The Annual Notice of Change, or ANOC, is the letter your Medicare Advantage or Part D plan must get to you by September 30, listing every change to your premium, cost-sharing, benefits, drug coverage, provider network and service area that takes effect on January 1 (42 CFR 422.2267(e)(3)). It lands two weeks before Medicare Open Enrollment opens on October 15 for one reason: so you can decide, with the numbers in front of you, whether to keep the plan for another year.
Most people don’t open it. It arrives in the same week as a flood of plan marketing, it looks like more of the same, and nothing bad happens on the day you set it aside. The consequence shows up in January, when a copay is different, a prescription has moved tiers, or a specialist is no longer in network, and the window to do anything about it has closed.
Here is what the document is, what it must contain, the lines worth reading first, what changes for every plan in 2027 regardless of what your plan does, and what your options are if you don’t like what you see.
What the Annual Notice of Change actually is
The ANOC is not a courtesy mailing. It exists because federal rules require a Medicare Advantage organization that intends to change its plan rules for January 1 to notify every enrollee “at least 15 days before the beginning of the Annual Coordinated Election Period” (42 CFR 422.111(d)(2)). The Annual Coordinated Election Period is the formal name for Medicare Open Enrollment, which runs October 15 through December 7. Fifteen days before October 15 is September 30, which is why the ANOC has that deadline.
The same regulation, at paragraph (b), sets out what a plan must disclose to its members. The ANOC is the yearly update to that list, and it covers:
- the service area, meaning the counties where the plan operates;
- benefits, including any conditions and limitations on them;
- premiums and cost-sharing, meaning the monthly plan premium, deductibles, copays and coinsurance;
- provider access, including the composition of the network;
- prior authorization and other review requirements;
- supplemental benefits such as dental, vision, hearing or fitness, and any premium attached to them;
- out-of-area and emergency coverage rules;
- your disenrollment rights.
For a plan with drug coverage, the ANOC also flags formulary changes: drugs added or dropped, drugs moved between tiers, and new utilization rules like step therapy or quantity limits on a drug you take.
Medicare.gov’s own description is short: the ANOC “includes any changes in coverage, costs, and more that will be effective in January,” and you should “review any changes to decide whether the plan will continue to meet your needs in the next year” (Medicare.gov).
When does the ANOC arrive, and what if it doesn’t?
The rule is receipt, not mailing: plans “must send for enrollee receipt no later than September 30 of each year” (42 CFR 422.2267(e)(3)). Many plans mail in early or mid September, and most also post the document to the member portal. If you joined the plan recently with an October, November or December effective date, the plan has until the last day of the month before your coverage starts, or 10 days after CMS confirms your enrollment, whichever is later.
If it has not arrived by the first days of October, do not assume nothing changed. Medicare.gov’s instruction is one sentence: “If you don’t get this important document, contact your plan.”
The ANOC is often confused with a second, thicker document that follows it.
| Document | What it is | Deadline | How to use it |
|---|---|---|---|
| Annual Notice of Change (ANOC) | Only what is changing from this year to next | Receipt by September 30 (422.2267(e)(3)) | Read first. Find every line that moved. |
| Evidence of Coverage (EOC) | The full contract for next year: every benefit, rule, cost and appeal right | Available to current members by October 15 (422.2267(e)(1)) | Look up the detail on any line the ANOC flagged. |
| Formulary and provider directory | The drug list and network for next year | Alongside the EOC | Confirm your specific drugs and doctors, by name. |
The ANOC tells you that the specialist copay changed. The EOC tells you what counts as a specialist visit, whether a referral is required, and what happens out of network.
The seven lines to check first
An ANOC is usually laid out as a side-by-side table, this year against next. Reading the whole thing is worth an evening. If you only read seven lines, read these.
| # | Line | What to compare | Why it matters |
|---|---|---|---|
| 1 | Monthly plan premium | 2026 vs 2027 | A $0 plan premium means no monthly plan premium. You still pay the Part B premium, which is $202.90 in 2026, plus the plan’s cost-sharing when you use care. |
| 2 | Deductibles | Medical and drug, separately | A new or higher drug deductible is applied to every fill in the first months of the year. |
| 3 | Maximum out-of-pocket (MOOP) | In-network, and combined if a PPO | This is the most you pay for covered Part A and B services in a year. For 2026, CMS set the ceiling at $9,250 in network for HMOs and $13,900 combined for local PPOs (CMS CY 2026 MOOP calculations). Plans can set theirs lower, and can raise it year to year up to the ceiling. |
| 4 | Copays for what you actually use | Primary care, specialist, hospital stay per day, outpatient surgery, diagnostic imaging, ambulance | A plan that leaves the primary care copay alone and raises the per-day hospital copay looks unchanged to a healthy member and very different to one with a planned surgery. |
| 5 | Your drugs, by name and tier | Each medication you take | A tier change moves a drug from a fixed copay to a percentage coinsurance. New step therapy or prior authorization on a drug you already take is also listed here. |
| 6 | Network | Your doctors, your hospital, your pharmacy | The ANOC flags network changes in general terms. Confirm your specific providers in the 2027 directory, and call the office too. |
| 7 | Prior authorization and referral rules | Any service newly requiring approval | These rules change the experience of using the plan more than any single copay. |
Two more lines are easy to skip. Service area: if your county has been dropped, the plan is effectively ending for you, and the section on plan terminations below applies. Extras: a dental, vision, hearing, over-the-counter or fitness benefit can be reduced or removed without the core medical benefits changing at all, and for some members those extras were the reason they chose the plan.
