One of the first things you learn when shopping for a Medicare plan is that you have a range of options. Medicare plans can vary quite a bit in cost and coverage. No matter which plan you choose, you’ll get a document that tells you important details about your plan. It’s generally known as the Evidence of Coverage (EOC).
The EOC is the legal contract between you and your Medicare plan. If you have questions about your plan, start here. Most times, Medicare plans start to post new EOCs in September for changes that will start on the following January 1. While some companies still send a copy of your EOC in the mail, many simply send a notice to tell you where you can find it online.
Having your Evidence of Coverage online can be helpful for a few reasons. First, you can look at it anytime. You don’t have to worry about where you filed away your paper copy. Second, you can use the search tool on your computer to scan your EOC for key terms.
It’s also helpful because EOCs can be over 200 pages long. (Few people sit down and read them from start to end.) Your EOC will be more useful and less scary if you think of it as a kind of book with chapters that you check when you need it.
It’s a good idea to skim your EOC highlights every year. Here are some sections you’ll find in every EOC. Plus, some quick tips on how to find key information in each section.
Still have questions? You can always contact Aetna® Medicare Member Services.
Have questions about your Medicare plan? All Medicare members can read a document online that outlines the plan features. This is usually called your Evidence of Coverage (EOC). Start with the sections shown below to learn about your plan's costs and coverage.
Tip: Printed EOCs can run as long as 200 pages. You can read your EOC online and quickly skim through the sections. You can also use the find function on your computer to search the terms you're interested in.
Information about costs
All EOCs have a section where you can find important details about your costs, including premiums, copays and coinsurance.
Look for this heading if you have questions about:
- How much you’ll be charged each month for coverage
- What you’ll pay when you visit the doctor
- What percentage of a bill you’ll be responsible for paying for covered health care services
Information about coverage
Every EOC has a section on plan benefits. It’s usually in the same chapter as the cost information shown above.
If you're wondering whether your plan helps pay for certain services, such as dental care or depression screening, come directly here.
You'll also find more information about costs. If your plan covers out-of-network care, this is where you will see the price difference between services by a network provider versus an out-of-network provider.
Information about medical emergencies
It helps to know how your plan covers emergency services before you actually need them.
This section defines what is considered an emergency. It can help you decide whether to go to the emergency room, urgent care or walk-in clinic.
In this section, you can learn whether your plan covers follow-up care and when your plan considers an emergency episode over.
What other materials will you get?
You’ll get your EOC, which is a great resource for understanding your plan’s benefits and coverage. You’ll also get your member ID card and a notice that tells you how to get other important documents online or by mail.
If you have a Medicare Advantage plan, this section will tell you where you can find a list of doctors who are in your plan’s network. You’ll also find a list of pharmacies that work with your plan.
If you have a plan that includes prescription drug benefits, this section will direct you to where you can find your plan’s formulary. The formulary lists the drugs that your plan covers.
Your plan may provide other materials, like a membership card or a prescription drug benefit card. This section will tell you what to expect.
Related content
Need help?
Call us at 1-833-329-0412
${tty} to chat about any Medicare questions you have.
Need help?
Call us at 1-833-329-0412
${tty} to chat about any Medicare questions you have.