Is an "Explanation of Benefits" (EOB) a bill?

No, an EOB is not a bill. It's a statement from your insurance plan (like a Medicare Advantage Plan) that shows what services you received, what the plan paid, and what you might owe. You will get a separate bill from your provider for any amounts you owe.

What is the difference between a copay and coinsurance?

A copay is a fixed dollar amount you pay for a service, like $20 for a doctor's visit. Coinsurance is a percentage of the cost of a service you pay, for example, 20% of the total bill. Both are ways you share the cost of care after your deductible is met.

Can I choose my doctors with Medicare?

If you have Original Medicare, you can generally see any doctor or hospital that accepts Medicare. If you have a Medicare Advantage Plan, you might need to use doctors and hospitals within the plan's network, similar to other private insurance plans. Always check with your plan.

What if Medicare denies a service I think I need?

If Medicare or your plan denies a service, you have the right to appeal that decision. This means you can ask for a review of your case. There are specific steps and deadlines for filing an appeal, and you can get help from organizations like SHIPs.

How do I know if I have Original Medicare or Medicare Advantage?

You have Original Medicare if you get your Medicare card directly from the government and have separate Part A and Part B coverage. You have Medicare Advantage if you enrolled in a plan through a private insurance company that covers your Part A and Part B benefits, often with a separate plan card. Check your insurance cards and enrollment paperwork.

Medicare Explained

How do I make sense of my Medicare paperwork?

Understanding your Medicare paperwork starts with knowing what each document means. We'll help you identify common statements and explain key terms. This guide will point you to resources for more detailed help.

By the ExplainMyBill.ai Editorial Team · Reviewed by our billing research team

Published June 5, 2026 · Updated June 5, 2026

What Medicare Paperwork Will I Get?

After you use a medical service, you will likely get several documents. These can come from Medicare itself, your insurance plan, or your healthcare provider. It's normal to feel confused because they often look different.

One important document is the 'Medicare Summary Notice' (MSN). If you have Original Medicare, you get this every three months. It shows what services you received and what Medicare paid. It is NOT a bill.

If you have a Medicare Advantage Plan, you will get an 'Explanation of Benefits' (EOB) from your plan. This EOB also explains what services were covered and what your plan paid. It is also NOT a bill.

You might also get a bill directly from your doctor or hospital. This bill will show what you still owe after Medicare and any other insurance has paid their share. Always compare this bill to your MSN or EOB.

Medicare Summary Notice (MSN)
Explanation of Benefits (EOB)
Bills from your doctor or hospital

Understanding Your Medicare Costs

Medicare has different kinds of costs you might need to pay. These can include premiums, deductibles, copayments, and coinsurance. Understanding these terms helps you know what to expect.

A 'premium' is a regular payment, usually monthly, to keep your insurance coverage. Most people pay a premium for Medicare Part B. If you have a Medicare Advantage Plan or a Part D drug plan, you might pay additional premiums.

A 'deductible' is the amount you must pay for healthcare services before Medicare starts to pay. Once you meet your deductible for the year, Medicare will then begin to cover its share of the costs.

A 'copayment' (or copay) is a fixed amount you pay for a service, like a doctor's visit or a prescription. For example, you might pay $20 for a doctor's visit, and Medicare pays the rest.

'Coinsurance' is a percentage of the cost of a service that you pay. For example, after your deductible, Medicare might pay 80% of the cost, and you would pay the remaining 20% as coinsurance.

How Medicare Coverage Works

Medicare is generally divided into different parts. Knowing your plan type is key to understanding your coverage and costs.

'Original Medicare' includes Part A (hospital insurance) and Part B (medical insurance). With Original Medicare, you can usually go to any doctor or hospital that accepts Medicare. You might also have a separate Part D plan for prescription drugs.

'Medicare Advantage' (also known as Part C) is an all-in-one plan offered by private insurance companies approved by Medicare. These plans cover Part A and Part B services, and often include Part D drug coverage and extra benefits like vision or dental. They usually have networks of doctors and hospitals.

'Part D' is prescription drug coverage. You can get it through a stand-alone Part D plan if you have Original Medicare, or it's often included in a Medicare Advantage Plan.

What If I Don't Agree? (Appeals)

Sometimes, Medicare or your plan might not pay for a service you received. Or they might deny a service your doctor says you need. You have the right to challenge these decisions through an 'appeal'.

An appeal is a formal request to have your case reviewed again. This process allows you to explain why you believe the decision should be changed. It's important to act quickly, as there are deadlines for appeals.

The first step is usually to file an appeal with Medicare or your Medicare Advantage Plan. If you are still not satisfied, there are further levels of appeal. Getting help from an advocate can be very useful during this process.

Where to Get More Help

You don't have to figure out Medicare alone. Many resources are available to help you understand your paperwork, costs, and rights.

The official Medicare website (Medicare.gov) and phone number (1-800-MEDICARE) are great places to start. They have a lot of information about your benefits and how Medicare works.

State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling to people with Medicare. They can help you understand your options and resolve issues. These programs are available in every state.

Patient advocates or billing advocates can also help you review your bills, understand your EOBs, and guide you through the appeals process. They can be a great support when things feel overwhelming.

Frequently asked questions

Is an "Explanation of Benefits" (EOB) a bill?: No, an EOB is not a bill. It's a statement from your insurance plan (like a Medicare Advantage Plan) that shows what services you received, what the plan paid, and what you might owe. You will get a separate bill from your provider for any amounts you owe.
What is the difference between a copay and coinsurance?: A copay is a fixed dollar amount you pay for a service, like $20 for a doctor's visit. Coinsurance is a percentage of the cost of a service you pay, for example, 20% of the total bill. Both are ways you share the cost of care after your deductible is met.
Can I choose my doctors with Medicare?: If you have Original Medicare, you can generally see any doctor or hospital that accepts Medicare. If you have a Medicare Advantage Plan, you might need to use doctors and hospitals within the plan's network, similar to other private insurance plans. Always check with your plan.
What if Medicare denies a service I think I need?: If Medicare or your plan denies a service, you have the right to appeal that decision. This means you can ask for a review of your case. There are specific steps and deadlines for filing an appeal, and you can get help from organizations like SHIPs.
How do I know if I have Original Medicare or Medicare Advantage?: You have Original Medicare if you get your Medicare card directly from the government and have separate Part A and Part B coverage. You have Medicare Advantage if you enrolled in a plan through a private insurance company that covers your Part A and Part B benefits, often with a separate plan card. Check your insurance cards and enrollment paperwork.

This article is educational information, not medical, legal, or financial advice. Billing rules change and individual situations vary — always confirm details with your provider or insurer.