What the Annual Notice of Change is telling you

Each autumn, people with a Medicare Advantage or Part D plan receive a document called the Annual Notice of Change. It is typically the thickest envelope of the year and the one most likely to be put aside. That is unfortunate, because it is also the only document that tells you, in one place, how next year's version of your plan differs from this year's.

What it is for

The Annual Notice of Change, usually shortened to ANOC, is a comparison document. Its job is to set what applies now beside what will apply in the coming plan year, so that a member can see the differences without reading two full contracts. It typically arrives alongside or shortly before the Evidence of Coverage, which is the longer document describing the plan's rules in full.

The important thing to understand about the ANOC is that it is not a sales document and it is not optional reading. If you do nothing, you are generally enrolled in next year's version of the plan — the version the ANOC describes, not the version you signed up for.

What tends to be in it

Contents vary by plan, but an ANOC commonly covers:

• —the monthly premium for the coming year
• —the deductible, if the plan has one, and the annual out-of-pocket maximum
• —copayments and coinsurance for common services, often in a side-by-side table
• —changes to the drug list, including drugs added or removed and tiers that have moved
• —changes to the provider or pharmacy network
• —changes to extra benefits the plan includes
• —whether the plan will continue to be offered in your area at all

That final item is the one worth checking first. If a plan is being discontinued in your area, nothing else in the document applies to you, and a different and more time-sensitive set of options opens up instead.

An order to read it in

The document is laid out for completeness rather than for priority, so it helps to impose your own order. A reading that answers the questions most likely to affect you looks roughly like this:

• —Is the plan still being offered in my area next year?
• —What is the new premium, and what is the new out-of-pocket maximum?
• —Do any of my prescriptions appear in the drug list changes, by generic name as well as brand name?
• —Are the clinicians and the hospital I rely on still in the network?
• —Have the copayments changed for the services I actually use, rather than for the full list?
• —Have the rules changed — new prior authorisation or referral requirements, for example?

Six questions is usually enough to know whether the plan still fits, and it is a far smaller task than reading the document front to back.

Small numbers, large effects

A change that reads as minor can matter a great deal depending on how you use the plan. A modest increase in a specialist copayment is close to irrelevant if you see a specialist rarely and significant if you see one every few weeks. A drug moving up a tier may be trivial for a prescription you fill occasionally and material for one you take daily. The ANOC cannot weight these for you, because the weighting depends on your year rather than on the plan. That is the part only you can supply.

What the ANOC does not do

An ANOC describes one plan: yours. It does not tell you how next year's version of your plan compares with the other plans available where you live. Those comparisons are made elsewhere, including through the official plan finder at Medicare.gov and through your local State Health Insurance Assistance Program. The ANOC answers whether your plan has changed. It does not answer whether it is still the plan you would pick.

A habit worth keeping

Keep the ANOC where you can find it after you have read it, along with a one-page note of what changed and what you decided. Next autumn, that note turns a thick envelope into a ten-minute comparison, because you will already know which half-dozen things you care about and which you do not.