§1804. Notice of medicare benefits: medicare and medigap information4

Social Security Act

Title XVIII — Health Insurance for the Aged and Disabled

(42 U.S.C. 1395b-2)

(a) The Secretary shall prepare (in consultation with groups representing the elderly and with health insurers) and provide for distribution of a notice containing-

(a)(1) a clear, simple explanation of the benefits available under this title and the major categories of health care for which benefits are not available under this title,

(a)(2) the limitations on payment (including deductibles and coinsurance amounts) that are imposed under this title, and

(a)(3) a description of the limited benefits for long-term care services available under this title and generally available under State plans approved under title XIX.

Such notice shall be mailed annually to individuals entitled to benefits under part A or part B of this title and when an individual applies for benefits under part A or enrolls under part B.

(b) The Secretary shall provide information via a toll-free telephone number on the programs under this title. The Secretary shall provide, through the toll-free telephone number 1-800-MEDICARE, for a means by which individuals seeking information about, or assistance with, such programs who phone such toll-free number are transferred (without charge) to appropriate entities for the provision of such information or assistance. Such toll-free number shall be the toll-free number listed for general information and assistance in the annual notice under subsection (a) instead of the listing of numbers of individual contractors.⁵

(c) The notice provided under subsection (a) shall include-

(c)(1) a statement which indicates that because errors do occur and because medicare fraud, waste, and abuse is a significant problem, beneficiaries should carefully check any explanation of benefits or itemized statement furnished pursuant to section 1806 for accuracy and report any errors or questionable charges by calling the toll-free phone number described in paragraph (4);

(c)(2) a statement of the beneficiary's right to request an itemized statement for medicare items and services (as provided in section 1806(b));

(c)(3) a description of the program to collect information on medicare fraud and abuse established under section 203(b) of the Health Insurance Portability and Accountability Act of 1996; and

(c)(4) a toll-free telephone number maintained by the Inspector General in the Department of Health and Human Services for the receipt of complaints and information about waste, fraud, and abuse in the provision or billing of services under this title.

⁴ See Vol. II, P.L. 101-239, §6011(b), with respect to determining the payment amount for services to hemophilia inpatients.

See Vol. II, P.L. 104-191, §203, with respect to beneficiary incentive programs.

See Vol. II, P.L. 106-113, §1000(a)(6) (229(c)), with respect to a MEDPAC study on the complexity of the Medicare program and the levels of burdens placed on providers through Federal regulations; (312(c)), with respect to a MEDPAC report on the appropriateness of the initial residency period under §1886(h)(5)(F); (411), with respect to a MEDPAC study of rural providers; and (520(c)), with respect to a MEDPAC study on quality improvement standards.

See Vol. II, P.L. 106-554, §1(a )(6) (214), with respect to MEDPAC analysis of impact of volume on per unit cost of rural hospitals with psychiatric units.

⁵ P.L. 108-173, §923(d )(1), added this second sentence for subsection (b).

See Vol. II, P.L. 108-173, §923(d )(2), with respect to a study and report on the accuracy and consistency of information provided through the toll-free telephone number 1-800-MEDICARE.