Does my Medicare plan cover my medications next year?
Your plan mails an Annual Notice of Change every September. It lists what changes in January. Here are five things to check before you file it away.
- The Annual Notice of Change, or ANOC, is the letter your plan mails every September listing what changes about your coverage in January.
- If you do nothing, the plan renews on January 1 with every one of those changes applied.
- You have from October 15 to December 7 to move to another plan, and that window does not extend.
Your plan tells you in a letter it mails every September, the Annual Notice of Change, or ANOC. It lists everything that is different about your plan next year, including your drug list. Read that part and you have your answer.
It looks like junk mail. Fifteen minutes with it now can spare you a surprise in January.
Why the Annual Notice of Change matters
If you do nothing, your plan renews on January 1 with all of these changes applied. That happens whether or not you ever open the letter.
Nobody calls to tell you a medication moved to a higher tier, or that your cardiologist left the network, the doctors and hospitals the plan contracts with.
The ANOC arrives in September so you have time to act before Annual Enrollment closes on December 7.
The five things to check
- Your medications. Check that each one is still on the formulary, the plan's list of covered drugs, and still on the same tier. Tiers set your share of the cost, so a drug that moves from tier 2 to tier 4 can multiply what you pay. Watch for new rules like prior authorization, where the plan has to approve a drug before it pays, or step therapy.
- Your doctors and your hospital. The ANOC notes network changes, but the plan's directory is better. Call their billing offices and ask.
- The out of pocket maximum, the most you can be asked to pay in a year before the plan covers the rest. If it went up, your worst year got more expensive.
- Copays and coinsurance. A copay is a flat dollar amount for a visit. Coinsurance is a percentage of the bill. Check primary care, specialist, inpatient hospital and imaging, and watch for anything that switched from a flat amount to a percentage.
- The premium, the monthly bill for the plan, and any extra benefits. Dental, vision and hearing allowances are commonly adjusted.
Step therapy is the change people miss. It means the plan now wants you to try a cheaper drug first, before it covers the one you are stable on. After years on the same medication, that is a real disruption, and reason enough to switch plans.
What to do with what you find
If nothing meaningful changed and your doctors are still in network, let the plan renew.
If something did change, you have from October 15 to December 7 to move. That is the window and it does not extend.
If your ANOC changed something that matters, have a licensed agent review it with you first.
How to compare against alternatives
- List every medication with its dosage.
- Run them through the Plan Finder at Medicare.gov, with your ZIP code and your pharmacy.
- Sort by total estimated cost for the year, not by premium.
- Check the top few results against your doctors, by phone.
- Compare out of pocket maximums.
See how to look up plans in your area.
If you already threw it out
Call member services at your plan and ask for another copy. The same information is in your Evidence of Coverage, the booklet that spells out what the plan covers, and on the plan's website.
You can also skip the letter and compare in the Plan Finder. That measures your plan against the plans sold where you live, not just against its own prior year.
See what to do during Annual Enrollment.
Find this year's letter, check the five items above, and mark December 7 on your calendar. If you want someone to read it with you, call our McAllen office at (956) 687 3334, or enter your ZIP code in the form on this page.
Common follow-up questions
When does the ANOC arrive?
By the end of September each year, before Annual Enrollment opens on October 15.
What if I do nothing?
Your plan renews automatically on January 1 with all the listed changes applied. That happens whether or not you read the notice.
My drug moved to a higher tier. What are my options?
You have three. Ask your doctor whether a covered alternative would work, ask the plan for a formulary exception, which is a request to cover your drug at a lower cost, or change plans during Annual Enrollment. All three are worth looking into.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.