Medicare Advantage and Prescription Drug Plan Explanation of Benefits

What is an Explanation of Benefits statement (EOB), and why do you get one? Get to know your EOB so you can get more out of it.

Medicare Advantage and Prescription Drug Explanation of Benefits Statement

 

We will send you an Explanation of Benefits (EOB) statement for each month you receive medical services or purchase prescription drugs. The EOB helps you keep track of your monthly medical and prescription drug costs and manage your budget. It includes helpful definitions, drug list updates, phone numbers to call for assistance and other useful information. See below for descriptions of each section of the prescription drug EOB.

Section 1: Your current cost summary.

 

This section summarizes all claims processed in the past month and year-to-date. It includes a section for your medical and hospital costs, as well as one for your prescription drug costs.

Section 2: Your out-of-pocket maximum and total drug costs.

 

Your out-of-pocket costs (copayments, coinsurance and deductible) show the most money you will have to pay for covered services or prescription drug expenses in a plan year. This section defines and tracks these costs for medical/hospital and prescription drugs.

Section 3: Your medical and hospital claims processed.

 

This section provides a detailed list of all the medical and hospital claims processed in a certain month (if applicable).

Section 4: Your dental claims processed.

 

If you have dental services included with your plan or a rider, this section will display a detailed list of your dental claims processed in a certain month.

Section 5: Your prescription drug claims received.

 

This section shows your claims for covered drugs received in a certain month. It also defines important terms to help you better understand the information listed on the page. And it contains important information about drug payment stages and other useful drug cost information. You can also sign in or register to easily track which drug payment stage you're in.

Section 6: Important things to know about your drug coverage and your rights.

 

Your Evidence of Coverage includes details about your drug coverage and costs. It also explains the rules you need to follow when you are using your drug coverage.

Section 7: What to do it you see mistakes on your EOB or if you have questions.

 

If something doesn't look right on your monthly prescription drug EOB, or if you don't understand how your drug plan coverage works, use the contact information in this section to get answers.