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Is there a difference between my Medicare plan's Explanation of Benefits (EOB) and the Evidence of Coverage (EOC)?

Category: Explanation of Benefits (EOB)
Updated: Jul, 19 2023

Yes.  Your Explanation of Benefits (EOB) is a monthly statement that your Medicare Part D prescription drug plan (or Medicare Advantage plan) will send you to explain your year-to-date Medicare plan usage.

The printed Explanation of Benefits document can be around 20 pages long (ten pages printed front-and-back) and your Medicare Part D EOB will show you a detailed list of your drug purchases, current out-of-pocket spending, and your progress toward any Medicare plan limits or the phases of your Medicare plan (for instance, how close you are to entering or exiting your Coverage Gap or Donut Hole).

If you have a dispute about your Medicare Part D coverage (wrongly-charged for a formulary drug or denied coverage), you will probably refer to the EOB as evidence of your wrongful-payment or error in coverage.

Most Medicare Part D plans will allow you to access your monthly EOB statement online (electronically) so as to avoid mailing you a printed copy of the document.

Your EOB probably will state "THIS IS NOT A BILL" on the top margin of each page.

You can click here to read more about our Explanation of Benefits letter and what is contained in an EOB.  If you wish, you can contact your Medicare plan and ask that you receive your monthly EOB document electronically.

On the other hand, your Evidence of Coverage (EOC) document is a large, 200+ page printed document that your current Medicare plan (Medicare Part D or Medicare Advantage plan) sent you each year as part of your Annual Notice of Change (ANOC) mailing.

Some Medicare plans are now sending people a link to electronically download this large document and save on printing charges, save on postage, and consider the environmental impact.

Whether printed or electronic, your EOC document will contain detailed coverage information about your Medicare Part D or Medicare Advantage plan. And your EOC will explain your rights as a Medicare plan member. The EOC will not contain your drug list or formulary. 

Please note, with changes to the Medicare program, your Medicare plan will now send you the ANOC letter in late-September, several weeks before sending you the EOC document (along with other plan documents, such as a plan formulary).  In this way, you should see how your plan is changing for the upcoming plan year, and then, two weeks later, you will receive the EOC that will detail the forthcoming coverage in more detail.

Bottom Line:  Both EOB and EOC documents are important and should be reviewed - and then kept in a safe place for reference.

Your monthly EOB will show you a year-to-date summary of your Medicare Part D coverage (and can point out errors in healthcare or prescription drug billing or possible Medicare fraud) and your EOC will show you the details of your annual Medicare Part D (or Medicare Advantage) plan coverage - along with your rights.

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