§ 1395b–2. Notice of medicare benefits; medicare and medigap information

1,237 words·~6 min read·/usc/title-42/section-1395b-2

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The Secretary shall prepare (in consultation with groups representing the elderly and with health insurers) and provide for distribution of a notice containing— a clear, simple explanation of the benefits available under this subchapter and the major categories of health care for which benefits are not available under this subchapter, the limitations on payment (including deductibles and coinsurance amounts) that are imposed under this subchapter, and a description of the limited benefits for long-term care services available under this subchapter and generally available under State plans approved under subchapter XIX.

Such notice shall be mailed annually to individuals entitled to benefits under part A or part B of this subchapter and when an individual applies for benefits under part A or enrolls under part B. The Secretary shall provide information via a toll-free telephone number on the programs under this subchapter. 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. The notice provided under subsection

(a)shall include— 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 1395b–7 of this title for accuracy and report any errors or questionable charges by calling the toll-free phone number described in paragraph (4); a statement of the beneficiary’s right to request an itemized statement for medicare items and services (as provided in section 1395b–7(b) of this title ); a description of the program to collect information on medicare fraud and abuse established under section 1395b–5(b) of this title ; and 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 subchapter. The notice provided under subsection

(a)shall include— references to educational resources regarding opioid use and pain management; a description of categories of alternative, non-opioid pain management treatments covered under this subchapter; and a suggestion for the beneficiary to talk to a physician regarding opioid use and pain management. ( Aug. 14, 1935, ch. 531 , title XVIII, § 1804, as added Pub. L. 100–360, title II, § 223(a) , July 1, 1988 , 102 Stat. 747 ; amended Pub. L. 103–432, title I, § 171(j)(1) , Oct. 31, 1994 , 108 Stat. 4450 ; Pub. L. 105–33, title IV, § 4311(a)(1) , Aug. 5, 1997 , 111 Stat. 384 ; Pub. L. 108–173, title IX, § 923(d)(1) , Dec. 8, 2003 , 117 Stat. 2394 ; Pub. L. 115–271, title VI, § 6021(a) , Oct. 24, 2018 , 132 Stat. 3977 .)

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