Reviewing your quarterly Medicare Summary Notice (MSN) is important, but understanding it can be a challenge.
See also: Understanding your Medicare statement.
That's why AARP has created two easy-to-use MSN "decoders": one for Part A and the other for Part B. The text below is a printable version of what appears within the pop-up boxes of AARP's Part A Medicare Summary Notice Decoder.
1. Medicare Summary Notice
Medicare sends out statements like this example quarterly. If you don’t use any medical services in a particular three-month period, a statement won’t be sent. Your Medicare Summary Notice shows all services billed to your Medicare Part A account for inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care services. If you want to know your MSN’s contents before it arrives by mail, call the Medicare help line at 800-633-4227 or set up a private online account at MyMedicare.gov where you can view your records at any time.
2. Name and Address
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.
3. This Is Not a Bill
Yes, that's right! Your Medicare Summary Notice is not a bill. It is a statement you should review for accuracy and keep for your personal records.
Very important: Never send payments to a health care facility or provider for charges listed on a Medicare Summary Notice until you've received a bill for the service directly from the facility. If you have already paid the facility, check to make sure that what you paid matches the amounts on your Medicare Summary Notice. If you paid more than needed, contact the facility's billing office to request a refund.
4. Your Medicare Number
This is the last four digits of your Medicare number. Protect it just as you would a credit card, bank account or Social Security number because, as you may have noticed, it is your Social Security number!
5. Date of This Notice
This is the date the notice was printed for mailing. Medicare Summary Notices are sent out four times a year — once a quarter — but you don’t necessarily 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.
6. Claims Processed Between
This shows the dates of the three months in which claims were submitted on your Medicare account.
7. Did Medicare Approve All Claims?
“Yes” means that Medicare covers this type of health care service. If you see “No” in this space, contact the health care facility and ask for an itemized statement. Also see the section “How to Handle a Denied Claim” (described by item No. 26, below). For more about non-covered services, see the article "What Medicare Doesn't Cover."
8. Total You May Be Billed
This is the maximum amount the facility is able to bill you. It may include your Part A deductible, any coinsurance charges or any other expenses that Medicare does not cover. Compare your Medicare Summary Notice with the facility’s billing statement to make sure you are paying the correct amount. If you have already paid the facility, check to make sure that what you paid matches the amounts on your Medicare Summary Notice. If you paid more than needed, contact the facility's billing office to request a refund. Contact the facility if you spot errors in this section of your MSN. If you have a Medicare supplemental insurance policy (also called Medigap), Medicare will send this claim information directly to your insurance company. Your supplemental insurance may cover some or all of your out-of-pocket costs, depending on which policy you buy.
9. Facilities with Claims This Period
This is a list of the health care facilities that filed claims during this three-month billing period. Check to make sure you received care at those places on the dates listed here. If you did not, contact the facility’s billing department. If the facility cannot resolve your concerns, contact Medicare at 800-MEDICARE (800-633-4227).
10. Your Deductible Status
The Part A deductible of $1,216 is required for each hospital benefit period. A benefit period begins when you go into the hospital and ends when you have been out of the hospital for at least 60 days. If you return as an inpatient before the 60 days are up, the benefit period continues and another deductible is not required. But if you are hospitalized again after having been out for 60 days, you must pay another deductible in full (unless your Medigap policy covers it).
11. How to Check This Notice
Follow these tips on how to check the accuracy of this notice.
12. How to Report Fraud
This section gives tips on how to protect against Medicare fraud. For more information, visit AARP.org/FightFraud.
13. How to Get Help with Your Questions
State health insurance assistance programs (SHIPs) provide free, expert counseling on the phone or in person on Medicare issues. There’s a SHIP in every state, plus the District of Columbia, Puerto Rico and the U.S. Virgin Islands. To find the phone number of your SHIP, call the Eldercare Locator at 800-677-1116 or go online to www.shiptalk.org.
14. Your Benefit Periods
Your benefit period starts the day you first receive inpatient care in a hospital and ends when you have not received inpatient care in a hospital or skilled care in a skilled nursing facility for 60 days in a row. For more information, visit Ask Ms. Medicare.
15. Your Messages from Medicare
These messages change regularly.
16. Date of Service
This is the date or dates you were an inpatient at the hospital. To make sure this information is correct, you can check your calendar or the statement you were given by the facility. If you did not go to the hospital on the dates listed here, contact the facility filing the claim. It could be a mistake that the facility can easily correct. If it cannot resolve your concerns, contact Medicare at 800-MEDICARE (800-633-4227).
17. When your Benefit Period Starts
This shows when your current benefit period began.
18. Benefit Days Used
This is the number of benefit days you used during your hospital stay.
19. Service Approved?
“Yes” means that Medicare covers this type of health care service. If you see “No” in this space, contact the facility and ask for an itemized statement. Also see the section How to Handle a Denied Claim at item No. 26. To challenge an unpaid charge, see “Appealing a Medicare Claim Decision.”
20. Non-Covered Charges
For more about hospital charges Medicare does not cover, see "What Medicare Doesn't Cover."
21. Amount Medicare Paid
This is the amount Medicare paid the facility for this claim.
22. Maximum You May Be Billed
This is the maximum amount the facility can bill you. It may include your deductible ($1,216 in 2014 for each benefit period), your coinsurance charges for stays over 60 days in your benefit period or other charges that Medicare does not cover. Compare your Medicare Summary Notice with the facility’s billing statement to make sure you are paying the correct amount. Contact the facility if you spot errors in this section of your MSN.
23. See Notes Below
This column directs you to additional information about your claims. If there’s a letter in this column, refer to the Notes for Claim Above (described by item No. 25) at the bottom of the page for explanations of the claims on this Medicare Summary Notice.
24. Claim Number
Each claim made to your Medicare Part A account is assigned a distinct number. Refer to this claim number when speaking with the facility or Medicare.
25. Notes for Claim Above
Medicare uses this area to give you extra information about the claims listed in your Medicare Summary Notice. For instance, the message shown here is about benefit days and coinsurance.
26. How to Handle a Denied Claim or File an Appeal
Follow the steps in this section if Medicare denies payment for a claim you think should have been paid. Your appeal must be in writing. Print a copy of your online MSN at MyMedicare.gov, which includes this appeal page, or use the form you get in the mail with your paper MSN.
Complete the form by hand. Be sure to make a copy of everything you send to Medicare, and send it by recorded delivery or keep a note of when you mailed it.
For more information about appealing a denial and deadlines for filing, see Appealing a Medicare Claim Decision.
27. If You Disagree with a Coverage Decision, Payment
You have 120 days to appeal your claim. The date listed in the box is when your appeal must be received at the Medicare Claims Office. The address you should use is at the bottom of the form.
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