Medicare Documents to Keep for a Parent: Cards and Letters

The Medicare documents to keep for a parent start with a front-and-back copy of every card they carry (the red, white and blue Medicare card, plus any Medicare Advantage, Medigap, Part D, retiree, TRICARE or Medicaid card), this year's plan Evidence of Coverage and drug list, the Annual Notice of Change that arrives each September, and recent Medicare Summary Notices or plan statements. Add any Social Security letters about Extra Help or income-based premiums, and Medicare's permission form if you want 1-800-MEDICARE to talk to you. Most of the rest of the pile can go.

Below: which card to hand over where, what each piece of mail is, how long to keep it, and what to check before Open Enrollment closes. For wills, powers of attorney and deeds, see the companion guide to important documents for aging parents. This one stays in the Medicare drawer.

The cards your parent might have

Most people on Medicare end up with two or three cards that look nothing alike. Lay them all out on the table first.

According to Medicare.gov's page on the Medicare card, the Medicare Number is unique to your parent and is not their Social Security Number. The card also shows when Part A and Part B began, which your parent needs to join a plan or buy a Medigap policy.

One combination deserves a second look. A Medigap card and a Medicare Advantage card rarely make sense together: Medicare.gov says Medigap can't pay Medicare Advantage copays, deductibles or premiums, and most Medigap policies don't cancel on their own when someone joins an Advantage plan. If both are in Dad's wallet, he may be paying a premium for nothing. Read the Open Enrollment section before canceling anything, though. There's a timing trap.

The same page notes that Medigap plans sold after 2005 don't include drug coverage. A parent with Original Medicare and Medigap usually has a separate Part D card too. If there's no Part D card and no retiree, VA or TRICARE drug coverage either, ask why.

Which card to show where

Original Medicare, with or without Medigap. Medicare.gov says to carry the red, white and blue card when away from home, show it to the doctor or hospital, and carry any drug plan or supplemental card too.

Medicare Advantage. Your parent uses the plan's card for care, not the Medicare card. Medicare.gov says to keep the Medicare card in a safe place in case they switch plans or return to Original Medicare later.

At the pharmacy. The Medicare.gov page on using drug coverage lists a photo ID, the drug plan card, and the red, white and blue Medicare card as proof of Medicare. If your parent has Medicaid or gets Extra Help, bring proof of that too, so they don't pay more than they should.

Everything else. Tell every provider about coverage besides Medicare; Medicare's who pays first page says it helps them bill the right payer and avoid delays. From that page: with retiree coverage, Medicare pays first and the retiree plan second. Medicare and the VA generally can't pay for the same service, so your parent picks one each time. Medicaid never pays first for services Medicare covers. And for TRICARE For Life, TRICARE says proof of coverage is the Medicare card plus the Uniformed Services ID card, with Medicare paying first.

For the full hospital grab-and-go list, see what to bring to the ER.

Copy the front and back of every card

A photo of the front isn't enough. The back of a plan card is where the phone numbers usually live: member services, pharmacy help, sometimes where providers send claims. When you're on hold at 4 p.m. on a Friday chasing a prior authorization, that's the side you need.

1. Photocopy both sides of each card on one sheet, labeled with your parent's name and the date.
2. If the Medicare card is lost or damaged, print an official copy or order a replacement through your parent's Medicare.gov account, or call 1-800-MEDICARE. Railroad Retirement Board beneficiaries call the RRB at 1-877-772-5772.
3. Make a one-page coverage summary to sit in front of the copies.
4. Recopy whenever a new card arrives.

Medicare.gov says to protect the Medicare Number like a credit card. For a binder, that means the copy lives at home where you can find it, not taped to the fridge or sent around a group text.

Fields for the coverage summary page:

• Original Medicare or Medicare Advantage
• Where the actual Medicare card is kept
• Part A and Part B start dates
• Each plan's name, member ID and phone number
• Medigap plan letter (for example, Plan G) and insurer
• Part D plan, preferred pharmacy and any mail-order pharmacy
• Other coverage: retiree plan, TRICARE, VA, Medicaid
• Whether your parent gets Extra Help or pays an income-related surcharge
• Whether a Medicare permission form (CMS-10106) is on file, and for whom

The mail: what each letter is and when it comes

Medicare mail comes from Medicare, Social Security and private plans. Medicare.gov keeps calendars of costs and coverage mailings and help-with-costs mailings. The condensed version:

Medicare Summary Notices and EOBs

The MSN is not a bill. Medicare.gov's MSN page says it lists everything providers billed to Medicare for the period and the most your parent may owe, and that it now comes every 6 months if there were any services in that period. Some older guides still say every three months, so a quiet spring isn't a sign anything went missing. If your parent signs up for electronic MSNs through their Medicare.gov account, they get an email for any month with a processed claim, without waiting for paper.

