Well, since becoming an agent, I learned I was in good company, as the majority of people ignore them as well. Here\u2019s the question: How many benefits are being ignored and lost, because we don\u2019t know what\u2019s in our plan?<\/p>\n
So, let\u2019s take a quick look at what they are and how to use them.<\/p>\n
The Summary of Benefits: Your Plan in a Nutshell<\/h2>\n
As the name implies the SOB (not to be confused with another acronym, but I digress) is a summary of the plan benefits. It does not provide all the minutia (little details). It\u2019s made for quick answers in a small booklet, usually about 12 to 16 pages long.<\/p>\n
Some Summaries are more detailed, and some are simpler. For example, below are two snippets from two different Summary of Benefits. You will notice one gives little information and the other a more detailed breakdown.<\/p>\n
In the first example below, you see a breakdown of how the copays would apply based on where one went for the service. You understand your options.<\/p>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/Summary-of-Benefits-Detailed.jpg\")
<\/p>\n
In the second example below, it provides you a range, but it does not give you the breakdown of how that range is applied. While you know you will have to pay at most $25, it doesn\u2019t explain how it could cost you $0.<\/p>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/Summary-of-Benefits-Simple.jpg\")
<\/p>\n
This is where the Evidence of Coverage comes in. When you need to know the details of the benefits, you will find it in the EOC.<\/p>\n
The Evidence of Coverage<\/h2>\n
If I were to look for the details regarding the simple SOB above, what I would find is a multipage explanation, breaking down each and every service it covers. Below is a partial of that explanation, as an example.<\/p>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/EOC-Simple-SOB.jpg\")
<\/p>\n
When we look at the first example above (the more detailed one), while it gave a pretty good breakdown of how you can get the lower cost copay, it doesn\u2019t cover any stipulations there may be. If we look at the following snippet from the EOC of that plan, you can see there is more information.<\/p>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/Evidence-of-Coverage-Outpatient-Services.jpg\")
<\/p>\n
Other Information You Will Find<\/h2>\n
Besides knowing your medical, drug and other benefits, you also learn:<\/p>\n
- \n
- Your rights and responsibilities<\/li>\n
- What to do if you have a problem<\/li>\n
- How to file a complaint or ask for an appeal to a decision you don\u2019t agree with<\/li>\n
- State agencies contact information<\/li>\n
- And more<\/li>\n<\/ul>\n
Invest a Couple of Hours Reading<\/h2>\n
So, during this AEP, take a few hours and read your Summary of Benefits. If there is anything in particular you don\u2019t completely understand, look it up in your Evidence of Coverage. And if you still have questions, call Member Services at the number on the back of your ID card or your agent. Don\u2019t allow lack of knowledge that is available to you to either make you lose or cost you money by surprise. Become an educated beneficiary and you will love your plan.<\/p>\n","protected":false},"excerpt":{"rendered":"
As my mom\u2019s caregiver for the last three years of her life, I remember when I first enrolled her into a Medicare Advantage plan in St. Petersburg, FL. Having just […]<\/p>\n","protected":false},"author":2,"featured_media":12761,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[9],"tags":[],"class_list":["post-3896","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/posts\/3896","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/comments?post=3896"}],"version-history":[{"count":0,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/posts\/3896\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/media\/12761"}],"wp:attachment":[{"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/media?parent=3896"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/categories?post=3896"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/yourcarerep.com\/agent-clone-template\/wp-json\/wp\/v2\/tags?post=3896"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}