Q1Medicare.com Announces a New Section on Understanding Your Medicare Part D Explanation of Benefits

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Q1Medicare.com now provides Seniors and other Medicare beneficiaries with a section dedicated to understanding their Medicare Part D prescription drug plan’s Explanation of Benefits. All Medicare prescription drug plan members receive an Explanation of Benefits (or EOB) document from their Medicare plan if they have purchased any covered medications within the prior month or if there are changes to their plan coverage. The Explanation of Benefits letter contains comprehensive information on the cost-sharing of the beneficiary’s drug purchases (or medication claims); the beneficiary’s current prescription drug plan coverage stage; the beneficiary’s progress toward the next coverage stage; and any important formulary changes to medications that affect the plan member.

From the questions and comments we receive, we find that Section 4 is one of the most important, and often most overlooked, sections of the Explanation of Benefits

Q1Medicare.com has now added an online section dedicated to helping seniors and other Medicare beneficiaries better understand their Medicare Part D prescription drug plan’s Explanation of Benefits document. The new Q1Medicare.com section can be found directly at Q1Medicare.com/EOB.

Every Medicare Part D prescription drug plan is required to provide their plan members with an Explanation of Benefits (EOB) summarizing the member’s monthly prescription drug purchases and showing any changes that will be made to the member’s plan coverage. The Explanation of Benefits letter is separated into six sections with details about the Medicare beneficiary’s covered drug purchases since the last EOB letter, including the cost allocation for those purchases covered in Section 1. The EOB also shows the beneficiary’s current prescription drug plan coverage stage and their progress toward the next coverage stage in Section 2; as well as the beneficiary’s out-of-pocket costs and total drug costs in Section 3.

Section 4 of the Explanation of Benefits letter includes any formulary changes that affect the beneficiary’s medications. For instance, Section 4 can include the removal of drugs from a plan’s formulary, or the addition of, or changes in, drug usage restrictions such as step therapy, quantity limits or prior authorization. Section 4 will also show a beneficiary if their medications are moving from one cost-sharing tier to another. Q1Medicare.com/EOB Sections 4 not only explain how a member’s formulary can change, but also provides the member with information and links on how to request a formulary exceptions, should they wish to request an exception to the plan’s change. Sections 5 and 6 of the EOB explain administrative topics such as errors and beneficiary rights.

“From the questions and comments we receive, we find that Section 4 is one of the most important, and often most overlooked, sections of the Explanation of Benefits,” notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. “Unfortunately, although an Explanation of Benefits letter is well organized, it seems that many people use their EOB to review their past purchases and their present plan stage, but rarely do they notice that Section 4 shows them the future of their drug coverage.”

The new Q1Medicare.com Explanation of Benefits section is organized according to the six sections that a Medicare beneficiary will find in their own printed Explanation of Benefits letter and includes tips and answers to frequently asked questions about the EOB. For instance, Seniors trying to see where they are in comparison to the Coverage Gap or Donut Hole portion of their drug plan can use the Q1Medicare.com’s EOB Section 2 to find more information. Medicare Part D beneficiaries are also encouraged to submit their own EOB related questions should they need more information.

About the Q1Medicare.com Website
Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, caregivers, advocates, advisers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs.
Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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Lynnea Christner

Susan Johnson MS-MIS, MBA, PhD
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