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FAQs on Explanation of Benefits (EOB)



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Will my Medicare prescription drug plan need to notify me if the plan's formulary changes?
Yes - if you are using the drug.  Your Medicare Part D plan will typically give you a 60-day notice if there is a coverage change for any medications that you have taken during the plan year (Jan . . .

I read that my negotiated retail prescription drug costs go toward meeting my Initial Coverage Limit before reaching my Medicare Part D plan's Donut Hole, but is this the normal retail drug cost or the total cost in my Explanation of Benefits letter?
The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug cost can be (and usually is) different than the retail price that your pha . . .

How can I find out if - or when I will reach my Medicare Part D plan's Donut Hole or Coverage Gap?
Here are 5 ways to see how close you are to your Donut Hole or Coverage Gap. 1.  Call Member Services.You can always call your Medicare Part D prescription drug plan and ask a Member Services . . .

I never got a report from my Part D plan showing how close I am to the Donut Hole. Shouldn't I be getting a summary of my prescription drug spending?
Yes, you should receive regular statements on your prescription spending.Medicare Part D plans send out a monthly "Explanation of Benefits" (or EOB) letters to all of their members.  The EOB lett . . .

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


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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
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  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.