Medicare Claim form (MS014)

Use this form to make a claim for a Medicare benefit by mail or in person at a service centre. This can be for a paid or unpaid account.

All Medicare benefits are paid directly into your nominated bank account. Put your bank details on the form if you haven’t given them to us already, or they need updating.

Depending on the item number, you might be able to submit your claim online. Read more about submitting your Medicare claim online.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 1 May 2018