By Christian BrinkleyLicensed NC Insurance Agent, NPN 22217190, NC Life & Health · Updated October 14, 2026 · 4 min read
Every fall, your Medicare Advantage or Part D plan sends you an Annual Notice of Change, or ANOC. It arrives by September 30. It tells you what is changing in your plan for next year. It is not junk mail. It is one of the most important letters you will get all year. Plans change yearly. Premiums, deductibles, copays, drug formularies, doctor networks, and extra benefits can all shift. Your ANOC tells you exactly what is changing so you can decide whether to stay or switch during Annual Enrollment, October 15 to December 7.
When You Get It
Your plan must send the ANOC by September 30, by mail or electronically if you chose paperless. If you have a Medicare Advantage plan with drug coverage, one ANOC covers both. If you have separate Part D, you get one for each.
Summary of Changes
The first page or two is a summary of the biggest changes. Read this first. It usually shows a table: this year, next year, and what changed, covering premium, deductible, maximum out of pocket, and key copays.
Deductible
The deductible is what you pay before the plan starts paying. The Part D deductible resets every January 1. If it is rising, you pay more early in the year.
Copays and Coinsurance
Copays are flat amounts per service, like 20 dollars for a primary care visit. Coinsurance is a percentage, like 20 percent. Your ANOC lists changes for common services.
Maximum Out of Pocket
The maximum out of pocket, or MOOP, is the most you pay in a year for covered medical services. After you hit it, the plan pays 100 percent of covered services the rest of the year. It does not include premiums or drug costs, which are tracked separately.
Drug Formulary Changes
This section is critical if you take prescriptions. The formulary is your plan covered drug list. Your ANOC notes drugs added or removed, drugs moving tiers, and new rules like prior authorization or step therapy.
Pharmacy Network Changes
Plans have preferred pharmacies where you pay less, standard pharmacies where you pay more, and out of network pharmacies where you pay the most. Check that your pharmacy is still in network and still preferred. A pharmacy moving from preferred to standard raises your costs even if the formulary did not change. Also check mail order terms for 90 day supplies.
Doctor and Hospital Network Changes
For Medicare Advantage HMO or PPO plans, the ANOC may note that networks can change during the year. It may not list every doctor joining or leaving, but it tells you where to find the current provider directory.
Extra Benefits Changes
Medicare Advantage plans often include dental, vision, hearing, gym membership, transportation, or an over the counter allowance. These can change a lot year to year. A dental allowance might drop from 1,000 to 500 dollars. A gym program might be replaced.
Service Area Changes
Your ANOC notes service area changes. If your plan stops serving your county or ends entirely, you may qualify for a Special Enrollment Period. If your plan is ending, you will get more notices. If you do nothing, you may be returned to Original Medicare. Read any non renewal letter carefully.
What to Do After Reading
Get help if you need it. Your state SHIP program offers free, unbiased counseling. In North Carolina, it is called SHIIP. Counselors can walk through your ANOC and run a Plan Finder comparison. You can also call 1-800-MEDICARE or a local licensed insurance agent.
Common Mistakes
This article is general information only. It is not personal advice or a recommendation about any specific plan.
Questions people ask me about this
What to do after reading?
Decide whether the changes are acceptable. A small premium increase with stable doctors, drugs, and copays may be fine. A drug tier jump, a doctor leaving the network, or a MOOP spike is worth comparing against other plans. Compare during Annual Enrollment, October 15 to December 7, using the Medicare Plan Finder.
When you get it?
Your plan must send the ANOC by September 30, by mail or electronically if you chose paperless. If you have a Medicare Advantage plan with drug coverage, one ANOC covers both. If you have separate Part D, you get one for each. If yours has not arrived by early October, call your plan. You need it before Annual Enrollment starts.
What should I know about summary of changes?
The first page or two is a summary of the biggest changes. Read this first. It usually shows a table: this year, next year, and what changed, covering premium, deductible, maximum out of pocket, and key copays. Watch the direction of changes. A 10 dollar monthly premium increase is 120 dollars a year.
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