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Dear Marci: What do my Medicare notices mean?

It is a great idea to look more closely at your Medicare notices. Understanding what they mean can help you avoid and resolve issues with your Medicare coverage! We won’t discuss every kind of notice you may receive about your Medicare, but let’s start with a few common ones that you’ll receive regularly:

First, those with Original Medicare receive a Medicare Summary Notice quarterly. The Medicare Summary Notice (or MSN) is a summary of health care services and items you have received during the previous three months. It contains information about charges billed to Medicare, the amount that Medicare paid, and the amount you are responsible for, although the MSN itself is not a bill (you will receive a bill from providers). Your MSN will also show any non-covered charges. This field shows the portion of charges for services that are denied or excluded (never covered) by Medicare. A $0.00 in this field means that there were no denied or excluded services. A charge in this field means you are responsible for paying it. For more information on why you were denied coverage of a service, you can call 1-800-MEDICARE, check www.medicare.gov, or read your Medicare & You handbook. If you disagree with a non-covered charge, you should file an appeal.

If you have a Medicare Advantage or Part D plan, you will receive an Explanation of Benefits, or EOB. EOBs are usually mailed each month. They similarly show a summary of the services and items you have received and how much you may owe for them (although again, an EOB is not a bill). If your EOB shows that an item or service is not being covered, look for a section that includes notes, comments, footnotes, or remarks to find out the reason why. Contact your plan if you have any questions about your EOB, including to ask for more information about any services not covered. You may decide to file an appeal, depending on what your plan tells you.

Try to save your MSNs and/or EOBs. You might need them in the future to prove that certain costs have been covered or paid for. For instance, you may need old MSNs or EOBs if a provider’s billing department makes a mistake or if you claimed a medical deduction on your taxes. If you have lost your notice or need a duplicate copy, call 1-800-MEDICARE (for MSNs) or your plan (for EOBs).

Another important notice to look out for is the Annual Notice of Change, or ANOC. The ANOC is the notice you receive from your Medicare Advantage or Part D plan in late September. This notice gives a summary of any changes in the plan’s cost and coverage that will take effect January 1 of the next year. You should review this notice to see if your plan will continue to meet your health care needs in the following year. If you do not receive an ANOC from your plan, you should contact your plan. The ANOC is typically mailed with the plan’s Evidence of Coverage (EOC), which is a more comprehensive list of the plan’s cost and benefits for the upcoming year. If you are dissatisfied with changes on your ANOC or EOC, remember that you can change your Medicare coverage during Fall Open Enrollment.

One last notice we’ll discuss here are notices of creditable coverage. If you are enrolled in a prescription drug plan through an employer, you should receive a notice from your employer or plan around September of each year, informing you if your drug coverage is creditable. Keep these notices. You may need them as proof that you had creditable coverage and should not have a Part D late enrollment penalty if you decide to enroll in a Part D plan in the future.
 
As you said, there are often numerous notices you may receive about your Medicare. These are just a few types to look out for, read closely, and keep for your records.  

-Marci

Dear Marci is a free e-newsletter from the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. For more free answers to your Medicare questions, visit Medicare Interactive (MI) at www.medicareinteractive.org. Subscribe to Dear Marci by registering for your free account on Medicare Interactive.  

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Posted June 7, 2021 by at United States in Medicare
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