim form itself.
Review Your Explanation of Benefits (EOB)
Your plan will send an EOB explaining what they paid, what you may still owe, and any denial reasons. Keep all EOBs for your records in case you need to appeal.
Can You File an Out-of-Network Claim?
Yes — but how it works depends on whether you have Original Medicare or a Medicare Advantage plan.
With Original Medicare: There's no traditional "network" — but if a provider doesn't bill Medicare directly, you pay upfront and file the CMS-1490S to get reimbursed. Medicare will pay the approved portion directly to you.
With Medicare Advantage: Networks do apply. Your ability to get reimbursed for out-of-network care depends entirely on your plan type (HMO vs. PPO) and your plan's specific rules. Always check before purchasing.
Original Medicare vs. Medicare Advantage
Here's a side-by-side comparison to help you know exactly what to do based on your coverage type.
| Factor | Original Medicare (A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Has a Network? | No traditional network | Yes — HMO, PPO, or POS |
| Claim Form to Use | CMS-1490S (Patient's Request for Medical Payment) | Your plan's own claim form |
| Where to File | Your Medicare Administrative Contractor (MAC) | Your insurance plan's claims department |
| Filing Deadline | 12 months from date of service | 90–180 days (varies by plan) |
| What You Receive | Medicare Summary Notice (MSN) | Explanation of Benefits (EOB) |
| Out-of-Network Coverage | Yes, if provider is Medicare-enrolled | Depends on plan type (HMO usually no; PPO often yes) |
| Reimbursement Goes To | You (since you paid upfront) | You (if you paid upfront) |
Need Help Getting Started?
DME Superstore provides itemized bills, HCPCS codes, and payment documentation to support your Medicare reimbursement claim. Contact our team — we're here to help.
Contact DME SuperstoreOriginal Medicare → You use the CMS-1490S form and file with Medicare directly.
Medicare Advantage → You use your plan’s own claim form and file with the insurance company, not Medicare.