How to Submit a Claim for Reimbursement to Medicare or Other Insurance for Out-of-Pocket Expenses Due to the Hack and Cyberattack on Change Healthcare

Thousands of people on Medicare (and other insurances) are still being affected by the hack and cyberattack on Change Healthcare, which happened, mind you, in February 2024 and which has resulted in pharmacies being unable to submit prescriptions and services such as vaccinations to Medicare (and, again, other insurances), and thousands of people across the U.S. having to either pay out of pocket for prescriptions and vaccinations, or do without. If you’ve had to pay out of pocket for a prescription or vaccination or booster because of this, here’s how to submit a claim for reimbursement to Medicare. It’s almost certainly the same for other insurance carriers as well, except they will have a different claim form and/or submission process.

If you need to submit the claim specifically to Medicare (versus a different insurance carrier) be sure to read the second part of this, which explains exactly how to submit a claim for reimbursement to Medicare because, like everything else associated with Medicare, they have made it needlessly and ridiculously complicated, so there is a plain English explanation of what you need to do for Medicare along with links to what you need.

What You Need from the Pharmacy in Order to Submit a Claim for Reimbursement Because the Pharmacy Couldn’t Submit Your Prescription to Medicare or Your Insurance Because of the Change Healthcare Hack

First, of course, you need an itemized receipt.

But second, and importantly, you need a note from the pharmacy saying the following:

Date:
Patient name:
Pharmacy name:

Please be advised that (pharmacy name) was unable to process this prescription or service to submit to (Medicare / insurance carrier) because of the inability to connect to the prescription processing system owing to the ongoing malfunctioning of the system resulting from the hack and cyberattack on Change Healthcare.

(signed, Pharmacist)

What You Need to Submit Your Claim to Medicare for Reimbursement of Your Prescription

First, a little bit of Medicare craziness: You may think that vaccinations would be submitted under your Medicare Part D (remember, D is for drugs). You would be wrong. Your friendly pharmacist has to submit vaccinations (such as a Covid booster) under your Medicare Part B. If you have, instead, an Advantage plan (Part C) well, all bets are off. (Read my Plain English Explanation of Medicare and How and How Not to Sign Up here for plain English explanations of all of the various parts, and why you do not want you or a loved one to sign up for “Advantage” plans here.)

To submit a claim for reimbursement to Medicare you need Medicare form CMS-1490S “PATIENT’S REQUEST FOR MEDICAL PAYMENT” (link to that form below, but read the rest of this first).

On form CMS-1490S you MUST check “The provider or supplier is unable to file a claim for the Medicare Covered Services” as the reason for submitting the claim for reimbursement. If you check either of the other two reasons, or if you don’t check any of them, your claim will be rejected.

Now, once you have form CMS-1490S filled out, you need to submit it. Here is something that may blow your mind: did you know that you don’t submit Medicare claims for reimbursement directly to Medicare? If you, like many others, have never yet had occasion to submit a claim for reimbursement to Medicare, then when you start reading the claim form (info on that in a moment) and come across the instructions which say “Send the completed form and supporting documentation to your Medicare contractor” you may, understandably say, “WTF?,” followed by “How the hell do I find that??”

Well, form CMS-1490S consists of three pages of actual form that you need to fill out and submit, and fifteen pages of advisements, instructions, and other information. Somewhere around page seven is a list of all of the various Medicare contractors who handle claims regarding vaccinations and other Part B stuff for all of the various states. That list is itself 5 pages long. In addition, you can find the actual list of Medicare contractors at the following link, because why trust a form that was printed a while ago when you can check the actual live list that, one would hope, is most up-to-date? Plus, the linked list will give you the contractors in your state for all Medicare services (Part A, Part B, and the Home Health and Hospice services contractor); the list attached to form CMS-1490S is only for being reimbursed for Part B issues.

Link to live list of all Medicare contractors by state

Where to Download Medicare form CMS-1490s

Download Medicare form CMS-1490s here:

Download Medicare form CMS-1490s

How to Pay Your Medicare Premium Online and How to Set Up Medicare Autopay

Do you know where to make your Medicare premium payment? If you are wondering how to view your Medicare bill online, how to pay your Medicare bill online, or how to set up autopay (which is called ‘Medicare Easy Pay’) for your Medicare bill, here’s how. (First, wondering “why is my first medicare bill so high?” It’s because they often bill the first two months together.)

