- Medicare Advantage (Part C) and Medicare Part D companies mail or electronically send evidence of coverage forms prior to the Medicare open enrollment period.
- You should receive your form no later than October 15.
- It provides details on the costs and coverage for your Medicare Advantage or Part D plan. Any changes will take effect January 1 of the following year.
A Medicare evidence of coverage (EOC) form is an important document that Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug) companies send to their enrollees on an annual basis.
The form provides details about your coverage for the upcoming year, which may have slightly changed from the previous year.
Keep reading to find out more about EOC forms and what to do when you receive one.
A Medicare EOC form is sent to anyone enrolled in a Medicare Advantage or Medicare Part D plan.
Medicare Advantage, or Medicare Part C, is when you choose a private insurance company to provide your Medicare benefits.
Part D provides prescription drug coverage for those with original Medicare or those who don’t have this coverage under their current Medicare Advantage plan.
If you have only original Medicare (parts A and B), you won’t receive an EOC form because your benefits, costs, and copayments are standardized.
However, if you have Medicare Advantage, you may receive additional benefits as part of your plan. You may also have different costs related to:
The EOC form will outline these costs.
While the formatting and organization of EOC forms may vary across different insurance companies, each should include:
- the amount you’ll pay each month for your premium
- your out-of-pocket costs for coinsurance, deductibles, and copayments
- a list of covered and noncovered services
- cost differences between in-network and out-of-network providers or pharmacies
- where you can find a listing of in-network providers and pharmacies as well as the plan’s formulary (a list of covered drugs)
Some of these documents can be very lengthy — even up to hundreds of pages. Medicare considers this form a legal contract between you and your Medicare plan, so it’s important you read as much as you can and agree on your coverage.
Medicare requires Advantage and Part D companies to send EOC information to enrollees by no later than October 15. This is when the Medicare open enrollment period begins.
The way you receive the form will depend on how you told your benefits company to communicate with you. Some will send a printed copy by mail, whereas others may send an electronic copy via email.
A Medicare EOC form is designed to help you understand the costs and benefits associated with your plan. Along with this form, you should also receive a document called the annual notice of change (ANOC).
The ANOC includes information related to changes in a plan’s:
- service area
You should receive an ANOC by September 30 each year. These changes typically go into effect on January 1 of the following year.
Once you receive these documents, you can evaluate whether your coverage still meets your needs. Here are some of the actions you can take.
If your plan is ending…
Sometimes, the ANOC informs you that your plan will no longer contract with Medicare or provide coverage in your service area.
If this is the case, you can choose to go back to original Medicare or select a new Medicare Advantage and Part D plan.
If your coverage doesn’t meet your needs…
If you determine that your plan’s coverage for the upcoming year no longer meets your needs, you can search for a new Medicare Advantage plan.
Medicare’s open enrollment period is from October 15 through December 7 every year. During this time, you can select a new Medicare Advantage plan or choose to go back to original Medicare.
Note that if you go back to original Medicare and you previously had prescription drug coverage through Medicare Advantage, you’ll need to select a new Part D plan.
If you’re happy with your current coverage…
If you don’t wish to make any changes to your current coverage, you don’t have to take any extra steps. Your Medicare Advantage coverage will continue as outlined in your EOC document.
If you didn’t receive your EOC form by October 15, contact your plan provider. They should be able to quickly issue you another EOC document.
If you have an online account with your Medicare Advantage or Part D company, they’ll usually include this information as part of your account documents.
Even if you aren’t sure whether you’re going to change your Medicare Advantage or Part D plan, you can evaluate other available plans to comparison shop.
Resources include your State Health Insurance Assistance Program (SHIP).
This is a free program that offers plan advice and answers for your Medicare questions. You can also reach out to your plan provider directly if you have a private plan.
If for any reason your Medicare Advantage or Medicare Part D company refuses or fails to issue you an EOC document, you should report this to Medicare. You can do this by calling 800-MEDICARE (800-633-4227; TTY: 877-486-2048).
- Look for your EOC notice by October 15 if you have Medicare Advantage or Medicare Part D.
- Use this document, along with your ANOC, to determine whether you want to change your health plan or keep it as is for another year.
- You have from October 15 through December 7 to enroll in a new plan or return to original Medicare.
- If you’re happy with your current coverage, you don’t need to do anything.