Explanation of Medicare Benefits (EOMB)

An Explanation of Medicare Benefits (EOMB) is a statement that is sent to a Medicare beneficiary after a claim for medical services or supplies has been processed by Medicare. It is a summary of the payment decision made by Medicare and the amount the patient is responsible for paying.  

Here are some key features of an EOMB:

• Information about the service or supply provided, the date of service, and the amount charged
• The amount that Medicare paid for the service or supply, and the amount the patient is responsible for paying (if any)
• An explanation of why Medicare did not pay the full amount (if applicable)
• Information about the patient's deductible and coinsurance amounts, if applicable

• Instructions on how to appeal the payment decision, if the patient disagrees with it

For example, let's say a Medicare beneficiary received a knee replacement surgery. The EOMB would show the total cost of the surgery, the portion that Medicare paid, and the portion that the patient is responsible for paying. It may also include details about any deductible or coinsurance amounts that apply, as well as any additional information about the payment decision. The EOMB serves as an important record of the payment decision and can be used for billing and tracking purposes.