Now this is specifically how to pay your premiums for Medicare Part A and Part B. Of course, it’s quite possible (even likely) that you won’t have a premium for Medicare part A, but you are likely to have a premium for Medicare part B (because having read this you know better than to sign up for Medicare Advantage rather than Part B). So when you first sign up for Medicare you will get a premium bill of some sort, and here is how to pay it online, and how to set it up for autopay.

[For more information on Medicare see my articles Medicare Explained in Plain English & How and Where to Sign Up for Medicare, as well as How and Where to Find Your Medicare Number When You Don’t Have Your Card]

Once again, the Federal government has not made it particular intuitive in terms of how and where to pay your Medicare bill online, or how to set up autopay for which, of course, the Feds have created a whole new, non-intuitive term, “Medicare Easy Pay”. Fortunately once you know where to look, you will find all of your payment options in one place, so at least there’s that.

Now if you like to go paperless – or at least to attempt to go paperless by signing up for electronic payment and then just for the most part ignoring paper bills – you’ll be happy to know that Medicare not only makes it relatively easy, but that there’s an added incentive: their bills come with payment coupons! Holy 1970s, Batman! When was the last time that you had to deal with that??

How to Pay Your Medicare Premium Bill

As they explain it on the Medicare site, once you find it (link below), there are basically four ways that you can pay your Medicare premium bill. You can:

Pay online
Sign up for Medicare Easy Pay (their autopay option)
Pay by direct bank withdrawal (also known as ACH, which stands for ‘Automated Clearing House’, which is the financial network that processes electronic payments)
Send a credit card, check, or money order via USPS

Here’s how they explain it:

1. Pay online through your secure Medicare account (fastest way to pay).

Log into (or create) your secure Medicare account to use this free service to pay by credit card, debit card, or from your checking or savings account.

2. Sign up for Medicare Easy Pay.

With this free service, we’ll automatically deduct your premium payments from your savings or checking account each month.

3. Pay directly from your savings or checking account through your bank’s online bill payment service

Some banks charge a service fee.

4. Mail your payment to Medicare.

Pay by check, money order, credit card, or debit card. Fill out the payment coupon at the bottom of your bill, and include it with your payment.

If you’re paying by credit or debit card, be sure to complete and sign the coupon. If you don’t sign the coupon, we can’t process your payment and it will be returned to you.

Where to Pay Your Medicare Premium Bill or Set Up Medicare Easy Pay (Autopay)

How and Where to Pay Your Medicare Premium Online

It all starts with logging in to your Medicare account, which you can do at https://www.medicare.gov/account/login/

Paying a single Medicare premium bill:

Once you are logged in you can go directly to the premium payment link here:

https://www.medicare.gov/mbp/premiumpayment.aspx

The above link will give you payment options using credit and debit cards (including HSA cards), and direct withdrawal from your bank account (ACH).

Signing up for Medicare Easy Pay (autopayments):

To sign up for Medicare autopay, which Medicare calls ‘Medicare Easy Pay’, go here:

https://www.medicare.gov/mbp/easypaysignup.aspx

Pay by U.S. Mail

If you want to send a check, money order, or credit or debit card information by the USPS, you must have received your payment coupon book from Medicare in the mail, and you must include the payment coupon. Then mail your payment, along with the filled out coupon, to:

Medicare Premium Collection Center
PO Box 790355
St. Louis, MO 63179-0355

How and Where to Find Your Medicare Number When You Don’t Have Your Card

where how to find medicare number featured image

If you are newly signed up for Medicare you may be wondering how and where to find your Medicare number, especially if you don’t have your Medicare card yet. You know that you must have a Medicare number, because you were accepted into the Medicare plan and even received an email saying you are now enrolled in Medicare and that your card is on its way to you. The thing is, you need your Medicare number in order to enroll in either a Medicare supplemental plan, or a Medicare Advantage plan, and you also need your Medicare number to enroll in Part D (‘D is for Drugs’, just like on Sesame Street).

