When you choose original Medicare, health care providers and hospitals send their bills for your care directly to Medicare. The Medicare summary notice (MSN) is a statement that shows all the services and supplies that were billed to the program in the past three months, how much Medicare paid and the maximum amount you may owe a provider.
Similar to an explanation of benefits (EOB) notice you may have received from your pre-Medicare health insurance company, this statement is for your reference and is not a bill. If you haven’t receive any services or medical supplies, you won’t get an MSN for that particular quarter.
Medicare sends this notice every quarter in which you use Medicare Part A or Part B services. If you sign up for an online Medicare account, you can access the statement on the web and can opt out of the mail version and receive electronic Medicare summary notices (eMSNs). If you don’t want to wait for the quarterly statements, you can review your Medicare claims information each month.
Even though your MSN is not a bill, you should still review it carefully. This claims notice can help you keep track of the care you have received and allows you to monitor your out-of-pocket costs. It also can help you spot errors — and even instances of fraud — on your Medicare account.
It’s really two notices. You’ll receive a separate MSN for your claims for Part A — which helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, certain home health care services and end-of-life hospice care — and your claims for Part B (which helps cover diagnostic tests, doctors’ services, ambulance transportation and other outpatient costs).
The Part A Medicare summary notice shows the dates of the claims, how much of the deductible you have met, whether Medicare approved all of the claims, and the total amount you may be billed from the facility. It also lists the facilities where you have had claims this period and the dates you received services there.
Page 2 includes tips for reviewing the notice and how many days of coverage you have used in your benefit period for inpatient hospitalization and skilled nursing facilities.
Page 3 provides detailed information about your claim, including the number of benefit days used, whether the claim was approved, any charges that weren’t covered, the amount Medicare paid and the maximum you may be billed. Keep in mind that the bill may be covered by Medigap or other supplemental coverage.
It shows the numbers for the three-month period covered in the summary notice and the total for the claim. It also shows the dates you went to the hospital or facility and when your current benefit period began.
Page 4 explains how to file an appeal if you disagree with a coverage decision, payment decision or payment amount on this notice. It also includes resources for help with filing an appeal, how to file an appeal in writing using the form on the MSN, and the deadline for filing an appeal.
The Part B Medicare summary notice indicates how much of the deductible you have met, your claims and costs for the three-month period, whether Medicare approved all of the claims, and the total amount you may be billed by the provider. It lists the providers with claims this period and the date of the service.
Page 2 includes tips for reviewing the notice, where to find more about preventive services and how to get help with your Medicare questions.
Page 3 provides detailed information about your claim, including the service provided, its billing code, whether the service was approved, the amount the provider charged, the Medicare-approved amount, the amount Medicare paid and the maximum you may be billed. It also states whether the claim was sent to your Medigap insurer or other insurer, which could cover some of those expenses. You’ll find a definition of terms too.
Page 4 includes information about how to file an appeal if you disagree with a coverage decision, payment decision or payment amount; the date Medicare must receive your appeal; how to get help filing an appeal; and how to appeal in writing using the form on the MSN.
Review the notice to make sure you recognize the names of the places, providers and the services you received. Also compare the information on your MSN with bills, receipts and statements from your health care providers, and ask them about any charges that don’t match. If a medical provider didn’t submit a claim correctly, ask the provider to resubmit it to Medicare.
If Medicare didn’t pay a claim you think should have been covered, you have the right to appeal. The back of the Medicare summary notice provides instructions on how to appeal the denial.
Keep the notices at least until your providers send you a bill for their services. It will help you see if a Medicare payment has been made.
If you’re claiming a deduction for medical expenses on your income taxes, you can use the Medicare summary notices to document your expenses. In that case, keep the tax records for at least three years after the tax-filing deadline, which is the amount of time the IRS has to initiate an audit.
Shred the notices afterward so identity thieves cannot view any personal information.
To sign up for eMSNs, start by creating an online Medicare account. Go to My messages at the top of your account home page and select Get your Medicare Summary Notices (MSNs) electronically. Click Go Paperless; you’ll then access the My communication preferences page, where you’ll see Change eMSN preference. Select Yes, then Submit.
If you choose eMSNs, you’ll get an email when your summary notice is available in your account every month that you use Medicare services. But you won’t get printed copies of the MSN in the mail every three months.
You can also review claims in your online account within 24 hours of when Medicare processes them.
Different name, same purpose. If you have coverage through a private insurer’s Medicare Advantage plan, instead of original Medicare, you’ll get an explanation of benefits (EOB) notice from your insurance company but not a Medicare summary notice from Medicare.
If you have Part D prescription drug coverage, you’ll get an EOB from your drug plan each month in which you fill a prescription. It lists your prescription drug claims and costs.
Other insurers have EOBs. You’ll also receive an EOB statement from any insurer that provides you additional coverage, such as a dental plan, an employer, a Medicare supplement plan (better known as a Medigap plan), a retiree health plan or other health insurance provider.
Updated June 28, 2022
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