If you have the Medicare Advantage Plan or Medicare Part D plan for prescription drugs, then you will be familiar with a notice called “Explanation of Benefits.” After you go to a healthcare provider to receive their medical service, you will receive an Explanation of Benefits notice in the mail about one month later. Sometimes you can access this notice online as well. A lot of beneficiaries will first assume this is a bill because it lists all the costs associated with the medical service. But the most important thing you need to understand about this notice is that it is not a bill. It is simply a summarized list of all the medical products and/or services that were administered to you.
The Explanation of Benefits will show you the total amount of money which Medicare paid for the medical services that you received. The healthcare provider normally sends a bill to Medicare which outlines the total cost. You will see this total on your notice and the amount of it that Medicare paid. There is also one more section called “Patient Responsibility.” This is the amount of money in which you still owe for the medical services. Even though the Explanation of Benefits is not a bill, it will still inform you of how much you still owe to your healthcare provider. Because of this, you can expect to receive a bill in the mail from your healthcare provider in the amount listed on the notice.
If you’ve already paid the co-insurance or co-payment when you went to visit your healthcare provider, then you shouldn’t owe any more money. However, if you have a deductible that has not been fully paid for you, then you may still owe money for that too. Then you won’t get any paid coverage until the deductible has been fully paid. As for the worst-case scenario, Medicare will flat out deny coverage for the medical service you received. If that happens, it will be mentioned on your Explanation of Benefits.