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Alliance recommends updates to Medicare’s explanation of benefits statement

Published August 3, 2023

The Alliance for Aging Research submitted comments today to the Centers for Medicare and Medicaid Services (CMS) recommending updates to the explanation of benefits (EOB) statement sent by Medicare plans following a health service or filling of a prescription drug prescription. The EOB provides information on the costs of a service, how much the insurer paid, and beneficiary out-of-pocket (OOP) expense.

In the letter, the Alliance urges CMS to utilize the EOB as a source – in addition to many other avenues – to provide information about the new “maximum monthly caps” (also referred to as “cost smoothing”) option that will be available to Medicare beneficiaries starting in 2025. The maximum monthly caps flexibility will permit beneficiaries to spread out their OOP costs through interest-free payment installments through the end of each calendar year.

The Alliance recommends that the maximum monthly caps information in the EOB include the eligibility criteria, coverage limits, the process for beneficiaries to opt into the maximum monthly cap program, as well as illustrative examples of how the program can help beneficiaries to afford their medications.

Read the full letter.

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