​Understanding Medicare billing in 2025 is crucial for beneficiaries aiming to manage their healthcare expenses effectively. With recent changes in coverage, coding systems, and dispute processes, staying informed can help you avoid unnecessary costs and ensure accurate billing.​

Decoding the Explanation of Benefits (EOB)

An Explanation of Benefits (EOB) is a statement provided by your Medicare Advantage or Part D plan detailing the healthcare services you’ve received, the amount billed, what the plan paid, and your financial responsibility. For those with Original Medicare (Parts A and B), a similar document called the Medicare Summary Notice (MSN) is sent every three months.​Verywell Health+1Verywell Health+1

When reviewing your EOB or MSN:

• Verify Services: Ensure all listed services were actually received.

• Check Provider Information: Confirm that the healthcare providers and facilities are correctly identified.

• Understand Charges: Review the amounts billed, what Medicare or your plan paid, and what you owe.

• Look for Denials: Identify any services that were not covered and understand the reasons.​Verywell Health

Regularly reviewing these documents helps detect errors or unauthorized charges promptly.​

Recognizing Common Billing Codes

Medical billing relies on standardized codes to describe diagnoses, procedures, and services. Understanding these codes can help you identify potential errors:​Verywell Health

• Current Procedural Terminology (CPT): Used to describe medical, surgical, and diagnostic services.

• Healthcare Common Procedure Coding System (HCPCS): Utilized by Medicare to identify services not covered by CPT codes, such as ambulance rides or durable medical equipment.

• International Classification of Diseases (ICD-11): Codes that represent diagnoses and health conditions.​Verywell Health

Errors in these codes can lead to incorrect billing. For instance, a typographical error in an ICD code could result in a claim denial or higher out-of-pocket costs. It’s essential to cross-reference the codes on your EOB or MSN with the services you received.​Verywell HealthVerywell Health+1Verywell Health+1

Disputing Billing Errors

If you identify discrepancies or suspect errors in your Medicare billing:

1. Contact Your Provider: Reach out to the healthcare provider’s billing department to discuss and resolve the issue.

2. File an Appeal: If the issue isn’t resolved, you can file an appeal with Medicare or your Medicare Advantage/Part D plan. Detailed instructions are available on Medicare.gov.

3. Report Fraud or Abuse: If you suspect fraudulent activity, report it to the Medicare fraud hotline or call 1-800-MEDICARE.​investopedia.com+3Verywell Health+3businessinsider.com+3

Additionally, medical-bill advocates can assist in reviewing bills, identifying errors, and negotiating with providers or insurers. Organizations like the Alliance of Professional Health Advocates and the National Association of Healthcare Advocacy offer directories to find certified advocates.​en.wikipedia.org

Staying Informed and Proactive

With the evolving landscape of Medicare in 2025, staying informed is more important than ever. Regularly review your EOBs or MSNs, understand the billing codes, and don’t hesitate to question or dispute charges that seem incorrect. Being proactive can lead to significant savings and ensure you receive the benefits you’re entitled to.​Verywell Health

For more information and resources:

• Medicare.gov

• Centers for Medicare & Medicaid Services (CMS)

• State Health Insurance Assistance Program (SHIP)

By taking these steps, you can navigate Medicare billing with confidence and protect yourself from unnecessary expenses.​