(If you are not yet super-familiar with Medicare parts versus Medicare plans, supplemental Medicare plans, Medicare Advantage, and all the rest, you need to be, and that’s exactly why I put together this plain English explanation of Medicare and how to sign up for Medicare. Of course if you’re trying to figure out how to find your Medicare number, you’re probably already through with all of that, and have already signed up for Medicare, and been approved.)

The way that you know that you were accepted for Medicare is that you got a note from the Social Security Administration saying something like “Your Submission Status Has Been Updated. You can check the status of your submission online with your personal my Social Security account.”

This may confuse you because you applied for Medicare, not social security, and the link in the notice doesn’t even go to medicare.gov, it goes to ssa.gov, which is the Social Security Administration website. Medicare has its own website, so why would information about your Medicare application be on a different website?

See, this is your first mistake. Trying to make sense out of any of it. You’ll drive yourself crazy.

Here’s how to find your Medicare number once you are accepted into Medicare but before you receive your card.

How to Find Your Medicare Number

1. Log into your SSA account here.

2. Once logged in look for something that looks like this part-way down the page, and find the link to “Your Benefit Verification Letter”.

3. This will take you, not to your benefits verification letter as you might have thought, but to a new page with another link to “Your Benefit Verification Letter”. This time the link is to the PDF of the actual letter, which should also have been mailed to your home.

4. Click on the link to the PDF, and voila!

The letter will say something like:

You asked us for information from your record. The information that you requested is shown below. If you want anyone else to have this information, you may send them this letter.

Medicare Information

You are entitled to hospital insurance under Medicare beginning {Date it begins}.
You are entitled to medical insurance under Medicare beginning {Date it begins}.
Your Medicare number is 1234567890. You may use this number to get medical
services while waiting for your Medicare card.

And that’s how you find your Medicare number.

Medicaid for the Elderly Explained in Plain English: When Medicare Won’t Cover Long Term Elder Care

Did you know that if you have an elder parent who needs to get into a nursing home it is very likely that Medicare will not cover it? That means that you may very well need to get them onto Medicaid unless you are essentially independently wealthy, or they set up a long-term care insurance policy, or they have a huge retirement nest egg, as nursing homes cost several thousand dollars a month, as does home health care.

Of course, in order to qualify for Medicaid your elderly parent has to be essentially destitute. The vast majority of our elder parents (and we ourselves) are neither independently wealthy, nor completely destitute and so won’t qualify for Medicaid. This is why trying to get adequate care and placement for our elderly causes us to take out second mortgages, sell off the family home, and go deeply into debt.

After I published my post explaining Medicare in plain English, and how and where to sign up for Medicare, I was contacted by a good friend, whom I trust implicitly, with the following description, shared with their permission, of their experience trying to get an elderly parent into a nursing home when they are on Medicare, and the nightmare that is the Kafkaesque process of trying to get them onto Medicaid (which, again, you’ll need to do because while many nursing homes aren’t covered by Medicare, at least some accept Medicaid).

According to my friend, make no mistake about it: unless someone has and is prepared to pay many thousands of dollars a month, each and every month, for a nursing home, or for home health care, you will need to get them onto Medicaid before they can get into a nursing home. According to MoneyGeek my friend is exactly right, the average cost per year for a nursing home is about $90,000, 24/7 in-home care a whopping $175,000. And if your elderly parent is having memory problems then caring for them at home without the assistance of home health care can be very daunting and even dangerous, especially as the months pass and they decline.

Here is what my friend said, verbatim, other than to remove identifying information.

Your write up in Medicare was excellent. If you thought that was a mind bender consider Medicaid. This is important because nursing home care is not covered by Medicare. This comes up because with people living longer there are more people with dementia and also significantly debilitating non-neurological disorders. A nursing home can run on the order of $10K – $15K per month. There is talk about in-home care being less expensive. It is not. It can be more expensive for the same level of care. In addition, with the shortage of healthcare workers, in home care may not be available. Care for an elder who has dementia is not just about drugs, taking temperatures, and routine medical functions it’s also about feeding, bathing, and the other biological functions. This requires 24×7 level of help that is beyond most family members’ ability to provide without becoming highly self-destructive of the family member caregiver.

