Explanation of Benefits

If you have a Medicare Part D prescription drug plan, you have probably received something called an EOB. EOB stands for Explanation of Benefits. It is a statement that Medicare sends to you every month that you fill a prescription using the Part D coverage. After you have filled a prescription, you will receive an EOB at the end of the following month. You may also receive an Explanation of Benefits statement if your coverage changes or if you change prescription drug plans. It is important to note that the EOB is not a bill. It is simply a record of the coverage benefits you have used. Explanation of Benefits statements usually contain six pieces of information.

Section 1: The EOB summarizes all of the drug purchases since the last EOB.

Section 2: It summarizes your year-to-date costs, your total out of pocket costs, and total drug costs as well as basic plan information including your deductible, any coverage gaps, and your initial coverage amounts.

Section 3: If you have changed Part D plans, the EOB will also summarize your out of pocket and total drug costs transferred from your previous plan.

Section 4: The Explanation of Benefits will also note any adjustments to your out of pocket and total drug costs if necessary. For example, if you have a reversed claim or a supplemental wrap around payment,the EOB form will display them.

Section 5: The EOB will also list any updates to your drug plan’s formulary that overlap with the drugs you take.

Section 6: Finally, the EOB includes a section with contact information as well as instructions in case you want to appeal any decisions made by Medicare regarding your drug coverage.

Verifying your statement

When you receive an Explanation of Benefits statement, you should verify that it is correct. It is important to save your filled prescription receipts and check them against the claims on the EOB. Failure to do so could result in higher than necessary out of pocket costs if either Medicare or your pharmacy makes a mistake. The EOB’s monthly and year-to-date summaries are the best way to make sure that your drug plan costs are progressing properly though each payment state. This will help you avoid higher costs.

Medicare Part D plans often update their formularies by adding new drugs, removing outdated drugs, and even changing the tiers on which certain drugs are placed. Medicare may also adjust its rules for whether or not a particular plan covers a particular drug. It is important to stay abreast of these changes to avoid any interruptions in the supply of medications that you need. Some changes will not go into effect until the following year, while others will take effect 60 days after you receive the EOB notice. If your drugs are affected by plan changes, the EOB may list alternative drugs. Consult with your doctor before making any changes to your drug plan.

If you have questions about any of the information listed on your Explanation of Benefits statement, contact Medicare by dialing 1-800-633-4227.

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