How do you review your Medicare plan each year?
Open your ANOC (arrives September) → verify every doctor by NPI number in the 2026 provider directory → check each medication’s formulary tier and prior auth status → calculate total annual cost including premium, copays, drug costs, and Part B ($202.90/mo) → decide switch or stay before December 7. A licensed NC broker does all 5 steps in one free 30-minute appointment. Call (828) 761-3326.
5-Step Annual Medicare Review
Complete between September and December 7 every year · ANOC arrives September · AEP closes December 7
Open Your ANOC
Annual Notice of Change. Mailed September. Lists every plan change for 2026. Most valuable Medicare document you receive each year.
Verify Doctors by NPI
Search every provider in the 2026 directory by NPI number — not just name. Check hospital, surgeons, anesthesiologists separately.
Check Drug Formulary
Run each medication against the 2026 formulary. Note tier changes, new prior auth requirements, preferred pharmacy status.
Calculate Total Cost
Premium × 12 + copays + drugs + Part B ($202.90/mo). Compare your plan vs 2–3 alternatives. Include OOP max worst-case.
Switch or Stay by Dec 7
AEP closes December 7. Changes effective January 1. A broker does all 5 steps in one free appointment. Call (828) 761-3326.
Why Reviewing Every Year Matters
Medicare plans change every January 1. Your premium, copays, drug formulary, provider network, out-of-pocket maximum, and supplemental benefits can all shift — and your plan is only required to tell you once, in a document called the Annual Notice of Change that most people set aside without reading. A 30-minute annual review catches changes that cost $420–$3,000+ per year. Below are all 5 steps, in order, with what to look for and what it costs if you skip each one.
This checklist applies to Medicare Advantage (MA-PD) and standalone Part D plans in North Carolina. Medigap policyholders still need to review their standalone Part D plan and Original Medicare costs annually. Call (828) 761-3326 for a free review appointment.
What it is: A document your plan mails every September listing every change for the coming plan year: premium increases or decreases, copay changes, formulary updates, network changes, benefit modifications, and new prior authorization requirements. It is the starting point for every review decision.
What to look for: Premium increase or decrease. Copay changes (primary care, specialist, ER, hospital). OOP maximum change — an increase means higher worst-case exposure. Formulary changes — drugs added, removed, or moved to different tiers. Network changes — providers leaving or joining. Supplemental benefit changes — dental allowance, OTC credit, vision benefit, hearing benefit, transportation.
If you skip it: You discover changes at the pharmacy counter in January ($420+ per tier change) or at the doctor’s office when told your provider is now out-of-network. The ANOC gives you the full picture before the December 7 deadline to act.
Where to find it: Mailed to your address on file each September. Also available on your plan’s member website under “Documents” or by calling member services. If you did not receive it, call your plan directly or call (828) 761-3326 and we will pull it up for you.
Most people search their doctor by name in the plan’s online directory. This works most of the time — but fails in exactly the situations where it matters most. Two doctors at the same practice can have the same name but different NPI numbers. A doctor who joined a new group may appear under the new group name but not their previous one. Hospital-based providers like anesthesiologists, hospitalists, and radiologists rarely appear in name searches but are the most common source of surprise bills.
The National Provider Identifier (NPI) is a unique 10-digit number assigned to every licensed healthcare provider. It never changes, even if the provider moves practices or changes their name. Ask your doctor’s office for their NPI — they can give it to you in 30 seconds. Then search the plan’s 2026 directory by NPI to confirm in-network status.
🔓 Verify These Providers by NPI
- Primary care physician
- Every specialist you see regularly
- Preferred hospital facility (separate NPI from physicians)
- Surgeons you’ve used or plan to use
- Anesthesiologists (ask hospital for list)
- Hospitalists (ask hospital for list)
- Radiologists at your preferred imaging center
- Preferred pharmacy (retail and mail-order)
💰 Cost of Out-of-Network Surprises
- Out-of-network primary care: $150–$300/visit
- Out-of-network specialist: $500–$1,500/visit
- Out-of-network hospital stay: $10,000–$50,000+
- Surprise anesthesiologist bill: $2,000–$5,000
- Non-preferred pharmacy copays: +20–50%
- Out-of-network imaging: $400–$2,000/study
- HMO out-of-network: $0 coverage for non-emergency
Medicare Advantage HMO plans require you to use in-network providers for all non-emergency care — the consequence of an out-of-network visit is often 100% of cost with no plan payment. PPO plans allow out-of-network use at significantly higher cost-sharing. If any of your providers have left your HMO’s network, switching to a PPO may be worth a higher premium to keep access. A broker compares both. Call (828) 761-3326.
The Medicare Part D formulary is a tiered pricing system. Every covered drug is placed on a tier, and your cost-sharing depends entirely on which tier your drug lands on. Plans can change tiers year to year without your consent — and you only find out when the ANOC arrives in September or when you pick up your prescription in January. Check each drug against the 2026 formulary while there is still time to switch.
What to check per drug: Is it still covered? What tier is it on? Are there new prior authorization or step therapy requirements? Is your preferred pharmacy still “preferred” under this plan? Does a competing plan offer a better tier for the same drug at a lower total annual cost?
The 2026 Part D out-of-pocket cap is $2,100. Once you hit it, you pay $0 for covered drugs through December 31. But the cap does not change how fast you hit it or how much you pay per prescription along the way. A drug on Tier 3 at $47/mo means you pay $444 more per year than Tier 1 at $10/mo before the cap ever kicks in. Tier review remains the single most impactful step in drug plan selection. Call (828) 761-3326 for a free formulary check across all available NC plans.
