Track your drug spending with your Explanation of Benefits

For every month that you use your Blue MedicareRx (PDP) coverage to fill a prescription, you will receive an Explanation of Benefits (EOB) statement in the mail the following month or you can choose to receive your statement electronically through your account. Both the print and electronic statements are identical and will include: Your prescriptions filled during the previous month

  • Information about your current Medicare Part D Coverage Stage
  • Your “True Out-of-Pocket” (TrOOP) amount and Total Drug Costs to date
  • Updates to your plan’s formulary that affect the drugs that you take
  • How to report mistakes or ask questions about your EOB statement
  • Information about your coverage and your rights as a Blue MedicareRx member

If you do not fill a prescription in any given month, you will not receive an EOB for that month.

Section 1 – Your prescriptions

The first section of your EOB lists the prescriptions you filled during the previous month, the amount you paid and any amount paid by other programs or organizations, such as Extra Help. This section also provides your TrOOP amount and Total Drug Costs both for the previous month and for the current year.

Section 2 – Your current Medicare Part D coverage stage

All Medicare Part D plans have four coverage stages: Deductible, Initial Coverage, Coverage Gap and Catastrophic Coverage. This section of your EOB shows your current stage and the amount you will spend before moving to the next stage.

Learn about Medicare coverage stages

Section 3 – Your Troop and Total Drug Costs

This section clearly defines what’s included in your TrOOP and Total Drug Costs, and how much has been spent in these categories during the previous month and year-to-date.

Section 4 – Updates to your plan’s formulary

If changes are made to your plan’s formulary that affect drugs you have filled using your Blue MedicareRx coverage in the last 120 days, you will be notified in this section of your EOB.

Section 5 – Reporting mistakes and asking questions

The fifth section provides instructions on what you should do if you believe the information in your EOB is incorrect or suspicious, and who to call if you have any questions. You are always welcome to call the number on your Blue MedicareRx ID card at any time.

Section 6 – Your coverage and rights

The final section tells you where to look for details about your drug’s coverage and what to do if you have concerns about your coverage and drug costs. There is also information about what to do if you’re having difficulty paying for your plan premiums and drug costs.