Every September your plan sends you a document called the Annual Notice of Change. It is required to. It arrives among a great deal of other mail that looks similar and is not, and most of it goes in a drawer.
It is the only individual warning you get about what your coverage will look like in January. This guide is about reading it in fifteen minutes.
What it is, and what it is not
The Annual Notice of Change compares your plan next year against your plan this year. It is specific to the plan you are actually in.
It usually arrives with the Evidence of Coverage, which is the long document describing the plan in full. You do not need to read that one. You need the notice.
What it is not: it is not an advertisement, it is not a solicitation, and it is not from Medicare. The advertisements that arrive around the same time, in similar envelopes, from companies you have never dealt with — those are marketing, and some of them are designed to be mistaken for this.
Telling it apart from the marketing
The genuine notice comes from the plan you are enrolled in and names it. It refers to your current coverage. It does not ask you to telephone a number to “confirm your benefits”, it does not have a deadline in red, and it does not ask for your Medicare number.
Anything that arrives urging you to call immediately about benefits you might be missing is marketing at best. If it asks for your Medicare number, Social Security number or bank details, it is a fraud attempt and should be reported. There is a separate guide on that.
The six things to look for
Open the notice with your list of doctors and medications beside you, and look for these, in this order.
1. Is the plan still being offered? Occasionally a plan is withdrawn from your county. If so, that is stated at the front, and you have a window to choose something else. Do not let that one sit in a drawer.
2. What is happening to the premium and the cost-sharing? The notice sets out next year’s figures against this year’s. You are looking for the direction and the size of the change, not the exact number — you will check the number on Medicare.gov anyway.
3. What is happening to the annual out-of-pocket maximum? On an Advantage plan, this is your ceiling in a bad year. It is the number that matters most and gets the least attention.
4. What is changing on the drug list? Find each of your medications. Look for a tier change, a new restriction — prior authorisation, step therapy, a quantity limit — or removal from the formulary altogether. This is where most unpleasant January surprises originate.
5. What is changing about the network? Notices vary in how much detail they give. Treat any mention of network changes as a prompt to check your own doctors by name rather than as a complete answer.
6. What is changing about the extras? Dental, vision, hearing, transport, over-the-counter allowances. These change frequently, and the headline benefit is often less than the detail suggests. Read the detail.
Then do the twenty-minute check
The notice tells you what your current plan is doing. It says nothing about whether something else would suit you better.
Once you have read it, go to the Medicare Plan Finder at Medicare.gov, enter your ZIP code and your exact medications, and look at what every plan in your county would cost you across the year. That is the comparison the notice cannot give you, and it is free and available to everybody.
If you would rather not do it alone, your State Health Insurance Assistance Program will do it with you at no cost and sells nothing. So will 1-800-MEDICARE. So will we.
The dates
Annual Enrollment runs from 15 October to 7 December, and changes take effect on 1 January.
If you are in an Advantage plan, there is a second window from 1 January to 31 March in which you can switch to a different Advantage plan or return to Original Medicare with a drug plan.
Nothing about the notice requires you to act immediately in September. It requires you to read it before December.
If nothing has changed
That is a perfectly common outcome, and the answer is to do nothing. Staying put is a decision, and it is frequently the right one.
The point of the exercise is that you stayed on purpose.
Where to put it
Keep the notice with your plan card and your list of medications, in one place, where whoever helps you can find it. If you are helping a parent, ask where that place is now rather than in an emergency.
Fifteen minutes in September, twenty in October. That is the whole annual maintenance schedule for Medicare, and almost everybody who gets caught out skipped one of them.
General information, not advice
This guide describes how Medicare generally works. It is not advice about your situation, and rules, dates and figures change — verify anything that matters to a decision against Medicare.gov,1-800-MEDICARE, or your State Health Insurance Assistance Program, all of which are free.
Rights and rules vary by state; this describes Ohio, Kentucky and Indiana. Clearview Medicare Advisers LLC is not connected with or endorsed by the United States government or the federal Medicare program.
Not sure how this applies to you?
Tell us your birthday and whether you are still working. That is usually enough for us to say which periods apply to you and by when. No charge and no obligation.
