Below is a sample Medicare Summary Notice (MSN) for Part A services and information on how to read it. The MSN is not a bill. Do not send money to Medicare or to the provider until you get a bill.
- Date (1): Date MSN was sent.
- Customer Service Information (2): Who to contact with questions
about the MSN. Provide your Medicare number (3), the date of the MSN (1), and
the date of the service you have a question about (7).
- Medicare Number (3): The number on your Medicare card.
- Name and Address (4): If incorrect, contact the company listed in
(2), and the Social Security Administration immediately.
- Be Informed (5): Messages about ways to protect yourself and
Medicare from fraud and abuse.
- Part A Hospital Insurance - Inpatient Claims (6): Type of service.
See the back of MSN for additional information. (Please Note:
For outpatient services, this section is called "Part B Medical
Insurance - Outpatient Facility Claims.")
- Claim Number (7): Number that identifies this specific claim.
- Provider's Name and Address (8): Facility's name and billing address. The referring doctor's name will also be shown. The address shown is the billing address, which may be different from where you receive the
- Dates of Service (9): Dates service was provided. You may use these dates to compare with the dates shown on your hospital bill.
- Benefit Days Used (10): Shows the number of days used in the benefit period. See the back of your MSN for an explanation of benefit periods. (Please Note: For outpatient services, this column is called "Amount
- Non-Covered Charges (11): Shows the charges for services denied or
excluded by the Medicare program for which you may be billed.
- Deductible and Coinsurance (12): The amount applied to your
deductible and coinsurance.
- You May Be Billed (13): The total amount the provider may bill you,
including deductibles, coinsurance, and non-covered charges. Medicare supplement
(Medigap) policies may pay all or part of this amount.
- See Notes Section (14): If letter appears, refer to (15) for
- Notes Section (15): Explains letters in (14) for more detailed
information about your claim.
- Deductible Information (16): How much of your deductible you have
met for the benefit period.
- General Information (17): Important Medicare news and information.
- Appeals Information (18): How and when to request an appeal.