ABA Family Legal Guide

The Rights of Older Americans

Health and Long-Term Care Benefits

Medicare

How are Medicare claims filed and paid?

It differs for each part of Medicare. For Part A benefits, the provider submits the claim directly to the fiscal intermediary (the insurance company). The provider will charge you for any owed deductible or coinsurance payment. For Part B claims, doctors, suppliers and other providers are required to submit your Medicare claims to the carrier (the insurance company) in most cases, even if they do not take assignment. The provider will charge you directly (or your private supplemental insurance) for any deductible, coinsurance, or excess charge you owe. If you belong to a Medicare Advantage plan, there are usually no claim forms to be filed, although there may be a co-payment for any covered services. For Medicare Part D covered prescription drugs, your plan pays the covered portion of drugs directly to the pharmacist, while you pay deductibles and co-payments at the time of purchase.