If your elder had a good long term care policy or they have sufficient wealth to cover years in a nursing home then they are very lucky. If they were poor from birth and never had any wealth (in the general sense like “savings”) then getting Medicaid is straight forward. But if your elder is in between those extremes then one has to “qualify” for Medicaid via an application and review process. We enlisted the help of an elder law attorney to assist us in the process which is paper work intensive (imagine trying to track down one’s father’s army discharge papers, or one’s mother’s birth certificate and naturalization papers, and financial details for the last five years, etc.). We have reached the point where all our paper work has been submitted and we are awaiting the outcome of the review process. But that glosses over aspects of Medicaid financial planning.

On top of all this we have a heath care system that is not prepared to deal with large numbers of boomers soon to have many needs. My mother is pre-boomer and 90 years old, and finding her a spot in a nursing home was a harrowing experience. At one point my mother was #10 on a wait list to get into a home. But what that really meant was that 10 people had to die to free up space. I should qualify the above by saying that we needed a home that would accept Medicaid and would not have my sister run home crying and emotionally distraught from the horrors she witnessed.

Keep in mind that “independent living”, “assisted living”, “memory care”, and nursing homes are not the same. My mother started at “independent living”. When her condition accelerated we moved her into memory care and when she started breaking bones and such she was in a hospital until a qualified care facility was available. And my mother’s Medicare Advantage plan tried to deny her coverage. But luckily the hospital’s interests and my mother’s were aligned so the hospital attorneys negotiated with United Healthcare and made what would have been a more that $170k bill be about $2k. {Editor’s note: None of the foregoing were nursing home care, which is why Medicare covered it.}

So getting back to Medicaid I would expect that many people will eventually need it. But the question is are they are prepared with the knowledge to successfully get through the application process?

My main advice to people is to consult with an elder law attorney that specializes in Medicaid planning and the Medicaid application process. If they have older parents, work with an elder law estate attorney on Medicare, Medicaid, estate, power of attorney, and health care directives and such. Advanced planning will make an emotional and broken process survivable.

BTW we are not yet approved for Medicaid. There is a very small but non-zero chance we can be denied coverage.

The fall back is where people try to take care of the elders themselves. For healthy elders this is not an issue. But for elders with dementia it’s almost impossible for non-wealthy people to provide a level of care that does not look like elder abuse. And one consequence is the monthly posts on Nextdoor of the latest elder that got out of the house and is missing. The last few elders in our area that went missing didn’t survive it.

An elder with no support system would be out on the street in many parts of the country. Some of this is state and city specific.

My sister is not in a condition to take my mother in. So I would have to do that. Not sure how I would juggle that and work and life. It would be crushing for the estimated 4-5 years of my mother’s estimated remaining life. BTW that’s a figure that becomes part of the Medicaid process.

Medicare Explained in Plain English & How and Where to Sign Up for Medicare

This post gives you the link to sign up for Medicare because they make it so darned hard to find. Talk about burying the lede! It also explains Medicare in plain English, so that Medicare is demystified for you before you have to sign up for it. (Looking for my article that explains signing up for Social Security, the different choices, and what if you keep working? See How and When to Sign Up for Social Security Demystified and What if You Keep Working? a Plain English Explanation.)

So you’re turning 65 and it’s time to start the Medicare application. You do a web search (as one does) for “where to sign up for Medicare” or “how to sign up for Medicare”, and what you get are a bunch of ads followed by some nearly useless links to information about Medicare, and links to where to find out if you are eligible for Medicare, but no direct link to sign up for Medicare! Frustrated? I was too, and that’s why I am posting this, to save others the frustration.

“But Anne,” you say, “Surely you aren’t old enough to sign up for Medicare! You’re so youthful and energetic!” Well, thank you for the compliment, but in fact I will be 65 on April 3, 2023 (feel free to send birthday gifts and cards :~) ).

Medicare Explained in Plain English

First, it helps to understand that anything the government touches is never explained in a straight-forward, plain English manner.

Second, it helps to understand that anything that any insurance industry touches is never explained in a straight-forward, plain English manner.

