Medicare Reimbursement Claim Submission Guide
This document outlines the details and process for submitting a Medicare Reimbursement Account (MRA) claim. It provides methods for submission, necessary documentation, and reimbursement timelines. Ideal for members seeking annual reimbursement for Medicare Part B premiums.
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How do I fill this out?
To fill out this claim form, ensure you have all necessary proof of your Medicare Part B premium payments ready. Choose a submission method that best suits your preference, whether it's online or by mail. Follow the outlined steps carefully to ensure timely processing of your claim.

How to fill out the Medicare Reimbursement Claim Submission Guide?
1
Register or log in to your MRA account.
2
Download the claim form if submitting by fax or mail.
3
Fill out the claim form and upload or attach proof documents.
4
Submit your claim through your chosen method.
5
Wait for confirmation and reimbursement, typically within 1-10 days.
Who needs the Medicare Reimbursement Claim Submission Guide?
1
Individuals who are enrolled in Medicare Part B to receive reimbursement.
2
Families of basic option members who pay Medicare Part B premiums.
3
Members who want to optimize their health spending through annual reimbursements.
4
Anyone seeking guidance on how to efficiently submit a claim for reimbursement.
5
Customers looking to manage their medical expenses effectively.
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What are the instructions for submitting this form?
To submit your Medicare reimbursement claim, you have several options: online via fepblue.org/mra, using the EZ Receipts app, by fax at 877-353-9236, or by mail to P.O. Box 14053, Lexington, KY 40512. Ensure all necessary documents, including proof of payment, are attached. For best results, opt for online submission for quicker processing.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting claims include the start of the 2024 filing period on January 1, 2024, and the deadlines for the 2025 submission, which will be announced later. Ensure that all claims are submitted within the applicable tax year to avoid delays. Stay updated on specific dates by regularly checking the official site for announcements.

What is the purpose of this form?
The purpose of this form is to facilitate the reimbursement process for Medicare Part B premium payments to eligible members. By providing clear instructions and methods for submission, we aim to streamline the claims process to ensure members can receive their reimbursements hassle-free. This form empowers Medicare beneficiaries to manage their healthcare expenses more effectively and assures them of the benefits they are entitled to.

Tell me about this form and its components and fields line-by-line.

- 1. Member ID: Unique identifier for each member filing a claim.
- 2. Proof of Payment: Documents confirming payment of Medicare Part B premiums.
- 3. Claim Submission Date: Date when the claim is submitted.
- 4. Contact Information: Member's contact details for claim follow-ups.
- 5. Signature: Member's signature confirming the information provided is accurate.
What happens if I fail to submit this form?
Failure to submit the form will result in not receiving any reimbursement for your Medicare Part B premiums. Members must ensure that all documents are accurately completed and submitted on time to avoid delays in processing.
- Delays in Reimbursement: Incomplete or incorrect submissions lead to longer processing times.
- Denial of Claims: Claims missing required documentation will be denied.
- Increased Stress: Navigating the claims process without proper submissions can be frustrating.
How do I know when to use this form?

- 1. Annual Claim for Reimbursement: File every year after paying your Medicare Part B premiums.
- 2. After Changes to Your Medicare Plan: Update your claims if your Medicare selections change.
- 3. For Dependents: Ensure claims for dependents are filed accurately and separately.
Frequently Asked Questions
How can I submit my Medicare reimbursement claim?
You can submit your claim online, via the EZ Receipts app, by fax, or by mail.
What proof of payment do I need?
You need documents like a Social Security COLA statement, a canceled check, or a bank statement showing your Medicare Part B premium payment.
How long does reimbursement take?
Online claims are processed in about 1-2 business days, while fax and mail submissions may take up to 10 days.
Can I submit claims for previous years?
You cannot submit claims for 2021 premium reimbursement until January 1, 2021.
Where do I send my fax claims?
Fax copies of your receipts and completed form to 877-353-9236.
What is the mailing address for claims?
Send your claims to P.O. Box 14053, Lexington, KY 40512.
What if I need help with my claim?
For questions about Medicare reimbursement, call 1-888-706-2583 on weekdays.
How can I track my claim status?
Claims submitted online allow you to track the status through your MRA account.
What happens if my claim is denied?
You will receive a notification detailing the reasons for denial and any necessary steps to rectify it.
Do I need a separate form for each family member?
Yes, ensure separate forms are filled out for your spouse and other dependents.
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