Medicare 2026

How to File Your Own Medicare Claim Using Form CMS-1490S

Filing your own Medicare claim is unusual. In Original Medicare, the law requires doctors, providers and suppliers to submit claims for covered services on your behalf, and the official claim form reminds them to do so within one year of the date of service. But in rare situations — if a provider refuses, is unable to file, or isn't enrolled in Medicare — you may need to submit the claim yourself using the "Patient's Request for Medical Payment," better known as Form CMS-1490S. Here's a plain-English walk-through.

When you might need to file yourself

Medicare says most people should never have to do this. If you're in Original Medicare and see a provider or supplier — including labs, imaging centers and medical equipment suppliers — they're responsible for submitting the claim. If one refuses, you can call 1-800-MEDICARE to file a complaint. Medicare also suggests asking 1-800-MEDICARE for the exact filing deadline on your service and, if the one-year deadline is near, going ahead and filing the claim yourself to protect your right to payment. Miss the 12-month window and Medicare will not pay its share unless an exception applies.

If you're in a Medicare Advantage plan and use in-network doctors, suppliers and pharmacies, those providers submit claims directly to the plan, so you generally don't need to file. The same is true for a stand-alone Part D drug plan — your pharmacy bills the plan at the counter.

What Form CMS-1490S is

Form CMS-1490S is the Patient's Request for Medical Payment. On it, you check a box indicating whether the provider or supplier refused to file, was unable to file, or is not enrolled with Medicare. Important warning printed on the form itself: a claim for services from a doctor or supplier who is not enrolled in Medicare may be denied. If you suspect the provider isn't enrolled, it's worth confirming before you pay out of pocket and ask Medicare to reimburse you.

The form is available on Medicare.gov. Download it, print it, and complete it carefully.

What to send with the form

According to Medicare.gov, a complete self-filed claim generally includes:

• The completed CMS-1490S form.
• An itemized bill from the provider.
• A letter explaining why you're submitting the claim yourself (for example, the provider refused to bill Medicare).
• Any supporting documents, such as notes from your doctor.

The itemized bill must show:

• The date and place of service.
• The illness or injury (diagnosis).
• Each service or supply provided, with the charge for each.
• The doctor's or supplier's name and address.
• The provider's National Provider Identifier (NPI), if you know it.

If another insurer paid first — for example, an employer plan or other coverage — include a copy of that insurer's Explanation of Benefits (EOB).

What Medicare will not reimburse you for

Medicare will not process your own payment request for:

• Diabetic test strips.
• Part B drugs.
• Items paid for under the DMEPOS Competitive Bidding program (durable medical equipment, prosthetics, orthotics, and supplies covered under that program).

For these, the supplier has to bill Medicare directly. If you've been asked to pay out of pocket for one of these items, call 1-800-MEDICARE before sending any money.

Where to mail the claim

Your claim goes to the Medicare Administrative Contractor (MAC) — the company that processes Medicare claims in your area. You can find the correct mailing address by:

• Looking at a previous claim Medicare paid in your Medicare.gov account.
• Checking a Medicare Summary Notice (MSN) from a prior service.
• Using the address table included with the CMS-1490S form.
• Calling 1-800-MEDICARE if the address is still unclear.

Keep a copy of everything you send, and allow at least 60 days for Medicare to receive and process your request. If the contractor finds the form incomplete or invalid, they'll return it with a letter explaining what's missing — so make sure every section is filled in.

If the patient has died, the form directs the family to contact Social Security for instructions on filing.

A few other things worth knowing

Because this process takes time and effort, it's often easier to resolve the issue with the provider first. Ask the billing office why they haven't submitted the claim. If they still won't, document the conversation, then file.

It's also a good idea to review your Medicare Summary Notices every quarter (or check claims in your Medicare.gov account more frequently) so you catch missing claims early — well before the 12-month deadline.

A note on upcoming Medicare dates and figures

For 2027, the Part D out-of-pocket cap will be $2,400 (up from $2,100 in 2026), and no Part D plan may charge a deductible higher than $700. The Part D base beneficiary premium — a national figure used to calculate the late-enrollment penalty — is $41.33 for 2027; actual plan premiums are set plan by plan. Annual Enrollment for 2027 coverage runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. Social Security announced a 3.6 percent COLA for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, along with the IRMAA income brackets, have not yet been announced; CMS typically releases those figures in the fall.

Where can you get help with Medicare questions?

For the current version of Form CMS-1490S, mailing addresses, and step-by-step guidance, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.