If a service is not listed in the EOC, what will Medicare and the plan do?

When a service is not listed in the Evidence of Coverage (EOC) for Medicare, it typically indicates that the service is not considered a covered benefit under the plan. As a result, Medicare and the plan will not provide reimbursement for that service. The EOC outlines the specific services covered, limitations, and exclusions, creating a clear framework for what is eligible for coverage. If a service falls outside of this outlined coverage, beneficiaries can generally expect that costs associated with it will not be covered, thus leading to the conclusion that the plan will not pay for it. Understanding this principle is essential for navigating Medicare benefits and ensures beneficiaries are aware of their coverage limits.