When you combine the two? It’s enough to make you tear your hair out trying to understand something that is actually pretty straight-forward!

Obligatory disclaimer: This is neither medical nor legal advice. I am not an insurance expert nor a broker. This is my own explanation based on my own experiences. This is greatly simplified, but it is accurate.

Now for something we need to get out of the way:

Medicare is not free!

Regardless of which Medicare plan you select, you pay a premium for Medicare, just like any other health insurance.

Ok, now that that’s out of the way, here we go.

Medicare “Parts” and Their Alternate Names

Part of the reason that it’s all so damned confusing is that there are alternate names for each of the options (just to add extra confusion). Not only that but there are “Parts” and then there are “Plans” and they are not the same thing!

There are four “parts” to Medicare: A, B, C, and D

Part A is what covers things like hospital stays.

Part B is what covers things like visits to your doctor.

It helps to think of Part A as analogous to the Blue Cross part of Blue Cross/Blue Shield (which covers hospital stays and things associated with them), and Part B as analogous to the routine stuff and doctor visits covered by the Blue Shield part of Blue Cross/Blue Shield.

Parts A+B taken together is also called “Original Medicare”. If someone talks to you about “Original Medicare” they are talking about Part A + Part B.

Got that? (Note: Technically with Original Medicare you only pay a premium for Part B; Part A comes along for free. There are exceptions, but that’s the general rule. According to the Federal government’s Centers for Medicare & Medicaid Services the standard monthly premium will be $164.90 for 2023, with an annual deductible of $226.)

Part C is an alternative to the Blue Cross/Blue Shield-like coverage of Part A + Part B. It is separate, you opt in to either ‘Original Medicare’ (Parts A+B) or Part C, not both.

Part C is also called ‘Medicare Advantage’ (or more often just ‘Advantage’), and it is an alternative provided by private insurance carriers such as United Health Care, Anthem, and Aetna, not the Federal government. Basically it is the government outsourcing your Medicare coverage to the private insurance companies. This way the government doesn’t have to worry about it, and instead you are the private insurance carrier’s headache.

The insurance carriers offer all sorts of additional benefits to entice you to sign up with them, such as free gym memberships, or a couple of massage therapy sessions a year. Having done a lot of research, and heard the horror stories from both adult children who couldn’t get loved ones (elderly parents) the care they needed under their Part C ‘Advantage’ policy, or directly from people who were kicked out of the hospital because their Part C ‘Advantage’ policy only covered a very few number of days, and even from medical providers who weren’t able to get their patients the care they needed under the Part C ‘Advantage’ policy (and you can’t just switch back out of Part C ‘Advantage’ back to Original Medicare), I find it helpful to think of the ‘Advantage’ in Part C as standing for “we insurance companies take advantage of your gullibility in thinking this is a great deal” and “the Federal government takes advantage of tricking you out of signing up for Original Medicare (a/k/a Parts A+B).”

But hey, that’s just me.

Part D (D is for Drugs) is the prescription drug coverage. You have to sign up for it separately if you are going with Part A + Part B (again, collectively also known as ‘Original Medicare’). If you instead sign up for Part C (again, also known as “Advantage”) even though now you have my opinion on it, the Advantage companies will sometimes try to further entice you by saying that Part D (D for Drugs) is included in your Advantage premium. Don’t fall for it, whether rolled into your Advantage premium or having to pay for your Part D prescription coverage separately, you are paying for it.

Once you sign up for Medicare and are approved, you can add your Part D. You do that through the Medicare site. Basically you will be able to compare Part D plans for your state, plugging in the medication you currently take, and figuring out which one has the best coverage for you (both for your medication and also for which pharmacies are in-network for a given plan), along with the best premium and deductible price. One thing to note is that you can change Part D plans every year between October 15th and December 7th regardless of the medications you take, so it can make sense to look at the Part D plans each October and, if appropriate for you, switch to the Part D plan that has the lowest total cost (including premium, co-pays, and deductible) for your given medications and your choice of pharmacies at that time.

Medicare “Plans” (Different from Medicare Parts!)