People in Medicare Advantage or Part D plans get Explanation of Benefits statements from the plan instead, as a SHIP and Senior Medicare Patrol handout explains.

Compare each one to your parent's calendar. Did they actually see a podiatrist on the 14th? Did a walker really get delivered? Medicare.gov's Original Medicare appeals page says an appeal has to be filed by the date printed on the MSN.

Evidence of Coverage, Annual Notice of Change and the drug list

The Evidence of Coverage is the plan's rulebook: what it covers, what your parent pays, how to appeal. The Annual Notice of Change (ANOC) summarizes what changes next year. Both arrive in September. The ANOC is the one to read now, because it drives the Open Enrollment decision. For Part D, check every drug on your parent's medication list against next year's drug list.

The creditable coverage notice nobody keeps

If your parent has drug coverage through a current or former employer or union, that plan sends a yearly notice saying whether it's "creditable," meaning at least as good as Medicare's. Medicare's who pays first page says to keep it for your records. With creditable coverage, a person can delay joining a Medicare drug plan without a penalty, as long as they don't go 63 days without it. If the retiree plan ever ends and your parent signs up for Part D, those notices are how they show they never went without, which is what keeps a late penalty off the premium. They tend to arrive folded into a benefits packet nobody reads, so pull them out and file them.

IRMAA letters

IRMAA, the income-related monthly adjustment amount, is an extra charge on Part B and Part D premiums for higher incomes. Social Security generally bases it on the tax return from two years earlier.

If your parent's income has since dropped because of a "major life-changing event," Social Security can use a more recent year. The federal rule lists the qualifying events, including a spouse's death, marriage, divorce, and stopping or cutting back work. If Mom was widowed last year and still pays a surcharge based on two incomes, keep the letter and call Social Security. Social Security's form for this request is the SSA-44, or your parent can ask for an interview. Either way they'll need proof of the event and the lower income, so file the death certificate copy or retirement letter right behind the IRMAA notice.

Extra Help letters

Extra Help pays some Part D costs for people with limited income and resources. On Medicare.gov's calendar: Social Security's decision on whether it continues next year (early September), a copayment change (October), and reassignment to a new plan if the current one leaves Medicare or its premium rises above what Extra Help covers (late October). A November letter asking your parent to return an "Income and Resources Summary" is the one not to lose under a magazine.

How long to keep Medicare paperwork

There's no single federal rule for MSNs or EOBs. This schedule is built from the deadlines that do exist:

• Cards: the current ones. Copy a new card before shredding the old one, and wait until the old plan's claims have settled.
• MSNs and EOBs: until every bill on them is paid by everyone who owes, and the appeal date has passed.
• Medical expense deductions: the IRS says to keep supporting records until the period of limitations runs out, generally 3 years after filing. File those statements with that year's taxes.
• Evidence of Coverage, ANOC, drug list: current year only, unless there's an open appeal.
• Notices of Creditable Coverage: every one, indefinitely.
• IRMAA and Extra Help letters: the current year, plus anything tied to an appeal or a life-changing event request.
• Enrollment confirmations: until the new plan's card or first statement proves it took.

Shred rather than recycle. Most of these carry the Medicare Number, a plan member ID, or both.

Open Enrollment: October 15 to December 7

Medicare.gov's enrollment page says that from October 15 to December 7, your parent can join, drop or switch Medicare Advantage plans, move between Original Medicare and Advantage, and join, drop or switch a Part D plan. Changes start January 1, and the plan must get the request by December 7.

Pull out the ANOC and the medication list, sit down with your parent, and go through this:

• Read the ANOC for changes to the premium, deductible, copays and network.
• Check every prescription against next year's drug list.
• Confirm their doctors, preferred hospital and pharmacy are in network next year.
• If they spend part of the year in another state, check whether the plan covers them there.
• Watch for a non-renewal notice, which comes if a plan is leaving Medicare.
• Compare plans at Medicare Plan Finder, entering every drug they take regularly.
• With retiree or union coverage, call that benefits office first. Medicare.gov warns that joining a Medicare drug plan can cost someone their employer or union coverage for good.
• Save the confirmation number and letter for any change.

Medigap isn't part of Open Enrollment. The fall window covers Advantage and Part D plans. Under federal rules, Medicare.gov says switching Medigap policies after the initial 6-month Medigap enrollment period usually isn't guaranteed outside specific situations. Some states give more rights; a SHIP counselor or the State Insurance Department will know. So if your parent wants to drop Medigap for a cheaper-looking Advantage plan, slow down. The first time someone drops Medigap to join an Advantage plan, they get a one-time 12-month trial right: if they return to Original Medicare within that year, they can get the same policy back if the insurer still sells it, and certain other Medigap policies if it doesn't. Keep the old Medigap paperwork until that year is over.

