The New Year and Medicare Paperwork::

In the Part 2 article, we discussed the Explanation of Benefits forms you get for medical services when you have a Medicare Advantage plan. Another type of notice will come to you, also called an Explanation of Benefits, so………

An entirely different notice comes to you, also called an Explanation of Benefits, but for prescription drugs consumed — your Part D plan.

These notices are mailed monthly, if you’ve used Rx, and are mailed out to you by the plan that covers your Rx.

If you have a standalone Part D plan, as you may have along with Original Medicare/Medigap, you will get the notice from the PDP plan. If your Rx is included in a Medicare Advantage plan, then the carrier that offer the MA plan will send out the notice.

These PDP/EOBs can sometimes be difficult to read. They will state what period is being covered, and are split into sections for current medications, and year-to-date totals. Specific listings for each medication taken will be listed, and will look something like this::

PDP EOB Format

This will be followed by the year-to-date section::

You need to check this listing for the actual prescription Rx you’ve received, and note any discrepancies. Keep in mind that, not unlike a checking account statement, since this is a monthly listing, it will likely not be current. If you find problems, either contact me or your plan to discuss the issues.

Finally, there are some caveats to remember in the Part D EOB::

  • Remember that the out-of-pocket maximum in your Medicare Advantage plan, or the benefit structure of your Medigap plan, are not applicable to the Part D portion of Medicare. Your Part D expenses are, in effect, a separate out-of-pocket, with no maximum;
  • The EOB is the best place to track where you are with respect to the layers of your Part D plan — deductible, initial coverage, donut hole, or catastrophic — and to determine if your thresholds have been met

Again, if you find discrepancies let me know so we can get these issues solved

Do you have family, friends or co-workers that are approaching Medicare age?

If you have a club, association or a location near you that you would like for me to arrange a Medicare/Social Security presentation, please let me know and I will be happy to make arrangements.


Call R Allan Jensen at 303.912.5490.
Posted:: Centennial CO 1/22/2015