If you’re looking at a Medicare Explanation of Benefits for the first time, it can seem a little confusing. Is it a bill? There are charges listed on it, but there are also things you’ve already paid for. What exactly is an Explanation of Benefits?
Today, we’re going to break these documents down, so you know what to look for and how to understand each bit of information on them.
The Basics of a Medicare Explanation of Benefits
A Medicare Explanation of Benefits (EoB) summarizes the items or services you received during a given time that were paid for (at least in part) by your Medicare Advantage or Part D plan. Typically, these are sent out by plans monthly and available online.
An EoB summarizes the items or services you received and how they were paid for by your Medicare Advantage or Part D plan.
Generally speaking, an EoB shows you what your plan billed Medicare, along with Medicare’s approved payment amount. You’ll also see what Medicare paid and what’s left that you’re expected to pay to your provider(s). Note, an EoB isn’t a bill. In essence, it’s like a receipt for the Medicare services and items you recently used. It’s also important to recognize that an EoB is different from a Medicare Summary Notice, which is a summary of coverage usage for a three-month period in Original Medicare.
What Information Is on an EoB?
EoBs may look differently depending on who your plan is through, but the information provided on them is generally pretty standard. Your EoB should provide a brief description of your plan information, like your name and plan number. It should also contain a summary of the Medicare claims you made since the last EoB. This may include durable medical equipment purchases, medical services used, and prescriptions filled.
Your Explanation of Benefits should also contain a summary of the Medicare claims you made since the last EoB.
Each entry should include the date of the service and the amount billed. From there, you’ll see an overview of the billed amount that shows how much was paid by the plan, discounts, any amount paid through another source, and finally, how much you owe. EoBs also often include details related to individual claims, such as the claim number, the service provider, and a short description of the service.
Why Is a Medicare EoB Important?
Since Medicare EoBs track what Medicare services you’ve used and their costs, they’re not only useful for managing your treatment options, but also for analyzing facets of your plan. If you regularly use a service or take a prescription drug that you notice isn’t covered well by your plan, you may want to switch to another plan. If you rarely use a feature that’s an expensive part of your coverage, you may also want to find a new plan.
EoBs are not only useful for managing your treatment options, but also for analyzing facets of your plan.
By summarizing each Medicare claim each month, the EoB is also extremely useful for combatting fraud and mistakes. If you notice any claims on an EoB that shouldn’t be there, you should call your plan immediately. This is your chance to review your plan’s claims in your name. If there’s a mistake on your EoB, you can try to correct it by filing an appeal. It’s also wise to save your EoBs in case you need to reference them in the future. (You may need to do this if there are medical charges you disagree with.)
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Whether you use your Medicare benefits every day or once a month, it’s helpful to keep track of how your plan helps cut your costs. In this way, reading your monthly EoB is a useful way to stay informed about your Medicare plan and how well it’s working for you.