An Explanation of Benefits (EOB) specifically relates to Medicare Advantage and Part D prescription drug plans. Insurers send EOBs to detail the medical care you’ve received and how the plan covered or denied costs.
If you have Original Medicare, you’ll receive different documentation when you receive medical care. You’ll only receive an EOB if you have Medicare Advantage or Part D.
EOBs are usually triggered after you receive care, services, or items. But many insurers send them each month. These are not bills, and they do not require you to pay for the listed items.
Instead, EOBs will typically itemize the services you receive and the costs that your plan has covered.
All EOBs show the same information. But you may notice some differences between plan providers in the way the information is laid out or the order in which they display information.
The documents will list:
- your doctor, healthcare professional, facility, or pharmacy’s name
- the date you received the item or service
- the amount billed for the item or service
- how much the plan covers
- how much you owe in out-of-pocket costs
It’s not a bill that you should pay, as you’d generally have already paid your share of costs directly to the healthcare professional or facility during your visit.
The EOB will also provide details of any items or services that have been denied. And if you disagree with a claim decision, you can lodge an appeal.
EOBs and MSNs share similar information, but they’re different documents that relate to different types of Medicare plans.
Private insurers administer Medicare Advantage and Part D prescription drug plans. So if you have either of these plans, you’ll receive a monthly EOB from your insurer. The document will detail the treatment or service you’ve recently received.
If you have an Original Medicare plan (Part A and Part B), you’ll receive an MSN every 4 months (quarterly). It summarizes medical services or items that you’ve received and how they’ve been covered.
The table below shows how the two compare:
| EOB | MSN | |
|---|---|---|
| How often are they sent? | mailed every month or triggered when you use your plan | mailed every 4 months (quarterly) |
| Plans included | Medicare Advantage Part D prescription drug plans | Original Medicare (parts A and B) |
It’s important to remember that neither an EOB nor an MSN is a bill. They do not require you to make a payment.
You may sometimes receive a bill from a healthcare professional or facility that does not show the payment that Medicare has made.
In case this happens, it’s a good idea to keep records of your EOBs and MSNs. You can then make a copy and send it to the healthcare professional or facility so they can try to trace the payment and update their records.
Alternatively, if copies are unavailable, you should be able to log into your Medicare or plan provider account and download a copy from the website to email to the healthcare professional or facility.
You should receive an EOB from your Medicare Advantage or Part D prescription drug plan provider.
EOBs will show details of claims a Medicare plan has received, what the plan has paid toward your healthcare costs, and any out-of-pocket costs you can expect.
However, you’ll typically have paid your share of costs before leaving the doctor’s office, hospital, clinic, or pharmacy.
In case of payment disputes, it’s important to keep copies of your EOBs or confirm that you can access them online when you need them.