MOAA’s TRICARE Toolkit provides insight and tips for navigating your TRICARE benefits. Have a question or suggestion for an upcoming column? Email beninfo@moaa.org. Read other TRICARE Toolkit columns at MOAA.org/tricaretoolkit.
TRICARE beneficiaries track their annual medical expenses by accessing their explanation of benefits (EOB). The EOB statement is not a bill; it delineates an itemized summary action TRICARE has taken on claims filed by your provider or past medication orders.
Active-duty families and retirees who only use military treatment facilities (MTFs) have probably never encountered an EOB because MTF care and pharmacy services are provided without a co-payment; no EOB is generated.
Many TRICARE network providers seek co-payments at the time the patient is seen. However, the Defense Health Agency recommends anytime you see your doctor, dentist, or pharmacist or receive care from a hospital, you should try to access your EOB before receiving the bill — or after paying your co-payment — to verify the amount charged is in line with your plan’s benefits.
[RELATED: MOAA's 2022-23 TRICARE Guide]
It is important to understand the contents of your EOB and to read through it carefully.
EOBs typically contain the following information:
- The date you received a medical treatment or service.
- The amount billed by the provider.
- The amount covered by TRICARE, Medicare, or other health insurance, if applicable.
- Any balance you owe the provider.
- How much of the cost has been credited to your annual deductible and catastrophic cap.
You can access your medical EOB through a secure portal on the website of your specific TRICARE contractor.
What should you look for on your medical EOB?
- Did you receive the medical services listed on the EOB?
- Are you being billed more than once for the same service?
- How much of your care is covered, and what are you expected to pay?
- Was your claim accepted or denied?
[RELATED: TRICARE Will Pay for More Dialysis Services After Rise in Kidney Disease]
Your pharmacy EOB is similar to, but not exactly the same as, your medical EOB. It is a summarized statement of processed pharmacy claims. Again, no EOB is generated from medications dispensed from an MTF pharmacy.
To access pharmacy EOBs, visit Militaryrx.express-scripts.com. If you have signed up to receive pharmacy EOBs online, you’ll get an email once each month that lets you know when an updated EOB is available.
MEDIPLUS® TRICARE Supplement
Works hand-in-hand with your Select or Prime Plan. Count on valuable protection.