Ever opened up a Medicare notice and wondered, "Is this a bill?"
You’re not alone. Understanding the different documents you receive can feel overwhelming. Here’s a quick breakdown of some of the most common ones:
Medicare Summary Notice (MSN):
If you are enrolled in Original Medicare (Parts A & B), you will receive Medicare Summary Notices every few months – directly from Medicare.
These documents detail healthcare services you have used during a set period, such as doctor visits, tests, and hospital stays. MSN’s will show:
- What services were billed to Medicare
- What portion Medicare approved and paid
- Any denied claims and the reason why
- What you may still owe to your provider Medicare approved and paid
Medicare Summary Notices are not bills, and it’s important to verify what’s listed on them before making any payments, especially if you have supplemental insurance.
Medicare Supplement (Medigap) Notices:
Medigaps work alongside Original Medicare to help pay for out-of-pocket costs like deductibles, copayments, and coinsurance. In many cases, after Medicare processes your claim, it is automatically sent to your supplement provider. Medigap Notices show what remaining costs were covered by your plan after Medicare paid.
MA / PDP Explanation of Benefits (EOB):
If you are enrolled in a Medicare Advantage Plan and/or Prescription Drug Plan, you will receive an Explanation of Benefits any month after services have been used. EOB’s will outline:
- Services or prescriptions you received
- What your plan covered
- What portion you may be responsible for
These explanations are not bills and will come directly from your plan provider.
Summary of Benefits:
Summary of Benefits provide a simple overview of what each health insurance plan covers. This may include details of: covered services, restrictions/exclusions, deductibles, copayments, coinsurance, coverage limits, and cost examples for common medical scenarios.
They are provided annually to Medicare Advantage or ACA plan holders and sent during enrollment periods as well.
Outline of Coverage:
Similar to above, Outline of Coverage is a document for Medicare Supplement (Medigap) enrollees and summarizes your plan’s core components.
A quick Recap:
- MSN = What Medicare paid
- Medigap Notice = What your supplement paid after Medicare
- MA / PDP EOB = What your Advantage / Prescription Drug Plan paid
- Summary of Benefits / Outline of Coverage = Summary/Outline of your plan’s features
- None of these documents are bills
If you need any guidance on certain claims or would like someone to walk through your benefits, please don’t hesitate to reach out to our team. We are here to help!
1-800-627-2768
Not affiliated with or endorsed by any government agency. This is a solicitation for insurance, by responding to this ad, you may be contacted by a licensed agent to discuss Medicare Supplement Plans, Medicare Advantage Plans, and Prescription Drug Plans.