What Is an Annual Notice of Change (ANOC)?

The Annual Notice of Change — everyone calls it the ANOC — is a letter your Medicare Advantage plan or Medicare drug plan sends you every fall, telling you exactly what it’s changing about your coverage effective January 1. CMS requires plans to get it to you by September 30. It comes from the plan you’re already in, not from a company trying to sell you something.

It is, without much competition, the most useful piece of Medicare mail you receive all year. It is also the one most likely to end up in the recycling, because it arrives the same week your mailbox fills with plan advertising and it looks like more of the same.

If you read nothing else this fall, read this one.

What’s actually in it

The ANOC lays your coverage out in two columns: what you pay and get this year, next to what you’ll pay and get next year. CMS describes the notice as covering your plan’s formulary, benefit design, and premium changes for the coming year.

In practice, that means:

• Your monthly premium, and whether the plan is charging one at all next year
• Your deductibles — both the medical deductible, if the plan has one, and the Part D drug deductible
• Your copayments and coinsurance — primary care, specialists, hospital stays, urgent care, imaging, therapy
• Your maximum out-of-pocket — the ceiling on what a Medicare Advantage plan can make you pay in a year for covered medical services
• The drug list (formulary) — which of your prescriptions are still covered, what tier they sit on, and whether any new restrictions apply
• The service area — whether the plan still covers the county you live in

Plans use a standard template CMS publishes, so the ANOC from one company is laid out much like the ANOC from another. That’s deliberate, and it’s what makes side-by-side comparison possible.

What the ANOC is not

The ANOC is a summary of changes. It is not the full rulebook.

The full rulebook is a separate, much longer document called the Evidence of Coverage (EOC), which spells out everything the plan covers, every cost, and every procedure for appeals and grievances. CMS’s instructions to plans set a later deadline for that one — October 15 — and allow a plan to send you a short notice telling you how to access or request the EOC rather than mailing the whole book. So if a slim envelope shows up in October pointing you at a website, that’s the EOC notice, and you can still ask for a paper copy.

The ANOC is also not a bill, not an enrollment form, and not something you have to sign or return. Nothing about it requires action. It’s information.

The rest of the fall mail, and how to tell it apart

Here’s what CMS published for the most recent cycle, which is the pattern to expect:

Two of these get confused with each other constantly. The ANOC says your plan is continuing but changing. The Plan Non-Renewal Notice says your plan is going away entirely. Those call for very different responses, and the second one carries an enrollment right the first one doesn’t — more on that below.

How to read it in ten minutes

You don’t have to read the whole thing. Work down this list:

1. Find the premium line. Compare the two columns. Note the difference.
2. Find your prescriptions on the drug list. Every one of them, by name and dosage. Check that each is still covered, note the tier, and look for any new prior authorization, step therapy, or quantity limit. A drug moving up one tier can change your year more than a premium change does.
3. Check the maximum out-of-pocket. This is your worst-case number in a bad year. People skip it because they don’t expect a bad year.
4. Check the deductibles, medical and drug.
5. Check the copay for whatever you actually use. If you see a specialist monthly, the specialist copay matters more than anything else on the page. If you had a hospital stay last year, read the inpatient per-day rates.
6. Check the extra benefits — dental, vision, hearing, over-the-counter allowances, transportation. These aren’t standardized by Medicare, which means they’re the parts a plan can change most freely from year to year.

Then ask one question: given what I actually used last year, does this plan still work for me? If yes, you’re done — doing nothing is a legitimate choice, and your coverage continues automatically. If no, you have from October 15 to December 7 to change it.

What people get wrong

Assuming the ANOC is junk mail. It arrives in an envelope from your insurance company in the middle of advertising season. Look at the return address: it’s from the plan you’re already enrolled in, and the document is titled “Annual Notice of Change.”

Reading only the premium. A plan that drops its premium and moves your maintenance drug to a higher tier has not gotten cheaper for you. The premium is one line out of dozens.

Not checking the network. The ANOC covers costs and benefits. Your doctor’s network status is a separate question, answered by the plan’s provider directory — which CMS also requires plans to make available for the coming year. A doctor being in-network this year guarantees nothing about next year, and provider contracts can change mid-year too.

Throwing it out because “nothing changed last year.” Plans revise costs, benefits, networks, and drug lists annually. A quiet year doesn’t predict the next one.

Not noticing it never came. If September ends and you haven’t received an ANOC, that’s not normal. Medicare’s guidance is straightforward: contact your plan and ask for it. Plans are required to send it, and CMS tracks whether they did.

Confusing it with the non-renewal notice. If your plan is leaving Medicare next year, you’ll get a separate notice in October, and you get a Special Enrollment Period running December 8 through the last day of February to pick something new. If you don’t join another Medicare Advantage plan before your current one ends, you’ll be in Original Medicare. That extra window only applies to non-renewal — an ordinary ANOC does not extend your December 7 deadline by a single day.

If you get Extra Help

Along with the ANOC, plans send an LIS rider by September 30 to everyone who qualifies for Extra Help. It tells you how much help you’ll get next year toward your Part D premium, deductible, and copayments. The ANOC shows the plan’s standard costs; the rider shows what those costs mean for you specifically. Keep it with your Evidence of Coverage — they only make sense together.

Where to get help reading it

Your State Health Insurance Assistance Program (SHIP) offers free, personalized counseling and will go through the notice with you. 1-800-MEDICARE (1-800-633-4227) is staffed 24 hours a day, including weekends; TTY users can call 1-877-486-2048. And Medicare’s Plan Finder at Medicare.gov/plan-compare will estimate your total yearly cost under your current plan and under the alternatives, once next year’s plan data posts on October 1.

The ANOC won’t tell you what to do. It tells you what’s about to happen. What you do with two months’ warning is up to you — but the warning only works if you open the envelope.

Sources: Medicare.gov, “Plan Annual Notice of Change (ANOC)” (medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/upcoming-plan-changes); Medicare.gov, “Evidence of Coverage (EOC)”; Medicare.gov, “Plan Non-Renewal Notice”; Medicare.gov, “Open Enrollment” (medicare.gov/health-drug-plans/open-enrollment); Medicare.gov, “Special Enrollment Periods”; CMS, “Guide to consumer mailings from CMS, Social Security, and plans,” November 2025 (cms.gov); CMS Product No. 11220, “Your Yearly Medicare Review,” September 2025 (medicare.gov); CMS, “Annual Notice of Change and Evidence of Coverage Submission Requirements” and CY 2026 model material release memoranda (cms.gov); CMS, “Marketing Models, Standard Documents, and Educational Material” (cms.gov).