Understanding Your Evidence of Coverage

In this video, we’ll discuss what an Explanation of Coverage is (sometimes also known as an “EOC”) and why it’s important. We’ll also talk about when you will receive an Explanation of Coverage, and how to read it.

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If you're enrolled in a Medicare Advantage plan, each year, you will receive an

Evidence of Coverage document also known as an EOC. You'll be notified when your EOC

is available, and given details on how to access this important document.

The EOC has all the benefits information you need for the upcoming year.

It lists your coverage, costs and explains how your plan works.

This large document may seem intimidating, but knowing what's inside

and keeping it handy can help you get more from your plan all year.

Now let's go over some of the more useful sections of the EOC

that you're most likely to reference using the Table of Contents as a roadmap.

Let's say you want to know the out-of-pocket costs for a hearing exam.

You can see here that you should jump ahead to chapter four,

the Medical Benefits Chart section of the EOC to find your copay.

The services are listed in alphabetical order, so they're easy to find.

As you browse the Medical Benefits Chart, you'll notice an apple next to some preventive services.

The apple means there's no cost for members who are eligible.

Chapter four is also where you'll look to find out if you need a referral,

or prior authorization before surgery, or a medical procedure.

And it's a helpful chapter if you're unsure whether a service is covered,

what it should cost or how a specific benefit works.

If your plan includes prescription drug coverage, chapter six will explain the four stages of

drug coverage and how these stages affect what you pay for your drugs.

If you have any questions about your EOC, be sure to call

the number on the back of your member ID card.