If the numbers in your ANOC leave you unsure what a year on the plan will cost, the annual Medicare cost estimator lets you enter your own premium, deductible and copays and see the total.
What changes for every Part D plan in 2027, before your plan changes anything
Some of what you see in an ANOC is not the plan’s decision. The Part D benefit has federal parameters that reset every year, and CMS finalized the 2027 set in its Rate Announcement on April 6, 2026 (CMS, Table V-2).
| Part D standard benefit | 2026 | 2027 | Source |
|---|---|---|---|
| Standard deductible (maximum a plan may charge) | $615 | $700 | CMS CY 2027 Rate Announcement |
| Annual out-of-pocket cap on covered drugs | $2,100 | $2,400 | CMS CY 2027 Rate Announcement |
| National base beneficiary premium | — | $41.33 | CMS fact sheet, July 28, 2026 |
The out-of-pocket cap is the number to notice. In 2026, once your spending on covered drugs reaches $2,100, you pay nothing more for covered drugs that year. In 2027 that threshold is $2,400, a $300 increase that applies to every Medicare Advantage plan with drug coverage and every stand-alone Part D plan, whatever the ANOC says about the plan’s own copays. The deductible ceiling moves with it: a plan that charged the full standard deductible in 2026 may charge up to $700 in 2027.
Neither number tells you what your plan will charge. Many plans set a deductible below the standard or waive it on certain tiers, and the ANOC is where that decision appears. But if your ANOC shows a higher drug deductible for 2027, part of the reason is that the federal ceiling rose.
For Medicare Advantage medical benefits, the equivalent moving part is the MOOP ceiling. CMS recalculates it annually; the 2026 limits are in the table above, and your plan’s 2027 figure is on the ANOC. A plan whose maximum rises from, say, $5,500 to $6,750 has not changed a single copay, and has still shifted $1,250 of risk to you in a bad year. Those figures are illustrative; your ANOC has the real ones.
What happens if you do nothing
Your plan renews. That is the part the ANOC’s timing is built around.
CMS’s review booklet for this Open Enrollment, dated September 2026, puts it plainly: “If you’ve reviewed your options and you’re happy with your current coverage, you don’t need to do anything (your coverage will continue automatically)” (CMS Product No. 11220). The same sentence applies to someone who never opened the envelope. Automatic renewal is not a decision the plan makes about you; it is the default when you make no decision at all, and every change in the ANOC comes with it.
The calendar around the notice, from the same booklet and from Medicare.gov’s enrollment periods page:
| Date | What happens |
|---|---|
| By September 30 | ANOC must reach you. |
| October 1 | CMS’s own “get ready” date: review your notices, then compare plans at Medicare.gov/plan-compare. |
| October 15 | Open Enrollment begins. You can join, switch or drop a Medicare Advantage or drug plan, or return to Original Medicare. |
| December 7 | Open Enrollment ends. The plan must receive your request by this date. |
| January 1 | New coverage starts. If you kept your plan, every change in the ANOC starts too. |
| January 1 – March 31 | Medicare Advantage Open Enrollment. If you are in a Medicare Advantage plan, you can make one switch to another Medicare Advantage plan, or drop to Original Medicare with the option of a drug plan. Changes take effect the first of the following month. |
The January-to-March window is a real second chance, but a narrower one. It is only for people already in a Medicare Advantage plan, it allows one change, and it does not let someone on Original Medicare with a stand-alone drug plan switch drug plans. The enrollment window checker walks through which periods apply to your situation.
One more note for anyone weighing a move in the other direction. The same CMS booklet warns that if you have Medigap and join a Medicare Advantage plan, “you may not be able to get the same Medigap policy back later depending on your state’s Medigap enrollment rules and your situation.” In Florida, outside a guaranteed issue situation or a trial right, a Medigap application after the six-month open enrollment window is medically underwritten. We covered how that works in what happens if you miss the Medigap window.
