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Title 42, The Public Health and WelfareRelease 119-73not60

§1395b–7 Explanation of Medicare Benefits

Title 42 › Chapter 7— SOCIAL SECURITY › Subchapter XVIII— HEALTH INSURANCE FOR AGED AND DISABLED › § 1395b–7

Last updated Apr 5, 2026|Official source

Summary

The Secretary must send each person whose Medicare was paid (or would be paid without counting a deductible) a statement that lists each item or service and how much was paid. The statement must also tell the person they can ask for a detailed, itemized bill. A person can write to any doctor, provider, supplier, or other person who gave the care and ask for an itemized statement for services paid by Medicare. The provider must give that itemized statement within 30 days of the written request. If someone knowingly fails to do this, they can be fined up to $100 for each failure. After getting an itemized statement, the person has 90 days to ask the Secretary in writing to review it. The written request must point out specific charges they think were not provided or other billing errors, such as duplicate billing. The Secretary will decide if there were wrong charges or payment errors and will try to recover any money that should not have been paid. For statements covering periods in 2016 or later, people may choose to receive future statements electronically instead of by mail, following the Secretary’s rules. The Secretary may limit how many times a person can cancel that choice but must allow at least one revocation. Beginning January 1, 2017, a clear notice about the electronic option must be made available in a cost-effective way.

Full Legal Text

Title 42, §1395b–7

The Public Health and Welfare, Source: USLM XML via OLRC

(a)The Secretary shall furnish to each individual for whom payment has been made under this subchapter (or would be made without regard to any deductible) a statement which—
(1)lists the item or service for which payment has been made and the amount of such payment for each item or service; and
(2)includes a notice of the individual’s right to request an itemized statement (as provided in subsection (b)).
(b)(1)An individual may submit a written request to any physician, provider, supplier, or any other person (including an organization, agency, or other entity) for an itemized statement for any item or service provided to such individual by such person with respect to which payment has been made under this subchapter.
(2)(A)Not later than 30 days after the date on which a request under paragraph (1) has been made, a person described in such paragraph shall furnish an itemized statement describing each item or service provided to the individual requesting the itemized statement.
(B)Whoever knowingly fails to furnish an itemized statement in accordance with subparagraph (A) shall be subject to a civil money penalty of not more than $100 for each such failure. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1320a–7a of this title are imposed and collected under that section.
(3)(A)Not later than 90 days after the receipt of an itemized statement furnished under paragraph (1), an individual may submit a written request for a review of the itemized statement to the Secretary.
(B)A request for a review of the itemized statement shall identify—
(i)specific items or services that the individual believes were not provided as claimed, or
(ii)any other billing irregularity (including duplicate billing).
(4)The Secretary shall, with respect to each written request submitted under paragraph (3), determine whether the itemized statement identifies specific items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under this subchapter.
(5)The Secretary shall take all appropriate measures to recover amounts unnecessarily paid under this subchapter with respect to a statement described in paragraph (4).
(c)(1)Subject to paragraph (2), for statements described in subsection (a) that are furnished for a period in 2016 or a subsequent year, in the case that an individual described in subsection (a) elects, in accordance with such form, manner, and time specified by the Secretary, to receive such statement in an electronic format, such statement shall be furnished to such individual for each period subsequent to such election in such a format and shall not be mailed to the individual.
(2)(A)Subject to subparagraph (B), the Secretary may determine a maximum number of elections described in paragraph (1) by an individual that may be revoked by the individual.
(B)In no case may the Secretary determine a maximum number under subparagraph (A) that is less than one.
(3)The Secretary shall ensure that, in the most cost effective manner and beginning January 1, 2017, a clear notification of the option to elect to receive statements described in subsection (a) in an electronic format is made available, such as through the notices distributed under section 1395b–2 of this title, to individuals described in subsection (a).

Legislative History

Notes & Related Subsidiaries

Editorial Notes

Amendments

2015—Subsec. (c). Pub. L. 114–10 added subsec. (c).

Statutory Notes and Related Subsidiaries

Effective Date

Pub. L. 105–33, title IV, § 4311(b)(3), Aug. 5, 1997, 111 Stat. 386, provided that: “(A) Statement by secretary.—Paragraph (1) of section 1806(a) of the Social Security Act [42 U.S.C. 1395b–7(a)(1)], as added by paragraph (1), and the repeal made by paragraph (2) [amending section 1395b–5 of this title] shall take effect on the date of the enactment of this Act [Aug. 5, 1997]. “(B) Itemized statement.—Paragraph (2) of section 1806(a) and section 1806(b) of the Social Security Act [42 U.S.C. 1395b–7(a)(2), (b)], as so added, shall take effect not later than January 1, 1999.” Encouraged Expansion of Electronic Statements Pub. L. 114–10, title V, § 508(b), Apr. 16, 2015, 129 Stat. 169, provided that: “To the extent to which the Secretary of Health and Human Services determines appropriate, the Secretary shall— “(1) apply an option similar to the option described in subsection (c)(1) of section 1806 of the Social Security Act (42 U.S.C. 1395b–7) (relating to the provision of the Medicare Summary Notice in an electronic format), as added by subsection (a), to other statements and notifications under title XVIII of such Act (42 U.S.C. 1395 et seq.); and “(2) provide such Medicare Summary Notice and any such other statements and notifications on a more frequent basis than is otherwise required under such title.” Inclusion of Additional Information in Notices to Beneficiaries About Skilled Nursing Facility Benefits Pub. L. 108–173, title IX, § 925, Dec. 8, 2003, 117 Stat. 2396, provided that: “(a) In General.—The Secretary [of Health and Human Services] shall provide that in medicare beneficiary notices provided (under section 1806(a) of the Social Security Act, 42 U.S.C. 1395b–7(a)) with respect to the provision of post-hospital extended care services under part A of title XVIII of the Social Security Act [42 U.S.C. 1395c et seq.], there shall be included information on the number of days of coverage of such services remaining under such part for the medicare beneficiary and spell of illness involved. “(b)

Effective Date

.—Subsection (a) shall apply to notices provided during calendar quarters beginning more than 6 months after the date of the enactment of this Act [Dec. 8, 2003].”

Reference

Citations & Metadata

Citation

42 U.S.C. § 1395b–7

Title 42, The Public Health and Welfare

Last Updated

Apr 5, 2026

Release point: 119-73not60