If you are on Medicare there is something important you should know.
The plan you chose last year is not necessarily the right plan for this year.
Not because you made a bad decision. Not because your health has changed. But because Medicare plans change every single year and most beneficiaries have no idea it is happening until they are standing at a pharmacy counter in January wondering why their prescription suddenly costs three times what it did in December.
This is one of the most common and most preventable problems in Medicare. Here is what you need to know.
Medicare Plans Are Not Static
Every September, Medicare Advantage and Part D prescription plans are required to send their enrolled members an Annual Notice of Change.
Annual Notice of Change (ANOC) documents are typically mailed out in late September. By law, insurance providers are required to ensure you receive these documents no later than September 30, right before the Annual Enrollment Period (AEP) begins on October 15. [1, 2, 3]
The ANOC explains all changes coming to your plan on January 1st. Premium adjustments. Network changes. Formulary updates. Cost sharing modifications. Deductibles. Copays. New requirements for prior authorizations. [1]
This document is also one of the most consistently ignored pieces of mail in America.
Not because people do not care. Because it arrives in an envelope that looks like every other piece of insurance mail, it is written in language that requires genuine effort to parse, and life is busy.
But inside that document is information that can significantly affect what you pay for healthcare in the coming year.
If you have not received yours by early October, it is highly recommended to reach out directly to your insurance provider to request another copy, or log into your online member portal where the document should also be posted. [1, 2]
The Formulary Problem
Your plan's formulary is the list of drugs it covers and at what cost tier.
Tier 1 and 2 drugs are the least expensive. Tier 3 and above can cost significantly more. And every year carriers review their formularies and make changes. Drugs move between tiers. Some get removed entirely. New generics get added.
If your medications moved to a higher tier on January 1st and nobody told you, you found out at the pharmacy. And if it happened after December 7th, the Annual Enrollment Period window had already closed, meaning you are locked into that plan for the rest of the year.
This is not a rare scenario. It happens to Medicare beneficiaries across the country every single January.
The Network Problem
Medicare Advantage plans use networks of doctors, hospitals, and specialists. Those networks change every year too. Unfortunately, these changes can happen throughout the year and don’t line up to the Annual Election Period.
A provider who was in your plan's network last year may have dropped the plan this year. Your specialist. Your primary care doctor. Your preferred hospital. None of them are required to notify you directly when they leave a network.
You find out when you show up for an appointment and hand over your insurance card.
Out of network costs on a Medicare Advantage plan can be significantly higher than in network costs. In some cases, they are not covered at all depending on the plan type.
The Problem with Your Medigap/Medicare Supplement Plan Premiums
A common misconception is that you can choose a new Medigap plan during the Annual Election Period. In Nebraska, you will have to pass underwriting to be accepted into a new Medicare Supplement plan, meaning you will have to answer health questions. And you can shop for a new plan any time of the year, there is not an annual election period for these plans.
An exception is if you used your 12-month trial right of trying a Medicare Advantage plan, or if your current Medicare Advantage plan has left the market. Then you will have Guaranteed Issue into a Medigap/Medicare Supplement Plan.
If your Medicare Supplement plan premiums have become unaffordable, the Annual Election Period is the time to enroll in a Medicare Advantage plan. Enrolling in the Medicare Advantage plan automatically disenrolls you from your Drug plan. You would have to call your Medicare Supplement/Medigap plan to cancel. And you may want to consider also cancelling your Dental and Vision plans.
What To Do About It
The window to make changes to your Medicare plan is the Annual Election Period. October 15 through December 7 every year.
The beneficiaries who navigate the Annual Enrollment Period successfully are the ones who review their current plans, note any changes in their health or medications, and walk into Fall with a trusted, local independent insurance agent who knows them and their needs.
That preparation is the difference between a good decision made thoughtfully and a rushed decision made under deadline pressure.
The Bottom Line
Your Medicare plan deserves a review every single year. Not just when something goes wrong.
If your prescriptions or premiums have gotten more expensive, if you have started seeing new doctors, or if you have simply never had anyone walk you through your plan in plain language, fall is the right time to have that conversation.
Mary the Medicare Lady offers free Medicare reviews for beneficiaries who want to make sure their current plan is still their best option. There is no pressure and no obligation to change anything.
The IRMAA Problem
One last thing. This one surprises people every time.
Medicare Part B and Part D premiums are not the same for everyone. If your income was above a certain threshold two years ago, you are paying a surcharge called IRMAA, Income Related Monthly Adjustment Amount, on top of your standard premium right now.
The income Medicare uses to calculate this is from your tax return two years prior. So, your 2026 premium is based on your 2024 income. In 2027, your premium will be based on your 2025 income.
The good news is that IRMAA surcharges can be appealed if your income has decreased due to a qualifying life event. Most people do not know this option exists. Feel free to reach out for more information.
This article is for educational purposes only and should not be treated as tax or legal advice. Rules can change, and individual facts matter.