What to Do When a Parent Gets a Medicare Notice, Bill, or Denial

Do not ignore it, but do not panic. Identify the source, the deadline, and the requested action. Then move from there.

A Medicare notice, bill, or denial is usually less urgent than it looks and more important than it feels. The right first move is to identify exactly what the document is, who sent it, what it is asking for, and what the deadline is. Most are resolvable. Many are mistakes. A few require a real appeal. This article walks through how to sort which is which, and what to do in each case.

Mail with an official letterhead can make your stomach drop. The right response is to read it slowly, twice, before you decide what it actually is.

The short answer

When a Medicare-related notice, bill, or denial arrives for someone you are helping, work through four questions before doing anything else: (1) Who sent it? (2) What is the date and any deadline? (3) What type of document is it — a bill, an explanation of benefits, a denial, a marketing piece? (4) What is being requested? Once those four are answered, the right next step is usually obvious. Photograph or scan the document, then either call the source listed on it or — if it is a real denial — call SHIP and the plan. Do not pay, do not appeal, and do not call anyone until those four questions are answered.

How this applies to you

If a single bill or notice has arrived and you are unsure what it is. This article is for exactly that situation. Work through the four questions, then come back for the type-specific guidance below.

If a denial has been received and the appeal window is closing. Skip to the “It is a real denial” section below and to the appeal-timeframes reference page at /resources/medicare-appeal-timeframes/. Time matters. Do not let the window close while you research.

If multiple bills or notices have piled up. Sort them by date first. Read the most recent ones first. Older notices may have been resolved by newer ones.

If your parent has been hiding mail or has been confused about what to open. This is common and not a character flaw. Help them sort one stack together. The next time you visit, do it again. Building a habit of opening Medicare mail together — without judgment — is the most useful long-term routine.

The four questions

Before anything else, answer these four.

1. Who sent it?

Look at the top of the document and the return address. The sender is one of five things:

• Medicare itself (CMS or a Medicare contractor). Real Medicare mail comes with specific markings. The Medicare Summary Notice (MSN) is one example.
• The plan (Medicare Advantage, Medigap, or Part D carrier). Plan logos, plan member ID prominently featured.
• A provider (doctor’s office, hospital, lab, pharmacy). Provider letterhead, often with a patient account number.
• Social Security (SSA). The SSA logo and language about Social Security.
• A marketer or agent. No official agency relationship; the design may mimic official mail, but the actual sender is a private company.

The first question to ask yourself is: what kind of organization is this from? The answer changes everything that follows.

2. What is the date and any deadline?

Look for two dates: the date the document was issued, and any deadline it imposes. The deadline is the most operationally important piece of information.

• Bills usually have a “due by” date.
• Denials carry an appeal deadline.
• Notices about coverage changes sometimes have an effective date and a window during which the change can be contested.
• Marketing mail often has a fake “Respond by” date — these are sales tactics, not real deadlines.

Write the deadline at the top of the document in a contrasting color before you file it.

3. What type of document is it?

This is the key question. The same envelope can contain very different documents. The five most common:

• A bill — a request for payment from a provider (doctor, hospital, lab).
• A Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) — not a bill, a statement of what was billed and paid.
• A coverage decision — usually a denial of a claim, a service, or a drug.
• An Annual Notice of Change (ANOC) — sent each fall by the plan, describing changes for the upcoming year.
• A marketing piece — designed to look like one of the above, but actually a sales pitch.

Section by section below walks through what to do in each case.

4. What is being requested?

What does the document want the recipient to do? Pay something? File an appeal? Confirm receipt? Schedule a call? Sign something? Take no action?

The honest answer is sometimes “nothing.” MSNs and EOBs require no action — they are records. ANOCs require reading and possibly an AEP review, not an immediate response. Marketing mail requires no action and is usually best recycled.

If it is a bill

Read the bill against the most recent MSN or EOB for the same service.

The MSN or EOB will show: - The total billed by the provider - The Medicare-approved amount (the amount Medicare considers reasonable for that service) - What Medicare paid - What the patient is responsible for

The provider’s bill should show: - The same patient responsibility amount as the MSN/EOB

If the two match, the bill is real and accurate. Pay it (or arrange a payment plan with the provider’s billing office).

If they do not match — if the provider is billing more than the MSN/EOB says the patient owes — something is wrong. Common causes:

• Provider billed before Medicare processed. Wait for the MSN/EOB to confirm.
• Medigap has not yet paid. If the person has Medigap, the bill may need to go through Medicare first, then Medigap, then to the patient. The provider may have billed prematurely.
• The provider is balance-billing improperly. Some providers attempt to charge the patient more than Medicare’s “limiting charge” allows. Original Medicare has specific limits; MA plans have their own contract terms. If a balance bill looks excessive, the After You Choose hub covers this; SHIP can help.
• Billing error. Codes get entered wrong. The right move is a call to the provider’s billing office with the MSN/EOB in hand.

Never pay a bill before confirming it matches the MSN/EOB. Once paid, it is much harder to recover an overpayment than to resolve a billing dispute before payment.

