The Medicare Summary Notice: How to Read Your Medicare Bill

Protecting Yourself Against Medicare Fraud and Abuse

how to read your medicare summary notice and medicare bill

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You do not want to pay more than necessary, but if you don't read your Medicare bill, you could do just that. Medicare Summary Notices outline what care you received, how much Medicare covers, and how much you will be billed. Learn how to read your Medicare statements to make sure they are accurate. It is the best way to protect yourself against Medicare fraud and abuse.

The Medicare Summary Notice

If you are on Original Medicare (Part A and Part B), you will receive a Medicare Summary Notice (MSN) quarterly, i.e., every 3 months. You will receive separate MSNs for Part A and Part B coverage.

Authenticity

An MSN is a detailed statement about services that have been charged to Medicare during that time frame but is not a bill in and of itself. THIS IS NOT A BILL will be printed in bold capitalized letters at the top of the statement.

A logo for the Centers for Medicare and Medicaid Services (CMS) will also be found in the header portion of Page 1. If either of these markers is missing from your Medicare Summary Notice, it could be fraudulent.

Also, make sure that your name, address, and Medicare number are accurate. If there are any discrepancies with your demographic information, please reach out to Medicare immediately at 1-800-MEDICARE (1-800-633-4227) to correct them.

Deductibles

Your deductible status will be listed in the left-hand column on Page 1.

Part A

Deductibles for Part A are based on benefit periods. A benefit period is a time that begins when you have an inpatient hospitalization or are placed in a skilled nursing facility. It ends when you have not received inpatient hospital or skilled nursing facility care for 60 days in a row.

You will pay a deductible for each benefit period and multiple deductibles may be listed here. In 2020, each deductible costs $1,408.

Part B

There is an annual deductible for Part B. The annual amount ($198 in 2020) will be listed here as well as any amount you have paid toward that deductible in that calendar year. Medicare will not start paying for care until you have paid the full deductible amount.

Claims

Page 1 of your Medicare Summary Notice lists a brief overview of "Your Claims & Costs This Period". This summary is in the right-hand column and lets you know if Medicare denied coverage for any services that quarter and how much you can expect to be billed. Page 3 provides a more detailed summary of each service and its charges.

Part A

Page 1 will list a summary of "Facilities with Claims This Period" as well as the dates services were provided. Page 3 will list each service provided with the following categories:

  • Benefit Days Used: This lets you know how many days you used within a given benefit period. This is important to note because you will be charged a co-insurance for any inpatient hospital days after 60 days or any skilled nursing facility days after 20 days.
  • Claim Approved: This lets you know if Medicare covered the service.
  • Non-Covered Charges: This lets you know the dollar amount for any services not approved for coverage by Medicare.
  • Amount Medicare Paid: This lets you know the total amount Medicare paid for covered services.
  • Maximum You May Be Billed: This lets you know how much you can be charged for services you received.

Part B

Page 1 will list a summary of "Providers with Claims This Period" as well as the dates services were provided. Page 3 will list each service provided with the following categories:

  • Service Approved: This lets you know if Medicare covered the service.
  • Amount Provider Charged: This lets you know how much a provider charged for a given service. Doctors who accept Medicare for payment fall into two categories. Those who agree to pay no more than what Medicare recommends on the annual fee schedule are called participating providers. Non-participating providers can add a limiting charge up to 15% more than what is recommended on the fee schedule.
  • Medicare Approved Amount: This lets you know the dollar amount for any services approved for coverage by Medicare. Medicare does not cover the limiting charge.
  • Amount Medicare Paid: This lets you know the total amount Medicare paid for covered services. Medicare covers 80% of the cost for most services but will pay for 100% of costs for preventive care services if they are ordered by a participating provider.
  • Maximum You May Be Billed: This lets you know how much you can be charged for services you received.

Medicare Advantage and Part D Prescription Drug Plans

If you are on a Medicare Advantage (Part C) or Medicare Part D plan, you will not receive a Medicare Summary notice from CMS. You will receive a statement directly from the insurance company that sponsors your plan. The document you receive is called an Explanation of Benefits (EOB).

Your commercial Medicare plan will mail you an EOB monthly. Similar information will be presented to you as on the Medicare Summary Notice. Like an MSN, an EOB is not a bill.

How to Use the MSN and EOB

Whether you receive a Medicare Summary Notice or an Explanation of Benefits, it is important to save copies of these statements for your records. You can compare them against any medical bills you receive. It is encouraged that you also keep a log of any services you receive and on what days to make sure you are not being improperly billed.

Look for unfamiliar facility names. Odds are you know where you received your care. If your statement lists services at an unfamiliar location, find out if your doctor works in multiple offices. He may bill all services he performs from one office and the charges could be legitimate.

Look for unfamiliar provider names. If you are unfamiliar with a medical provider's name, ask yourself why. Is this the name of another provider in an office that cared for you? Was another doctor covering for your usual doctor in their absence? Were you hospitalized and saw a number of doctors during your stay?

Verify dates of service. Make sure that any dates of service match up with dates you actually received care.

Look for duplicate charges. Duplicate charges may be justified (e.g., you received multiple doses of a medication during a hospital stay) or they could be in error.

Compare your actual medical bills with the "Maximum You May Be Billed": Doctors cannot charge you more for a Medicare-approved service to make up for what Medicare does not pay. That is called balance billing and it is against the law.

Check to see if you signed an Advanced Beneficiary Notice (ABN) for any services Medicare did not approve. You are not liable to pay for these services unless you signed an Advanced Beneficiary Notice beforehand. The ABN is an acknowledgment that Medicare may not cover the service and that you are willing to pay out of pocket for the service.

If you did sign an ABN, it is not valid if it is illegible, if it signed after the service was performed, or if it is otherwise incomplete. You should reach out to your medical office to see if there is a copy of an ABN on record for that service.

Taking Action

Whenever you see something that does not match up with your records, reach out to your doctor or medical office for clarification. There could have been a misunderstanding or a true billing error. In the worst-case scenario, it could be a sign of Medicare fraud and abuse.

If you suspect Medicare fraud or identity theft, you should report the incident as soon as possible. Reach out to Medicare at 1-800-MEDICARE (1-800-633-4227), the Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477), or the Federal Trade Commission (FTC) at 1-877-FTC-HELP (1-877-382-4357).

A Word From Verywell

Too many people assume that their healthcare bills are accurate and pay them outright. You could be at risk for overbilling or Medicare fraud. Learn how to read your Medicare Summary Notice to make sure you are not paying more than your fair share.

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