Advanced EOB

An Advanced EOB is a predictive Explanation of Benefits that health plans are supposed to send to insured members before scheduled care, showing the expected charges, the plan's expected payment, and the estimated patient out-of-pocket cost. It's the insured-patient counterpart to the Good Faith Estimate that already applies to self-pay patients under the No Surprises Act.

The Advanced EOB requirement was written into the No Surprises Act and originally scheduled to take effect January 2022, but CMS delayed enforcement indefinitely pending regulations on how the data would flow between providers and plans in real time. In practice, most insured members still don't get an AEOB before care, and cost surprises remain common. Some progressive plans and TPAs have rolled out AEOB-like tools proactively — real-time member cost estimators tied to actual negotiated rates — because the data exists in the Machine-Readable Files and modern plan systems. When the AEOB rule is enforced, it will change the pre-service cost transparency landscape substantially.

The takeaway: if your plan offers a pre-service cost estimator tool, use it before any scheduled service. If it doesn't, call the plan for a written estimate citing your right to cost information — the estimate may not be legally required yet, but many plans will produce one on request.