Understanding Your Evidence of Coverage


MUSIC 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. MUSIC

Leave a Reply