For those of us enrolled into Original Medicare (Parts A and B), most of us have also enrolled into one of Medicare’s Part D Prescription Drug Plans (PDPs). Each year, we may make changes to this prescription coverage during Medicare’s Open Enrollment period, which runs from Oct. 15 through Dec. 7, for changes which will then go into effect from Jan. 1 onward. Leading up to this Open Enrollment, you will start to receive notices with information relating to any changes in your plan for the coming year. It is important to read and understand these notices, as they can help you decide if you should make changes to your coverage during Open Enrollment.
Annual Notice of Change and Evidence of Coverage
If you have a Part D prescription drug plan, you should receive a notice called an Annual Notice of Change (ANOC), and an Evidence of Coverage (EOC). Your plan should send you these notices by Sept. 30. If you do not receive these notices, contact your plan to request copies. There are three kinds of annual plan changes to look for in an ANOC or EOC:
First, look for changes to your plan’s deductibles and copayments, which can change each year. For example, your plan may not have a deductible in 2024 but could have one in 2025.
Second, look for changes to the plan’s pharmacy network. Plan networks can change each year, which means your pharmacy may not be in your plan’s network for 2025. Your preferred in-network pharmacy options may not be the same. If you obtain your prescription from an out-of-network pharmacy, your co-pay will likely be greater.
And third, look for changes to the plan’s formulary, which is the list of drugs the plan covers. Formulary changes can happen from year to year, meaning your prescription drugs may not be covered in 2025 even if these are covered during this year. Even if still on the plan’s formulary, the cost of your drugs may have changed. After reading about the changes to your coverage for 2025, decide whether your plan will still be able to meet your needs in the upcoming year. If not, I encourage you to review your options during the Open Enrollment period. The certified Medicare counselors in the Medicare Information Office will be glad to help you complete a prescription drug plan review to find the lowest cost plan for you.
Plan Non-Renewal Notice and Consistent Poor Performance Notice
In October, plans leaving the Medicare program in the coming year send out a Plan Non-Renewal Notice to people enrolled in the plan. If you receive this notice, you should make sure you are covered in 2025. You can choose to enroll in a new Part D plan during Open Enrollment, which again is Oct. 15 through Dec. 7. If you receive this notice, you may also enroll in a new plan up until the last day in February. You will be disenrolled from your previous plan starting Jan. 1, though, so if you do not pick a new plan by then you will likely experience a gap in coverage until you enroll in a new plan.
In late October, Medicare will also send a Consistent Poor Performance Notice to people enrolled in a plan that has received a low rating for three or more years in a row. A low rating is three stars or fewer out of five. The notice encourages you to complete a Part D Prescription Drug Plan review and choose another plan which has better service and support, and fully meets your prescription drug plan needs.
Medicare Summary Notice
Every three months, you should receive a Medicare Summary Notice (MSN), which provides a summary of the services and items you have received and how much you may be billed for them. Reading your MSN is important for detecting potential Medicare fraud, errors or abuse. Keep the following tips in mind:
Review your Medicare statements as soon as they arrive.
Keep notes of your medical appointments and compare these to your statements.
Confirm that everything listed on the statement is accurate — in other words, that you actually received all listed services or items.
Contact your health care provider if you have questions or notice any mistakes.
Contact our office for a My Health Care Tracker (which helps you keep track of your appointments) or to receive assistance reading your Medicare statements.
To discuss any of these notices, or to ask any questions regarding your specific situation, please contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
