Changes in Medicare Summary Notices Will Help Prevent Improper Billing

Providers, suppliers and pharmacies serving Medicare beneficiaries who are enrolled in the Qualified Medicare Beneficiary (QMB) program are not allowed to bill these beneficiaries for Medicare Part A or B deductibles, coinsurance or copays. Yet, repeatedly we and other advocates hear of QMB beneficiaries being improperly billed for these Medicare costs. To help provide additional clarification for providers and QMB beneficiaries alike, the Centers for Medicare and Medicaid Services (CMS) recently made some helpful changes to their Medicare Summary Notices (MSNs), which are mailed to beneficiaries every three months.


As of July 2018, QMB beneficiaries’ MSN notices show that the beneficiary has no financial liability for the Medicare coinsurance for items or services received. The box detailing the “Total you may be billed” is “$0.00”. (See the mock-up of the new MSN, provided by Justice in Aging.) In addition, there is a highlighted “Be Informed!” box that clearly states: “This notice contains claims covered by the Qualified Medicare Beneficiary (QMB) program, which pays your Medicare costs. When you’re enrolled in the QMB program, providers and suppliers who accept Medicare, aren’t allowed to bill you for Medicare deductibles, coinsurance, and copayments.”


QMB beneficiaries who come across providers questioning their QMB status, or their “responsibility” to pay their Medicare costs, can show them their MSN as proof of their enrollment in QMB and that they have no financial liability for their Medicare deductibles, coinsurance and copays. Also, the Remittance Advise (RA) that Medicare sends to providers contains this same information, so their providers should already have this information as well.


MSNs are only sent to beneficiaries in fee-for-service Medicare. Beneficiaries in Medicare Advantage (MA) plans receive an Explanation of Benefits (EOBs) instead. While CMS issued guidance to MA plans encouraging them to incorporate the same changes in the MSNs into their EOBs and their RAs to network providers, we encourage advocates to check up on the plans in their area to see if they’re complying.


If someone you know on QMB continues to get bills from their providers or suppliers on Medicare Part A or B deductibles, coinsurance or copays, contact our California Senior Medicare Patrol (SMP) at 1-855-613-7080 to report it.


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