A Medicare “Plan” (also known as a “Medicare Supplemental Plan” or a “Medigap plan” or just “Medigap” – they all mean the same thing) is an optional extra insurance that you can purchase to help cover the things that your Parts A+B don’t cover. It’s kind of like the extended warranty for your body and health. You don’t have to purchase it, but you may end up wishing that you had.

Medicare Supplemental Plans (again, also known as ‘Medigap’) are provided by private insurance companies such as Aetna, United Health Care, Anthem, etc.. You can sign up for a supplemental plan (Medigap) if you have signed up for Original Medicare (Part A + Part B). If instead you sign up for Part C (Advantage) then you cannot sign up for Medigap, because you are already opting out of Parts A + B (Original Medicare).

The Medicare “Plans” have letter designations (A, B, C, D, F, G, K, L, M and N). Isn’t that so nice of them to have both a Part A and Plan A, a Part B and a Plan B, a Part C and a Plan C, and a Part D and a Plan D, and have the “parts” and “plans” have nothing to do at all with each other? They are arbitrary, almost random, designations, and I’m pretty sure that they do this intentionally to make it as confusing as possible, so that when you get advice from your insurance broker (more on brokers below) you really don’t know what the hell they are talking about. (Hence this post!)

Not to put too fine a point on it, but the “parts” and the “plans” are two completely different things despite their very confusingly similar names.

(Does your head hurt yet?)

Also note that if you are newly signing up for Medicare, you can’t sign up for either Plan C or Plan F, they have been essentially replaced by Plan D and Plan G, but are still listed on all of the sites along with the other plans, just to confuse you further. (For what it’s worth, I chose Plan G, as it was the most comprehensive and best based on my criteria, but do your own research of course.)

Each plan has its own advantages and disadvantages, and just like any other health insurance, the better the coverage the higher the premium. So you get to weigh premium price against deductible amount, etc., just like signing up for any other insurance.

Brokers

As mentioned above, both Medicare Part C (‘Advantage’) and the Medicare Supplemental (‘Medigap’) plans are provided by private insurance companies and so for this reason you will need to work with an insurance broker for either your Medicare supplemental insurance (again, also known as “Medigap” or “the Plans”) or for your Medicare Part C (“Advantage”) (if you are going to go that route).

You can sign up for the government-provided Medicare Part A + Part B (also known as “Original Medicare”) on your own at the link that I’m about to give you, that elusive link that allows you to sign up for your government-provided Medicare.

Note: You have to sign up for Parts A+B before your broker can sign you up for your supplemental ‘Medigap’ insurance.

It’s important to understand that there is a set commission amount that brokers get whenever they write a Part C Advantage policy, or a Medigap (the Plans) policy, which in theory means that it doesn’t matter to them financially which one you choose, they will make the same commission. This sounds good on its face as it means they will be agnostic about which policy you choose. However, where they make that up is in volume. The more policies they write for Medicare-eligible people, the more money their brokerage makes.

I have talked with a lot of insurance brokers about this, and for the most part I needed to shower afterwards because I felt like I had just got done talking with a used car salesman (this may actually be an unfair comparison… to the used car salespeople). You can definitely tell which ones work for big brokerages where brokers are urged to write as many policies as possible, maybe even with sales quotas to fill, because some of these places really give you the hard sell.

The one broker with whom I spoke who did not leave me feeling like that, and who was the most helpful (truly) was Joel Rosenblum. Joel was recommended to me by a friend, and he is awesome (and he runs his own insurance brokerage business, so you aren’t bombarded with lots of spam trying to get you to sign up, etc.). Happily, he can work with people in all 50 states when it comes to Medicare, so wherever you are, I can highly recommend him. Here is his info:

Joel Rosenblum: email Joel

Where to Sign Up for Medicare: the Direct Link

Here’s that darned direct link:

The direct link to sign up for Medicare is: https://www.ssa.gov/medicare/sign-up

One last thing: You have a window within which to sign up for Medicare. That window is 3 months before the month in which you turn 65, and 3 months after the month in which you turn 65, for a total of a 7-month window. When you sign up during the 3 months before the month in which you turn 65 your Medicare will become effective in the month in which you turn 65, not before.

Mange Merde

…if you'll pardon my French

Tag: medicare