Medicare Reimbursement Account Claim Form and Instructions 2026

1. Click ‘Get Form’ to open the Medicare Reimbursement Account Claim Form in the editor.
2. Begin by filling out the Account Holder Information. Clearly print your first and last name, and complete a separate form for your spouse or dependents.
3. In the Claims for Out-of-Pocket Expenses section, indicate how your Medicare Part B premiums are paid. Check the appropriate box based on whether they are deducted from Social Security or paid after-tax.
4. Enter your service start date and end date accurately. This could be January 1 of the reimbursement year or your effective date if applicable.
5. Fill in the total amount of your Medicare Part B payment, either annually or monthly/quarterly as required.
6. Attach proof of payment documents that verify your Medicare Part B premium payments, ensuring they meet IRS requirements.

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