What Is MSN Medicare?

What They Are

An MSN is a lot like Explanation of Benefits notices received from private health insurance plans. It is a list of all claims sent to Medicare in the past three months for that beneficiary. It shows what claims have been made, what Medicare has paid out and what the beneficiary is responsible for paying.

The MSN is not a bill. If there are any outstanding charges listed on the MSN, the beneficiary's health care provider will have to bill the beneficiary directly. No payments need to be sent to Medicare after receiving an MSN.

Who They Come From

The MSN may come from Medicare directly, or it may come from a private insurance company that has been contracted by Medicare to process claims. If this is the case, then the name and address of a private insurance company may be present on the MSN.

If an item is denied and the beneficiary wants to appeal, he or she must appeal to the carrier listed on the MSN.

Additional Copies of an MSN

If a beneficiary needs to replace a lost MSN or wants a duplicate copy, the beneficiary should call 1-800-MEDICARE. The customer service representative will then refer the caller to the proper carrier who sent the original MSN, and the carrier can send another copy.

"You May Be Billed" Field

This field indicates the amount that the provider is allowed to bill the beneficiary; this may be a co-insurance. This document is normally forwarded to the supplemental insurance (e.g., retiree insurance, Medigap plan) if available, and this portion is paid by the supplemental plan. If there is no supplemental plan, the beneficiary will have to either pay it out of pocket to the provider or appeal to Medicare.

"Non-Covered Charges" Field

The "Non-Covered Charges" field shows any items that may be excluded or not covered by Medicare. The beneficiary is responsible to pay any dollar amount in this field. If the beneficiary believes that Medicare should cover it, the beneficiary can appeal. If it reads "$0.00," then there are no non-covered charges. Keeping track of charges and denials in Medicare can be complicated, but referring to a Medicare Summary Notice (MSN) that is sent every three months (four times a year) can help keep everything straight. MSNs are a detailed look into how Medicare coverage works for a particular Medicare beneficiary.