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How to Read Your Part A Medicare Summary Notice

AARP 'decoder' shows you what you need to know

Reviewing your Medicare Summary Notice (MSN) is important, but understanding it can be a challenge. That's why AARP has created two easy-to-use Medicare Summary Notice "decoders": one for Part A (below), the other for Part B. Follow the decoder instructions at right, or access a printable version of our MSN's pop-up text here.

 

How to use this interactive Medicare Summary Notice decoder

1. Click on a number to open its pop-up window.
2. When done reading, click on another number.
3. To hide a window, tap its "Close" button.

(1) Medicare Summary Notice

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Medicare sends out statements like this one quarterly. If you didn't use any medical services in a particular three-month period, a statement won't be sent. Your Medicare Summary Notice shows all services and supplies billed to your Medicare Part A account by hospitals, home health providers, and hospice and skilled nursing facilities.

(2) Date

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This is the date the notice was mailed. Medicare Summary Notices are sent out four times a year — once a quarter — but you don't have to wait for your notice to arrive in the mail. You can also check your account online at MyMedicare.gov. Claims typically appear on your electronic statement 24 hours after processing.

(3) Name and Address

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If the name or address listed here is not correct, visit your local Social Security Administration office or call 800-772-1213 (TTY 800-325-0778 for the deaf or hard of hearing), weekdays from 7 a.m. to 7 p.m. You can also make the corrections online at SSA.gov. In addition, be sure to contact the company that processes your Medicare claims (see pop-up No. 4) with any corrections or changes.

(4) Customer Service Information

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Medicare contracts with private companies called "Medicare administrative contractors" to process your Medicare claims and pay your health care providers. That's why you may see the name and address of a private company in this part of the notice. If you have questions about your Medicare statement, contact this company.

(5) Your Medicare Number

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This is the number on your Medicare card. Protect it just as you would a credit card, Social Security or bank account number.

(6) Be Informed

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This section gives tips on how to protect against Medicare fraud. For more information, visit AARP.org/fightfraud.

(7) Claims Included

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Your Medicare Summary Notice covers claims that were made between the two dates you see here. If you want to check a more recent claim, you can always review your account online at MyMedicare.gov. Claims typically appear on your electronic statement 24 hours after processing.

(8) Part A Hospital Insurance — Inpatient Claims

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Part A claims are made for medical services or supplies received while you are a patient in a hospital or skilled nursing or hospice facility. Some services or supplies you receive at home also are covered under Part A.

You have the right to receive an itemized statement listing all services and supplies referred to in this section. For an itemized statement, contact the billing hospital or facility directly. Also, contact the billing office if you spot errors in this section of the statement.

(9) Claim Number

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Each inpatient claim made to your Medicare account is assigned a claim number. If, for instance, you were hospitalized for three days, all billed services and supplies relating to that visit would have the same claim number.

(10) Hospital

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This is the hospital where you received treatment. If you did not receive services or supplies from this hospital, contact the hospital billing office directly. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, contact Medicare at 800-MEDICARE (800-633-4227).

(11) Referred by

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This is the name of the doctor who admitted you to the hospital or facility.

(12) Dates of Service

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These are the dates you received treatment. If you did not receive services or supplies on these dates, contact the hospital or facility billing office. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(13) Facility

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This is the name and address of the skilled nursing or hospice facility where you received care. It may also be the name of the company that provided home health care. If you did not receive services or supplies from this facility or company, contact the facility or company billing office directly. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(14) Benefits Days Used

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A "benefit period" begins on the day you are admitted to the hospital, hospice or skilled nursing facility and ends when you have been out for 60 days in a row. Benefit periods matter because you pay an out-of-pocket deductible ($1,132 in 2011) each time you enter a new benefit period.

This column indicates the number of days you have been in your benefit period. The example on this sample Medicare Summary Notice shows that 25 of the 60 benefit days have been used for back-to-back inpatient stays at two facilities.

If you are readmitted to a hospital or facility before you've been out for 60 days, you will continue in the "old" benefit period.

If you are admitted again after you have been out for at least 60 days, you begin a new benefit period and will pay another out-of-pocket deductible.

(15) Noncovered Charges

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Medicare doesn't cover all of your medical expenses. For example, Medicare does not pay for the first three units of blood used in a transfusion, nor does it cover copies of X-rays, or the charge for a television or telephone in your hospital room. The dollar amounts in this column are the part of the hospital's or facility's claim that Medicare did not pay. (For more about noncovered charges, see "What Medicare Doesn't Cover." To challenge an unpaid charge, see “Appealing a Medicare Claim Decision.”)

