What Is an Explanation of Benefits?
An EOB is a document your insurance company sends after you receive medical care. It breaks down what happened financially: what the provider charged, what the insurance negotiated it down to, what insurance paid, and what you owe. Despite looking like a bill, an EOB is not a bill — your bill comes separately from the provider.
How to Read Your EOB
- Service date: When you received care
- Provider charge: What the doctor/hospital billed (the "sticker price")
- Allowed amount: The negotiated rate your insurance agreed to pay
- Plan paid: What your insurance covered
- Your responsibility: Your copay, coinsurance, or deductible amount
- Reason codes: Why something was or wasn't covered
Always compare your EOB to your provider's bill. Billing errors are common — the provider may bill you more than your EOB says you owe. If the numbers don't match, call your insurance company first, then the provider's billing department.
EOBs Apply to All Plans
Both ACA marketplace plans and private plans from carriers issue EOBs. Most insurers now provide electronic EOBs through their member portals. Review every EOB — it's your proof of what was covered and what you legitimately owe.
Related Terms
Last updated: March 30, 2026.
