Here, we’ve compiled information and tips to make organizing your Medicare bills and claims easier to manage.
Topics on this page
- If You Have Original Fee-For-Service Medicare
- If You Have a Medicare Advantage (MA) Plan
- If You Have a Medicare Part D Prescription Drug Plan
- Notes on Medicare Billing & Assignment
1. If You Have Original Fee-For-Service Medicare
Filing claims with Medicare and your Medigap (supplemental insurance) company or retiree plan is easier if you organize your medical bills and records. It will also help simplify filing your annual income tax return. The following tips can help get your medical files in order.
Sort your bills. Make a separate file folder for each provider (doctor, hospital, lab, ambulance service, supplier, etc.). Arrange the bills by date with the most recent one on top.
Sort your Medicare Summary Notice (MSN) forms. You will receive an MSN for your claims every quarter. Note: This is a new timeframe; in the past, Medicare sent out MSNs each month. Previously known as the Explanation of Medicare Benefits, the MSN shows the costs associated with the services you received.
Match each MSN with the corresponding medical bill(s), putting both in the folders for each provider. Some MSNs list claims from more than one provider—make copies of these so you can put one in each provider’s folder. If you don’t have an MSN for each of your bills, either Medicare hasn’t finished processing the claim or it’s too early in the quarter for you to receive your MSN.
Sort your Medigap and retiree plan claims. Sort by provider, match the claims to the corresponding provider bills and MSNs, and put them in the same folders. If possible, wait until you receive your quarterly MSN to decide whether to submit a claim to your Medigap company or retiree plan. In many cases, your Medicare Administrative Contractor (MAC) will automatically forward your claims to your Medigap company or retiree plan—ask your plan if you have this option. If your MAC will not forward your claim, submit the provider’s bill—along with the MSN—to your Medigap company or retiree plan. Keep a dated copy of what you sent in the folder for each provider.
Fill out your Health Insurance Claims Record (PDF). This will give you a complete summary of all your bills and payments. This form offers an easy way to view the portion of each cost (if any) you are responsible for paying each provider. Keep your record up to date by revising it every time you get new information about your medical financial status (you can print out extra copies of this form as needed). If any information is missing, call your provider, your insurer or Medicare to get it. You can download the Claims Record form (PDF) and get more information: Instructions for Completing Your Health Insurance Claims Record.
2. If You Have a Medicare Advantage (MA) Plan
If you have a Medicare Advantage (MA) plan (such as a Health Maintenance Organization – HMO), you generally won’t receive statements from Medicare or need to file claims. MA plans process their paperwork internally. If you receive a statement directly from Medicare or a bill from a provider and you have questions or think this is in error, contact your MA plan’s customer service department or your local Health Insurance Counseling & Advocacy Program (HICAP) office online or at 1-800-434-0222.
3. If You Have a Medicare Part D Prescription Drug Plan
Like MA plans, Part D plans process their paperwork internally. You will receive an Explanation of Benefits (EOB) every month from your Part D plan that shows how much you and your plan have each paid for your prescriptions. This EOB helps you track both your out-of-pocket costs and the total costs you and your plan have paid. The EOB also helps you see your current Part D coverage period (i.e., deductible period, initial coverage period, donut hole or coverage gap period, or catastrophic coverage period). For more information, see Prescription Drugs.
4. Notes on Medicare Billing & Assignment
Ask providers if they accept Medicare assignment. If so, Medicare will pay them the approved amount, which is 80% of covered services. You will pay the 20% coinsurance and any remaining deductible for the year.
If your provider accepts Medicare assignment, he/she cannot charge more than the Medicare-approved amounts. You should not pay more than your 20% coinsurance and any portion of your annual deductible that hasn’t been met.
If your provider does not accept assignment, his/her charge is limited by Medicare. This is called an excess charge; it cannot be more than 115% of the Medicare-approved amount. This charge applies to independent physical and speech therapists, as well. For more information on excess charges, see Assignment for Original Fee-for-Service Medicare.
Consider only seeing providers who accept Medicare assignment so you are billed the least possible amount. Certain providers accept assignment for one patient but not others; it is important to ask if they will accept assignment for your treatment. Some providers may tell you they don’t accept Medicare at all, when in fact, they accept Medicare patients, but do not accept assignment for them. In a few cases, providers may not accept new Medicare patients, but continue to treat existing Medicare patients.
Your provider is required to bill Medicare for services covered by Medicare. Once Medicare has processed the claim, you will receive your quarterly MSN detailing how much you are expected to pay.
Check your MSN to be sure you received all the services billed to Medicare. If there’s an incorrect charge on the MSN, call your provider’s office to ask for clarification. If you are still not satisfied, contact Medicare directly (at the number listed on your statement) or your local Health Insurance Counseling & Advocacy Program (HICAP) office online or at 1-800-434-0222.
Be sure the amounts on the provider’s bill match both the amounts on the MSN and the amounts paid by your Medigap policy or retiree plan. If you have questions about the payment of your bill, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or your Medigap company or retiree plan. You can also contact HICAP for help.
Some providers that do not accept assignment may ask you to pay them directly for most or all of the bill at the time of service. However, they are still required to file a Medicare claim on your behalf. Medicare then pays its share of the bill directly to you. (Note: Medicare will only pay you its share of the bill after a Medicare claim is filed.) If you have a Medigap policy or retiree plan, your company will send you a check after it receives your claim from Medicare. In most cases, Medicare will automatically forward your claim to your Medigap company or retiree plan.