(16) Deductible and Coinsurance

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Each of your hospital benefit periods has an out-of-pocket deductible. (See pop-up No. 14 for more about "benefit periods.") You must pay the deductible amount ($1,132 in 2011) to the hospital or facility before Medicare pays on the claim.

This section shows the amount that has been applied to your insurance deductible, and/or to your coinsurance. (Coinsurance is a percentage of a charge that you pay out-of-pocket. For instance, Medicare might cover 80 percent of a charge and require you to pay the remaining 20 percent.)

This sample Medicare Summary Notice shows that the $1,132 deductible has been met and the patient must pay that amount to the hospital.

Also, keep in mind that depending on the services you receive, you might also need to pay an out-of-pocket co-payment, or fixed fee. For example, this could be the $10 or $20 you pay at the front desk in your doctor's office.

(17) You May Be Billed

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This is the maximum amount the hospital or facility can bill you. It may include your deductible, coinsurance charges or any other charges that Medicare does not cover. If you have a Medicare supplemental insurance policy (also called Medigap), Medicare will send this claim information to your insurance company. Your Medigap policy should cover at least some of the costs not paid by Medicare.

(18) See Notes Section

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This column directs you to additional information about your claims. If there is a letter code in this column, refer to the Notes Section at the end of your statement.

(19) Part B Medical Insurance — Outpatient Facility Claims

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Any services or supplies received on an outpatient basis — whether in a hospital or, say, a renal dialysis center — appear in this section. For other Part B claims, see your Part B Medicare Summary Notice. (For help understanding your Part B MSN, use “AARP’s Part B Medicare Summary Notice Decoder.”)

(20) Claim Number

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Each outpatient claim made to your Medicare account is assigned a claim number. For instance, a single doctor's visit has a claim number as would each dialysis treatment session.

(21) Facility

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This is the name and address of the facility that provided your outpatient treatment. If you did not receive treatment from this facility, contact the facility's billing office. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(22) Referred by

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This is the name of the doctor who ordered the outpatient services.

(23) Dates of Service

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These are the dates you received outpatient services at the hospital or facility. If you did not receive services or supplies on these dates, contact the hospital or facility billing office. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(24) Services Provided

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This is a brief description of the provided service. If you did not receive the service, contact the facility directly. It may be a simple mistake that the facility can easily correct. If the facility does not resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(25) Billing Code

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Medical procedures and services are assigned billing codes. Compare this code with the code that appears on the billing statement you received from the facility. If the codes are different, contact the facility making the claim. It may be a simple mistake that the facility can easily correct. If the facility does not resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).

(26) Amount Charged

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This is the total amount the facility billed Medicare for the service or treatment.

(27) Noncovered Charges

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Medicare doesn't cover all of your medical expenses. For example, Medicare does not pay for copies of X-rays or the first three units of blood used in a transfusion. (For more about noncovered charges, see "What Medicare Doesn't Cover." To challenge an unpaid charge, see “Appealing a Medicare Claim Decision.”)

(28) Deductible and Coinsurance

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Your outpatient services fall under your Medicare Part B deductible. This is the amount of money you pay out-of-pocket before Medicare helps with the costs. After you have met the annual deductible ($162 in 2011), you pay 20 percent of the Medicare-allowed fees for later charges.

Depending on the services you receive, you may also be charged a co-payment. For example, if you visit an emergency room and are not admitted to the hospital, you pay a co-payment directly to the hospital.

(29) You May Be Billed

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This is the maximum amount the hospital or facility can bill you. It can include your deductible and coinsurance or other charges Medicare does not cover. If you have Medicare supplemental insurance (also called Medigap), Medicare will send this claim information to your insurance company. Your Medigap policy should cover at least some of the costs not paid by Medicare.

(30) See Notes Section

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This column directs you to additional information about your claims. If there's a letter in this column, refer to the Notes Section (described by item No. 32) at the end of your Medicare Summary Notice.

(31) This Is Not a Bill

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Yes, that's right! Your Medicare Summary Notice is not a bill. However, it is a statement you should review for accuracy and keep for your personal records.

Very important: Never send a health care provider payment for charges listed on a Medicare Summary Notice until you've received a bill for the service directly from the provider. If you have already paid the provider, check to make sure what you paid matches the amounts on your Medicare Summary Notice. If you paid more than needed, contact the provider's billing office to request a refund.

(32) Notes Section

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Medicare uses this area to give you extra information about the claims listed in your Medicare Summary Notice. If a letter code appears in the column called "See Notes Section," you'll find an explanation of that code here.

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