How to Understand Medicare Summary Notices

By Patricia Barry

Copyright © 2015 AARP. All rights reserved.

If you’re enrolled in traditional Medicare, you’ll receive one of these notices every three months — but only if you’ve had any medical services that Medicare has paid for in that period. If you want to see these notices instantly at any time, you can access them on the Medicare website.

An MSN is similar to the explanation of benefits statement you’re familiar with if you’ve had health insurance in the past. It itemizes everything that’s been billed to Medicare for medical services and supplies that you’ve received, what Medicare paid for them, and what you may still owe to the providers. The MSNs that show Part A and Part B services are different, as follows:

  • Part A summary notice: If you’ve been in a hospital, hospice, or skilled nursing facility, this document shows how many days you’ve used in the benefit period; how much of the Part A deductible you’ve met; and how much Medicare has paid. This notice also has a Part B section, which itemizes services that you received in the hospital or other facility but that are billed to Part B. Examples include doctors’ services, units of blood, or maybe even a whole hospital stay if you’ve been placed in observation status rather than formally admitted to the hospital.

  • Part B summary notice: This statement itemizes any doctors’ services, outpatient care such as screenings and lab tests, and medical equipment or supplies that you’ve received in the three-month period. It shows the names of the providers, how much they charged, the amount Medicare considers reasonable for each service (the “Medicare-approved” amount), how much Medicare actually paid, and how much (if anything) you still owe the providers. This notice also shows whether Medicare has denied payment for a claim and (if you have supplemental insurance) whether a claim has been forwarded to the other insurer for payment.

Medicare Summary Notices have been redesigned so they’re much more consumer friendly than they used to be — easier to read with larger print, plainer language, better explanations, and clearer instructions on how to file an appeal. But here are some particular things worth knowing about MSNs:

  • The MSN isn’t a bill. If it indicates that you owe money to a provider, you should wait to receive the provider’s bill and pay it directly, if you haven’t already done so.

  • You should carefully compare the claim details on your MSN with the bills you receive from the providers. Make sure that provider names, dates, billing codes, and descriptions match. That’s quite easy in the case of the Part B MSN, where each service is itemized.

    However, each service you receive in the hospital doesn’t appear on the MSN for Part A. Medicare officials say the list is usually too long. (And if you’ve ever perused a hospital bill — with charges for every aspirin and even the paper that covers the operating table — you can see what they mean.) Sure, you’ll receive an itemized bill from the hospital, but how can you tell whether Medicare has been billed correctly without an itemized MSN to compare it with? Medicare officials suggest that you can

    • Create an online personal account at www.mymedicare.gov (as explained in the later section “Tracking information online”) and use the blue button icon to access a full itemized list of all your Part A or Part B claims.

    • Call Medicare at 800-633-4227 (TTY 877-486-2048). A customer service rep can access your complete Part A claims record and tell you what you want to know or, on request, send you a printout.

  • If you find a line item on your MSN that you don’t remember receiving, first check with the provider. If it’s a mistake, ask for it to be corrected. If you see that Medicare has denied a claim you believe it should’ve covered, ask the provider to check the service identifier codes that were submitted to Medicare, in case the wrong one was sent.

    If you suspect that a provider has filed incorrect — and potentially fraudulent — claims to Medicare, report it. The MSN encourages you to do so, even saying, “If we determine that your tip led to uncovering fraud, you may qualify for a reward.” In fact, the reward may be as much as $1,000 — worth scrutinizing your MSNs for! (Which is the point. In 2013, Medicare saved more than $4.3 billion in this way.) Reporting a claim for a service or item you never received can also save you a lot of hassle. For example, if Medicare was fraudulently billed for a wheelchair in your name, later on it may deny your genuine claim for a wheelchair because, according to its records, you already have one.

  • You have the right to file an appeal if Medicare denies a claim you believe was filed properly. The MSN tells you how to go about it.

For more help in reading your MSN, you may want to check out the online MSN decoder tool devised by AARP.

If you’re in a Medicare Advantage plan, you won’t receive an MSN. Instead, you’ll get explanation of benefits statements that also itemize the services and supplies you’ve received from the plan. If you have Part D drug coverage, your plan will send statements that show not only the drugs you’ve used and their costs but also how near you are to meeting the deductible (if the plan charges one) or falling into the doughnut hole.