Understanding your Part D Explanation of Benefits (EOB)

The Explanation of Benefits (EOB) is a document you will get for each month if:

  • you had activity in your Part D benefit in the prior month or
  • we need to notify you of a change in coverage for a drug you are currently taking.

The EOB will show your “Total Drug Costs to Date” also known as “Total Drug Spend” which is what both you and Essence have paid for your Part D drugs. This Total Drug Costs to Date is what counts towards your initial coverage limit of $4,020 for Essence Advantage HMO & Essence Advantage Plus HMO. The EOB also provides your year to date True Out of Pocket (TrOOP) Costs to Date, and that amount is only what you have paid out of pocket and counts towards you reaching the Catastrophic Phase ($6,350).

Your Explanation of Benefits will contain the following information:

  • How much you have paid so far this year for your prescriptions
  • Your recent claims for prescriptions
  • Updates to our drug list (formulary)

If you have a question about any information contained in your EOB, we encourage you to contact us.

Please Note: Items/services appear on the EOB when a claim is processed, not necessarily for the month in which you received the item or service.

Y0027_20-322 - Last updated 01/30/2020