How do I read my explanation of benefits statement?

Who is this for?

Learn more about managing your Medicare plan

If you have a Blue Cross Blue Shield of Michigan or Blue Care Network Medicare plan, this information can help you understand the pieces and parts of your Medicare EOBs.

About once a month, you’ll receive an explanation of benefits, also called an EOB. It's a list of every time you visited the doctor, went to the hospital or filled a prescription, plus how much it all costs. It’s important to remember that this statement isn’t a bill. It’s a tool to help you keep track of your plan usage. We’ll only send you statements when you use your coverage. 

What’s on my medical explanation of benefits statement?

To help reduce the amount of mail you receive, you’ll see services like these all in one statement:

  • Medical services, like doctor, specialist and hospital visits
  • Dental services, like teeth cleanings and fillings
  • Vision services, like eye exams
  • Part B drugs, like flu shots and drugs that fight cancer
  • Durable medical equipment, like crutches or diabetes supplies
  • Lab services, like blood work

Before you get into the details, we show you a summary of how much you and your plan have spent so far. You’ll see how close you are to meeting your deductible and out-of-pocket maximum.

Then, we break down the cost of each procedure, so you can see how it all adds up. We show:

  • The date the service was performed
  • The amount the provider billed the plan
  • The total cost of the service (the amount the plan approved)
  • Your plan’s share of the cost
  • Your share of the cost

If we deny one of your claims, we’ll always explain why. We’ll also tell you whether you’ll still need to pay your share of the claim. You might see this referred to as “member liability.” If you’d like to appeal our decision, the last page gives you everything you need to know about how to do that.

For a more detailed look at what you’ll find in your medical explanation of benefits statement, check out our guides:

What’s on my prescription drugs explanation of benefits statement?

You’ll get a separate explanation of benefits statement for prescription drugs covered by Medicare Part D. These statements will tell you how much you and your plan paid for prescriptions in the last month.

We break down your out-of-pocket costs and your total drug costs to help you understand which drug payment state you're in. If you want to learn more about the stages, check out How do Medicare Part D prescription drug plans work?

What’s on my medical explanation of benefits statement?

We'll let you know if any updates to your plan’s drug list will affect the drugs you take. You'll also find instructions for what to do if you see mistakes on your statement and a review of your rights as a Medicare Part D customer.

How can I see my EOB statements online?

If you'd like to save time and paper, you can also get your EOB statements online.

Still have questions?

Please call the customer service number that’s listed on your EOB or on the back of your Blue Cross ID card.