If it is an MSN or EOB

These are records, not bills. They do not require action by default. They are useful in three ways:

• As a cross-check when a provider’s bill arrives later.
• To confirm that the plan paid what it should have. Compare against the Evidence of Coverage for cost-sharing accuracy.
• As documentation if a later dispute arises.

File them. The folder system from Article 2 in this hub is built around this.

If the MSN or EOB shows a service that did not happen — your parent never had the test, never saw the doctor — that is a possible billing error or Medicare fraud. Call 1-800-MEDICARE to report. The Senior Medicare Patrol (SMP) at smpresource.org is the federally funded program specifically for this.

If it is a denial

A denial is when Medicare or a plan refuses to cover a service, a drug, or a claim. Denials have appeal rights, and the appeal windows are time-sensitive.

First step: confirm it is actually a denial.

Look for explicit language: “Your claim has been denied,” “We have determined that this service is not covered,” “Coverage decision: unfavorable,” “Your appeal of [date] has been denied.”

Some documents look like denials but are something else — a request for additional information, a notice that processing is delayed, a coordination-of-benefits question. Read carefully.

Second step: identify the appeal window.

Original Medicare denials, MA plan denials, and Part D denials each have their own appeal windows and processes. The denial document should state the deadline. The reference page at /resources/medicare-appeal-timeframes/ covers them all in detail.

Typical first-level windows: - Original Medicare: 120 days from the date on the MSN to file a redetermination - Medicare Advantage: 60 days from the denial notice to file a plan reconsideration - Part D: 60 days from the coverage determination to file a redetermination

Mark the deadline prominently. Do not let it pass while researching.

Third step: decide whether to appeal.

Not every denial should be appealed. Some denials are correct — the service was not medically necessary, the drug is not covered by the plan, the provider is not in-network. Some denials are wrong — the documentation was incomplete, the wrong code was used, the medical necessity was not properly conveyed by the provider.

A 30-minute call with SHIP is the right first step. SHIP counselors review denials regularly and can quickly tell you whether the appeal is likely to succeed and what evidence to gather. The After You Choose hub has more detail on appeal mechanics.

Fourth step: gather documentation.

For most appeals, the patient’s prescribing doctor (for drug denials) or treating doctor (for service denials) writes a letter of medical necessity explaining why the denied item is needed. The patient can supplement with personal narrative — what happened, what was the impact, what was the alternative. SHIP can help structure all of this.

Fifth step: file by the deadline.

In writing. Keep a copy. Track the appeal reference number. The plan or Medicare is required to respond within specific timeframes — the reference page covers them.

If it is an Annual Notice of Change (ANOC)

The ANOC arrives in the fall, usually by the end of September, from the current plan. It describes changes for the upcoming plan year — premium changes, cost-share changes, formulary changes, network changes, prior-authorization rule changes.

What to do:

• Read it the same week it arrives. Do not file it unread.
• Note any changes that affect the person’s current doctors, prescriptions, or care patterns.
• If significant changes are noted, schedule a SHIP appointment by mid-November.
• Make AEP decisions (Oct 15 – Dec 7) based on what the ANOC reveals.

The ANOC is the helper’s most important annual document. The decision of whether to switch plans, change Part D, or stay put for another year is built on it.

If it is marketing mail

Most “Medicare-related” mail is marketing. Designed to look official; not from any government agency. Common signs:

• “Open immediately”
• “You may be eligible for additional benefits”
• “Important Medicare information enclosed”
• An envelope that mimics government mail without actually being from the government
• A return address from an insurance company, agency, or marketing firm

The right response is recycle. There is no obligation to engage. The next article in this hub covers the specific scam patterns that go beyond ordinary marketing.

A working filing system

Once you have sorted enough documents, a working system emerges. A few principles:

Open everything on a regular cadence. Once a week, ideally with the person you are helping if possible. Mail-pile-by-the-door is the enemy. A small habit prevents large problems.

Three short-term sorting piles: - Action needed — bills with a deadline, denials with an appeal window, requests for response - Read and file — MSNs, EOBs, ANOCs, coverage notices - Recycle — marketing, duplicates, “you may qualify” pitches

Two long-term filing piles: - Current year folder — anything in the current plan year, sorted by month - Reference folder — cards, EOC, formulary, last year’s tax forms

One running document: the running call log from Article 3. Each phone call, each reference number, each commitment, each follow-up.

This is a system that scales. Add new documents into the right pile. Pull from the right pile when a question arises. Do not let it backlog.

A small note on emotional load

This work is heavier than it looks. Reading bills for a parent who is declining — or for a spouse who used to handle this themselves and cannot anymore — is not just administrative. It is a relationship in transition. The paper is a visible reminder of that.

Give yourself permission to do this work slowly. Give yourself permission to ask for help — siblings, SHIP, an attorney for legal authority questions. There is no medal for handling all of it alone, and there is real cost to trying.

Notices look louder than they are. The work is to read them, sort them, and answer the right ones — not all of them.