What if the ANOC says the plan is ending or leaving your area?
Some ANOCs are really termination notices. The plan is not renewing its contract, is withdrawing from your county, or is being ended by Medicare. If that is what yours says, two things open up that an ordinary ANOC does not.
A Special Enrollment Period. If your plan’s contract is not renewed for the coming year, you can switch to another Medicare Advantage or drug plan between December 8 and the last day of February (Medicare.gov Special Enrollment Periods). If the plan ends its contract mid-year, the window runs from 2 months before to 1 month after the contract ends; if Medicare ends the contract, from 1 month before to 2 months after. In practice, most people in a non-renewing plan simply choose a new one during Open Enrollment so there is no gap on January 1.
A guaranteed issue right to Medigap. If you go back to Original Medicare rather than joining another Medicare Advantage plan, CMS’s Medigap guide lists these as guaranteed issue situations: “Your plan is leaving Medicare,” “Your plan stops giving care in your area,” “You move out of the plan’s service area,” and “Your plan’s network has a significant change” (CMS Product No. 02110, Section 3). The right is to buy Medigap Plan A, B, D or G sold in your state, or Plan C or F if you were eligible for Medicare before January 1, 2020, with no medical underwriting. You can apply up to 60 days before your plan coverage ends, or by the date in the plan’s termination notice, and no later than 63 days after it ends. The guide adds one condition worth reading twice: “You only have this right if you switch to Original Medicare (rather than join another Medicare Advantage Plan).”
Two trial rights sit alongside those, and they do not require the plan to end. If you joined a Medicare Advantage plan when you were first eligible for Medicare at 65 and leave within the first year, you can buy any Medigap policy sold in your state. If you dropped a Medigap policy to try Medicare Advantage for the first time and leave within a year, you can get the old policy back if the same company still sells it. Both carry the same 60-days-before, 63-days-after deadline.
Missing that 63-day mark is the expensive mistake. Past it, in Florida, a Medigap carrier can ask health questions and decline the application. If your ANOC is a termination notice and you have any interest in Original Medicare plus a supplement, the deadline is the first thing to write down.
Reading your ANOC in Tampa Bay
Three local facts shape how the ANOC reads here.
There is a lot to compare it against. For 2026, CMS’s landscape file lists 133 Medicare Advantage and Part D plan options in Hillsborough County (CMS CY2026 Landscape). That is the market your plan’s 2027 changes will be measured against, and it is why an ANOC that looks “about the same” can still leave you on a plan that is no longer the one you would choose. Your plan’s ANOC only tells you what your plan did. It says nothing about what the other 132 did.
Florida has a counselor on the other end of the phone. Florida’s State Health Insurance Assistance Program is SHINE, run through the Department of Elder Affairs, and CMS lists it at (800) 963-5337 for personalized counseling (CMS SHINE contact). SHINE counselors do not sell insurance. If you want a second reading of your ANOC from someone with no product to place, that is who to call.
Medigap prices are public. If your ANOC pushes you toward Original Medicare with a supplement, the Florida Office of Insurance Regulation publishes a CHOICES rate comparison that returns Medicare Supplement premiums by Florida county and age. You can price Plan G in Hillsborough County before you decide whether to use a guaranteed issue right, and the Plan G vs Plan N comparison shows how the two most common letters differ in what you pay at the point of care.
Snowbirds have one extra line to check. A plan’s service area is its counties, and if you spend part of the year outside Florida, the ANOC’s service area and out-of-area rules decide what routine care is covered while you are away. We covered the mechanics in whether Medicare Advantage covers you out of state.
A simple way to work through it
- Open it the week it arrives. Not in November. Every option below is easier with time.
- Mark the seven lines. Premium, deductibles, MOOP, the copays you use, your drugs by tier, your providers, prior authorization. Circle anything that moved.
- Confirm the specifics. For each drug, check the 2027 formulary. For each doctor, check the 2027 directory and call the office.
- Price the year, not the premium. Add the Part B premium, the plan premium, the deductibles and the copays for a normal year for you. Then look at the MOOP for a bad year.
- Decide by December 7. Keep the plan, switch plans, or return to Original Medicare. If the answer is keep, you are done. If it is anything else, the plan must receive the request by December 7.
- If the plan is ending, write down 63 days. That is the guaranteed issue clock if you want Medigap.
If you would like a second set of eyes on your ANOC before Open Enrollment, Virginia reviews them with Tampa Bay families every fall. It is an education conversation, not a sales pitch, and it is easier in October than in the first week of December. Schedule a time and bring the letter.