Decision Prep
When Your Plan’s ANOC Says Your Drug Costs Are Changing
The September Annual Notice of Change is where your plan tells you what is changing next year. Here is what to look for in the drug-cost section.
The short answer
The Annual Notice of Change (ANOC) is a document your Part D plan or Medicare Advantage plan sends every September. It lists what is changing about your plan for the next calendar year — premium, deductible, copays, drug formulary, drug tiers, pharmacy network, and (on MA plans) provider network, prior authorization rules, and supplemental benefits. The plan can change any of these and keep the same name. The ANOC is the only consolidated place where these changes are disclosed before they take effect. Reading it in September gives you time to act during Medicare Open Enrollment, October 15 through December 7.
The ANOC is a renewal notice. Like an apartment lease renewal — same address, possibly different terms.
What the ANOC actually contains
Plans format the ANOC differently, but federal rules require certain elements. The drug-cost section typically includes:
Premium. The monthly Part D portion of the plan’s premium for the new year. May go up or down.
Deductible. The amount you pay before the plan starts paying. The federal Part D deductible cap rises annually with inflation; the plan can charge anything from $0 up to that cap.
Tier structure. How many tiers, what they’re called, and the cost share for each tier. The structure rarely changes year to year. The cost shares often do.
Formulary additions and removals. Drugs added to the formulary and drugs removed. Removals are the ones worth attention. If a drug you take is being removed, the plan should tell you in the ANOC and usually in a separate formulary-change notice.
Tier changes for specific drugs. A drug that was on Tier 2 last year might be on Tier 3 this year. Same drug, different cost.
Pharmacy network changes. Pharmacies added to or removed from the network, and changes to which are preferred and which are standard.
Prior authorization and step therapy. New requirements added, existing requirements removed, or thresholds changed.
How to read it efficiently
Twenty minutes once a year is enough. The path:
- Open the envelope when it arrives. Most plans send the ANOC in late September.
- Find the “summary of changes” page at the front. It usually compares this year’s premium and deductible to next year’s, side by side.
- Find the formulary section. Search for every drug you currently take by name. Note: Is it still on the formulary? What tier is it on for next year? Are there any new prior authorization or step therapy requirements?
- Find the pharmacy network section. Confirm: Is your usual pharmacy still in network? Is it still preferred, or has it moved to standard?
- If the plan is MA, also check provider network changes. Are your doctors still in network for next year?
- If anything significant changed — a drug removed, a tier increase, a pharmacy moved from preferred to standard, a doctor dropped — make a note. Bring it to AEP.
When the ANOC change is a reason to switch plans
Most ANOC changes are minor. Most people who read their ANOC stay with their current plan. Some changes are significant enough to warrant a serious comparison:
- A drug you take is removed from the formulary
- A drug you take moves to a much higher tier
- Your pharmacy moves from preferred to standard
- A doctor or hospital you rely on is dropped from the MA network
- A supplemental benefit you actively used is reduced or eliminated
- The premium increase is large relative to comparable plans in your area
- A prior authorization is added on a drug you’ve been taking without one
In these cases, running the Plan Finder at Medicare.gov with your current drug list — and comparing your current plan against alternatives — is the next step.
How this applies to you
If the ANOC arrives in September and nothing major changed. Skim, save, and move on. The annual review is preventive, not reactive.
If something on the change summary stops you. Read the relevant section in full. Compare against your current usage. Decide whether the change is meaningful enough to compare plans during AEP.
If you are helping someone else. Open the ANOC together. The drug list comparison is concrete and a useful exercise in a conversation that might otherwise feel abstract.
If you didn’t get an ANOC. Plans are required to send it by September 30. If yours didn’t arrive, contact the plan.
What this is not
It is not a contract. The ANOC describes the new contract — the Evidence of Coverage is the contract document itself.
It is not the only information you have. Your own EOBs, MSNs, pharmacy receipts, and your “surprise file” from the year are the lived data. The ANOC tells you what is changing on paper. Your year’s worth of records tells you what was already a problem.
It is not the only place to look during AEP. The Plan Finder at Medicare.gov, SHIP counselors, licensed agents, and the plan’s member services line are all part of the comparison.
A renewal letter, not a press release. Read it like one.
The Clearing does not sell insurance, recommend specific plans, or earn commissions. When you are ready to decide, verify the details on Medicare.gov or with a SHIP counselor in your state.
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— Dan, at The Clearing
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