Advantage members get a second chance. From January 1 to March 31, someone already in a Medicare Advantage plan can switch plans or return to Original Medicare and add a drug plan. People in Original Medicare don't get this window.

For a neutral second opinion, the State Health Insurance Assistance Program, or SHIP, offers free one-on-one Medicare counseling, and Medicare.gov notes SHIPs aren't connected to any insurance company. Call in October rather than the first week of December.

Medicare card scams

Open Enrollment is also high season for people pretending to be Medicare. From Medicare.gov's card page and its fraud and abuse page, here are rules short enough for an index card by your parent's phone:

• Medicare will never call uninvited and ask for personal information. It calls only in limited situations, like returning a call your parent made.
• Medicare will never call to sell anything or visit the house.
• Don't give the Medicare Number to anyone who calls, emails or knocks, unless your parent contacted them first.
• If someone asks for the number or money, or threatens to cancel benefits, hang up and call 1-800-MEDICARE (1-800-633-4227).
• Don't join a plan over the phone unless your parent made the call.

The paperwork above is also your best fraud detector. A knee brace nobody ordered, showing up on an MSN or EOB, is a sign someone may be billing with your parent's number. Report it to 1-800-MEDICARE; for Advantage and Part D plans, the I-MEDIC line is 1-877-7SAFERX (1-877-772-3379). The HHS Office of Inspector General takes complaints online or at 1-800-HHS-TIPS, and the Senior Medicare Patrol (877-808-2468) can help you read a suspicious statement. If your parent trusts any friendly voice, a family safe word helps with the scams that pretend to be you.

Getting 1-800-MEDICARE to talk to you

You call about Mom's claim, and they politely won't discuss it. That's expected. Until your parent signs the CMS-10106 release, the 1-800-MEDICARE line can't share anything with you; the form itself notes that the law requires the permission to be in writing.

On the form, your parent enters their Medicare Number, names up to two people or organizations (more go on the back), and picks "any information" or limited categories such as claims, eligibility, plan enrollment and premium payments. They choose an end date or none, and sign. Submitting through their Medicare.gov account is fastest; mail works too. They can cancel it any time in writing. Someone signing as a personal representative attaches the paperwork, like a power of attorney.

This release only reaches 1-800-MEDICARE. Doctors' offices have their own permission forms, covered in the HIPAA authorization guide, and a signed doctor's form won't help you with Medicare either. Advantage, Medigap and Part D plans are separate companies, so ask each one how it wants permission given. File a copy of the signed form with the date you sent it.

Where it goes in the binder

A Medicare section that works in a hurry has four parts, in this order:

1. Coverage summary page, with the fields above. Anyone helping in a hurry will ask for this first.
2. Card copies, front and back, newest on top.
3. This year's plan documents: Evidence of Coverage, ANOC, drug list notes, and any new plan's welcome letter.
4. Letters and statements: MSNs and EOBs by date, then Social Security letters, creditable coverage notices and the CMS-10106 copy.

Put a copy of the summary and card copies in the hospital grab folder too. If your parent is admitted, the hospitalization guide explains why inpatient versus observation status matters for Medicare, and the discharge checklist covers the notices to collect on the way out. If you're paying the bills, statements can sit alongside the rest in a bill-tracking system.

Frequently asked questions

Should my parent carry their Medicare card if they have a Medicare Advantage plan?

They use the Advantage plan's card for care. Medicare.gov says to keep the Medicare card in a safe place in case they switch plans or return to Original Medicare. A copy in the binder covers most situations.

What should my parent bring to the pharmacy?

A photo ID, the drug plan card, and the red, white and blue Medicare card, plus proof of Medicaid or Extra Help if they have it. Without a new plan card, the plan's welcome letter or confirmation number usually works.

How often does Medicare send a Medicare Summary Notice?

Medicare.gov now says every 6 months, and only if your parent had services billed in that period. People in Medicare Advantage or Part D plans get Explanation of Benefits statements from the plan instead.

Can I call Medicare on my parent's behalf?

Only after your parent gives written permission on form CMS-10106, submitted through their Medicare.gov account or by mail. Private plans need their own forms.

If the mail pile wins this year

Nothing here needs special tools. A copier, some tab dividers and an afternoon at your parent's kitchen table with this guide will get the Medicare section done. If you'd like a head start on the rest of the binder, Emergency Binder Now asks about 25 minutes of guided questions and turns the answers into a printable binder for your parent: an insurance page with the Medicare, Medigap and Part D details, a one-page Emergency Information Sheet for the ER, and a gap list of what's still missing. Have a look at a sample binder to see how it's laid out.

This article is general information, not legal, medical or financial advice. For coverage questions, ask your parent's plan, 1-800-MEDICARE or a SHIP counselor.