If you have a Medicare Advantage or Part D plan, you receive an Annual Notice of Change (ANOC) each fall. This notice explains what will change in your plan starting January 1.
The document can contain a lot of information. You do not have to study every page. Instead, focus on the changes that could affect your doctors, prescriptions, benefits, and costs.
Here are seven areas to review before the Medicare Annual Enrollment Period (AEP) ends.
What Is an Annual Notice of Change?
Your ANOC is a notice from your current Medicare Advantage or Part D plan. It explains changes to your coverage for the coming year.
Depending on your plan, those changes may include:
- Monthly premiums
- Deductibles
- Copays and coinsurance
- Prescription drug coverage
- Provider networks
- Benefits
- Plan rules
Even if you are happy with your plan, it is important to review your ANOC. A plan that worked well for you this year may work differently next year.
Medicare's AEP runs from October 15 through December 7. Changes made during AEP generally take effect January 1.
If your plan is ending or will no longer be offered in your area, you may receive a separate non-renewal notice. This is different from a routine ANOC and may affect your enrollment options.
Where Can I Find My ANOC?
Your plan sends your ANOC each fall, generally by September 30. Depending on your delivery preferences and the plan's requirements, you may receive it by mail or electronically.
If you cannot find your copy, contact your insurance company or check your plan's member website.
You may also want to have your Evidence of Coverage or Summary of Benefits available. These documents can provide more details when you need them.
Once you have your ANOC, start with the areas that affect you most.
1. Has Your Monthly Premium Changed?
Look for the section that compares your current premium with the premium for the coming year.
Is it increasing, decreasing, or staying the same?
Your premium is important, but do not use it by itself to judge your plan. A lower premium does not always mean lower overall costs. Copays, coinsurance, deductibles, and prescription costs can also change.
Think of the premium as one piece of the puzzle.
2. Have Your Copays or Coinsurance Changed?
Next, look at what you may pay when you receive medical care.
Pay close attention to services you use regularly, such as:
- Primary care visits
- Specialist visits
- Urgent care
- Outpatient services
- Hospital care
Your ANOC may show your current cost next to the new cost. This makes it easier to spot changes.
A change may not matter much for a service you rarely use. It could matter more for care you receive often.
3. Has Your Deductible Changed?
A deductible is an amount you may have to pay before your plan begins paying its share for certain services.
Check whether your deductible is changing and which services it applies to.
Medicare Advantage plans can have different cost-sharing rules for medical services. Part D coverage may also have a separate prescription drug deductible.
Do not stop at the deductible amount. Look at where it applies so you understand how the change could affect you.
4. Are There Changes to Your Prescription Coverage?
Prescription drug coverage deserves careful attention because a plan's coverage can change from year to year.
Start with a current list of your medications. Include the name, dosage, how often you take each medication, and your preferred pharmacy.
Then check for changes involving:
Your formulary: A formulary is the plan's list of covered prescription drugs. Check whether each medication you take is still included.
Drug tiers: Plans place covered drugs into different tiers. If one of your medications moves to another tier, what you pay could change.
Coverage rules: Check whether a medication has new requirements, such as prior authorization, step therapy, or quantity limits.
Your pharmacy: Make sure your preferred pharmacy is still in the plan's network and check whether it offers preferred or standard cost sharing.
The ANOC may not provide every detail about how each of your medications will be covered. Compare your complete medication list with the plan's formulary and pharmacy information for the coming year.
Checking only whether a drug is covered may not tell the whole story. How the plan covers the drug matters too.
5. Are Your Doctors and Hospitals Still in the Network?
If you have a Medicare Advantage plan, your provider network can be an important part of your coverage.
Make a list of the providers you want to continue using, including your:
- Primary care doctor
- Specialists
- Preferred hospital
- Other providers you see regularly
Then confirm whether they will participate in your specific plan's network for the coming year.
Your ANOC may identify network changes, but it may not list every individual provider change. Provider directories can also change. Check with both your insurance company and the provider's office.
Do not assume that because a doctor accepts your plan today, nothing will change next year.
6. Have Any Benefits or Plan Rules Changed?
Some important ANOC changes are easy to overlook because they are not related to premiums or doctor visits.
Look for changes involving:
- Prior authorization
- Referrals
- Emergency and urgent care
- Outpatient services
- Prescription drug rules
- Extra benefits
- Other copays or coinsurance
You do not need to give every change the same amount of attention. Focus on the services and benefits you use or expect to use.
7. What Do All These Changes Mean for You?
After reviewing your ANOC, look at the changes together.
Ask yourself:
- Are my doctors and hospitals still in the network?
- Are my prescriptions still covered?
- Have any of my prescription drug coverage rules changed?
- Have my medical costs changed?
- Are the benefits I use still included?
- Does the plan still fit the way I receive healthcare?
One change by itself may not be a reason to choose a different plan.
What matters is how all the changes work together based on your healthcare needs.
Does a Change Mean You Should Switch Plans?
Not necessarily.
If your doctors remain in the network, your prescriptions are covered, and the plan's costs and benefits still meet your needs, your current plan may continue to be a good fit.
On the other hand, several changes may make it worth comparing your other options.
For example, you may want to take another look if a doctor leaves the network, a prescription's coverage changes, your costs change, or your healthcare needs are different than they were last year.
The purpose of reviewing your ANOC is not to find a reason to switch. It is to make sure you understand what you will have if you stay.
Don't Put Your ANOC Aside Without Reading It
It is easy to receive your ANOC and set it aside, especially if you are happy with your current coverage.
But this document explains important changes that may affect your coverage next year.
Take some time to review your doctors, prescriptions, pharmacies, costs, benefits, and plan rules before AEP ends on December 7.
Reviewing your Annual Notice of Change can help you understand how your Medicare coverage may change for the coming year. A personal benefits review is an opportunity to discuss your current coverage, healthcare needs, and available options.