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Medicare road map: What’s an EOC, why it’s important and how to read one

Color portrait of Mark Pabst By Mark Pabst

One of the first things you learn when shopping for a Medicare plan is that you have a range of options, especially if you choose a Medicare Advantage plan. This means that plans vary in cost and coverage. But no matter which plan you choose, you’ll be able to read a document that provides important details about your plan. It’s generally known as the Evidence of Coverage (EOC).

The EOC is the legal contract between you and the Medicare plan. It’s generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. If you have questions about your Medicare plan, start here. While some insurance companies still send a copy of your EOC in the mail, many simply send a notice telling you where you can find it online.

Having your Evidence of Coverage online can be convenient for several reasons. First, you can look at it anytime without having to worry about where you filed away your hard copy. Second, you can use the search function on your computer to scan your EOC for key terms.

This is important because EOCs can be over 200 pages long. (Few people sit down and read them cover to cover.) Your EOC will be more useful and less intimidating if you think of it as a kind of Medicare encyclopedia that you refer to as needed. Below are some sections included in every EOC, along with quick tips on how to find the important information in each section.

It’s a good idea to skim your EOC highlights every year. The graphic below can help you review important sections. If you still have questions, don’t hesitate to contact your plan’s customer service department.

Aetna_Medicare_roadmap-EOC_091319.jpg

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

Disclaimers

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.