Premium is the number most people use to compare plans. It is also the least informative single metric. A $0 premium plan with a $6,500 out-of-pocket maximum and Tier 3 drugs is far more expensive for most beneficiaries than a $45/month plan with a $3,000 OOP max and Tier 1 drugs. Total annual cost forces an honest comparison.
Real example: Current plan: $0 premium + $1,200 estimated medical + $800 drugs = $2,000 out of pocket. Alternative: $35/month ($420/year) + $600 medical + $400 drugs = $1,420 out of pocket. The plan with a premium saves $580/year — and often has a lower OOP max too.
Worst-case comparison matters most for anyone with a chronic condition or upcoming procedure. A $0 premium plan with a $6,500 OOP max carries a worst-case total of $8,935 (including Part B). A $45/month plan with a $3,000 OOP max carries a worst-case of $5,954. That $2,981 difference is the real cost of the “free” plan in a serious health event year.
Once you have the full cost picture from Steps 1–4, the switch-or-stay decision becomes data-driven. The goal is not to chase the newest plan or the lowest premium — it is to find the plan that delivers the best total value for your specific doctors, medications, and health profile in 2026.
✓ Reasons to Stay
- All doctors verified in-network for 2026
- Drug tiers unchanged or improved
- OOP maximum same or lower than 2025
- Total annual cost competitive with alternatives
- Prior authorization process has been smooth
- Supplemental benefits (dental, vision, OTC) still valuable
- No major medical procedures planned for 2026
↻ Reasons to Switch
- A doctor or specialist left the network
- Drug costs increased $200+ from tier changes
- OOP maximum increased $500 or more
- A competing plan offers same network at lower total cost
- Prior auth denials have been frequent or frustrating
- Upcoming surgery — compare OOP max and surgeon coverage
- Specialty drug user — check Tier 5 on every available plan
The Annual Enrollment Period runs October 15 – December 7 every year. Changes take effect January 1. After December 7, you are locked in until next AEP — unless you qualify for a Special Enrollment Period. The MA Open Enrollment Period (January 1 – March 31) allows one switch between MA plans or back to Original Medicare, but you cannot use it to add a Medigap plan without medical underwriting in North Carolina. Broker appointments fill up by late November. Call (828) 761-3326 now.
Last AEP I reviewed a client’s plan who said “everything is fine, I’ll just stay.” Her ANOC showed: one medication moved from Tier 1 to Tier 3 ($420/year increase), her OOP max went from $4,500 to $5,500 (+$1,000 worst-case exposure), and her preferred pharmacy lost preferred status (copays up 40%). Total impact of staying without reviewing: $900+ per year in hidden increases. We found an alternative plan with all the same doctors, lower drug tiers, and a $3,500 OOP max. She saved $1,400 the first year. The 30-minute review paid for itself 46 times over. Bring your ANOC, medication list, and doctor list — or just call (828) 761-3326 and I’ll walk through every step with you.
Free Annual Plan Review — All 5 Steps in One Call
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What is the ANOC and when does it arrive?
The Annual Notice of Change is mailed by your Medicare plan every September. It lists every change taking effect January 1: premium changes, copay changes, formulary updates, network changes, benefit modifications, and new prior authorization requirements. It is the most important Medicare document you receive each year and the starting point for every annual review. If you did not receive your ANOC, call your plan’s member services or call (828) 761-3326 and Rob will pull it up with you.
How do I check if my doctor is still in-network for 2026?
Look up each doctor by NPI number in the plan’s 2026 provider directory — not the current year’s directory and not just by name. NPI is a unique 10-digit identifier that never changes, even if the provider moves practices. Ask your doctor’s office for their NPI, then search the 2026 directory. Also verify hospital facility, surgeons, anesthesiologists, and hospitalists separately — they are the most common source of surprise out-of-network bills. A broker verifies all providers by NPI before recommending any plan. Call (828) 761-3326.
What does a drug tier change actually cost per year?
A single drug moving from Tier 2 at $12/month to Tier 3 at $47/month costs $420 more per year. Three drugs changing tiers equals $1,260/year in hidden cost increases. A drug moving to Tier 5 specialty with 33% coinsurance can cost $2,000+ per year on that medication alone. The 2026 Part D $2,100 cap protects your annual ceiling but does not change how much you pay before reaching it. Check every medication against the 2026 formulary before AEP closes December 7. Call (828) 761-3326 for a free formulary check across all available NC plans.
When is the deadline to switch Medicare plans?
The Annual Enrollment Period runs October 15 through December 7 every year. Changes take effect January 1. If you miss AEP, the Medicare Advantage Open Enrollment Period (January 1 – March 31) allows one switch between MA plans or back to Original Medicare with a standalone Part D plan. However, you cannot use MA OEP to add a Medigap plan without medical underwriting in North Carolina. Call (828) 761-3326 before December 1 — broker appointments fill up in late November.
Can a broker do all 5 review steps for me?
Yes — all 5 steps in one free appointment at no cost to you. Rob reviews your ANOC, verifies every doctor by NPI in the 2026 directory, runs every medication through each plan’s formulary, calculates total annual cost for your current plan and 2–3 alternatives, and gives you a clear switch-or-stay recommendation. Carriers pay the broker fee. Call (828) 761-3326 or book at calendly.com/robert-generationhealth.
Does the $2,100 Part D cap mean I don’t need to review drug tiers?
No. The 2026 Part D $2,100 cap protects your annual ceiling but does not change how fast you reach it or how much you pay per prescription before you do. A drug on Tier 3 at $47/month versus Tier 1 at $10/month means you pay $444 more per year on that one drug before the cap activates. If you take 3+ medications, tier placement differences can total $1,000–$2,000 per year in pre-cap costs. Tier review is still the most impactful single step in drug plan selection. Call (828) 761-3326 for a free formulary check.
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