What is a Medicare Summary Notice?

What does a Medicare Summary Notice show?

The MSN shows all the services or supplies that providers and suppliers billed to Medicare during the period, what Medicare paid and the maximum amount you may owe the provider. Medicare has separate sample notices for Part A, Part B and durable medical equipment (DME). On the sample Part B MSN:

• Page 1, your dashboard: your name, the last 4 numbers of your Medicare Number, the date the notice was printed and the dates of the claims, your deductible information, a summary of approved and denied claims with the total you may be billed, and the providers you saw during the claim period.
• Page 2: tips on how to check your notice, how to report fraud and where to get help.
• Page 3, your claims: whether each claim is assigned or unassigned, the service descriptions, whether each claim was approved or denied, and the maximum you may be billed.
• Page 4: how to handle denied claims and file an appeal.
• Your MSN also tells you if you're enrolled in the Qualified Medicare Beneficiary (QMB) program, which means Medicare providers aren't allowed to bill you for Part A and Part B deductibles, coinsurance or copayments (in some cases, you may be billed a small copayment through Medicaid).

When will I get a Medicare Summary Notice?

You'll get an MSN every 6 months if you get any services or medical supplies during that period; if you don't, you won't get one. If you choose electronic MSNs, you won't get printed copies in the mail: you'll get an email with a link to your MSN for any month you have a processed claim. To switch, log into (or create) your Medicare account, go to your account settings and choose to get MSNs electronically.

You can also get your MSNs in an accessible format, like large print or Braille, and you can view your Original Medicare claims in your Medicare account as soon as they're processed.

What should I do when I get my MSN?

Medicare.gov suggests these steps:

• If you have other insurance, check whether it covers anything Medicare didn't.
• Keep your receipts and bills, and compare them to your MSN to be sure you got all the services, supplies or equipment listed.
• If you paid a bill before you got the notice, compare your MSN with the bill to make sure you paid the right amount.
• If an item or service is denied, call your doctor's or other provider's office to make sure they submitted the correct information; if not, the office may resubmit.
• If you see services you didn't get or suspect fraud, report it by calling 1-800-MEDICARE or online.

How do I appeal a decision on my MSN?

In Original Medicare, the first appeal starts with your MSN. Circle the items you disagree with, write an explanation of why you disagree (on the MSN or a separate page), include your name, phone number and Medicare Number, and send the MSN or a copy to the Medicare Administrative Contractor listed on it, or use Form CMS-20027. Keep a copy for your records.

You must file by the date in the MSN; the sample Part B MSN explains that you have 120 days and that the date in the box is when your appeal must be received. If you miss the deadline, you may still get a decision if you can show good cause. You'll generally get a decision within 60 days, and if Medicare will cover the item or service, it will be listed on your next MSN. See How do I appeal a Medicare denial?.

How can I tell an MSN is really from Medicare?

Medicare sends the MSN, and Medicare.gov shows what to look for on the envelope: the Department of Health and Human Services (DHHS) logo, the phrase 'Official Medicare Information', the words 'To be opened by addressee only', and contact information for questions about the notice. If you need to change the address on your MSN, contact Social Security, or the Railroad Retirement Board if you get RRB benefits. More in Does Medicare ever call you, and how do you spot a Medicare scam?.

Do Medicare drug plans send an MSN?

No, drug plans send their own notice. The MSN covers Original Medicare Part A and Part B services. Each month you fill a prescription, your Medicare drug plan mails you an Explanation of Benefits (EOB) that summarizes your prescription drug claims and costs. Review it for mistakes, and contact your plan if you have questions, find mistakes or suspect fraud.