What is an Explanation of Benefits (EOB)?
The EOB isn’t a bill
- An EOB is a statement beneficiaries get for every month in which they fill a prescription using their Medicare Part D prescription drug plan.
- An EOB is also mailed to beneficiaries who have a change in coverage of a drug they take or if someone has changed plans and has a transfer of prescription cost totals from one plan to another.
. It provides detailed information about the drug plan coverage you have used to date. It also helps you understand how your prescription drug coverage applies to the prescriptions you fill.
What does an EOB include?
Explanation of Benefits (EOB) includes the following information:
- A summary of the claims (drug purchases) processed since your last EOB
- A summary of your year-to-date costs in the plan and information about the your current drug payment stage (for example, the deductible, initial coverage, the coverage gap, or catastrophic coverage) and your total out-of pocket costs and total drug costs
- A record of your total out-of-pocket costs and total drug costs transferred from your previous plan(s) (if a person changed plans during the year)
- Any adjustments (such as for a reversed claim or a wraparound payment by a supplemental payer) or corrections (such as a clerical error) to your total out-of-pocket costs and total drug costs that aren’t shown in a previous EOB (if there are any adjustments)
- Any updates to the drug plan’s formulary that will affect the drugs you are currently taking (if there are any updates)
- Resources for more information including the plan’s contact information and what you can do if you disagree with the accuracy of your EOB or a coverage decision the plan made (see: How to Request a Coverage Determination, Exception, or File an Appeal)