How to Review Your Current Coverage

Cassidy Clark

Sep 7

2 min read

Before you can decide whether to keep, adjust, or replace your Medicare coverage this fall, you need a clear picture of what you actually have right now. Here's how to give your current plan an honest look before AEP opens.

Start With Your ANOC and EOC

If you have a Medicare Advantage or Part D plan, your insurer is required to mail you an Annual Notice of Change (ANOC) by September 30 [1]. It arrives alongside or shortly before your Evidence of Coverage (EOC). Together, these two documents lay out exactly what's changing in your plan for next year, including cost, coverage, and network updates [1].

Don't treat this envelope like junk mail. It's the single most useful document you'll get all year for evaluating whether your current plan still fits. If you're enrolled in a Medicare Advantage or Part D plan and haven't received your ANOC by early October, contact your plan directly to request it.

Check the Numbers That Matter Most

Read the ANOC side by side with what you're paying today and look specifically for changes to:

Monthly premium, if applicable
Annual deductible
Maximum out-of-pocket limit (for Medicare Advantage plans)
Copays and coinsurance for the services you use most

A small premium change can hide a much bigger shift in what you'd actually pay over the year, so look past the headline number.

Confirm Your Doctors and Pharmacies Are Still In-Network

Provider networks change at any time. Your SGIA Benefit Consultant can help you confirm that your preferred doctors, specialists, and facilities are still contracted with your plan for next year [2]. The same goes for your pharmacy; a network change here can significantly affect what you pay for prescriptions.

Look Closely at Your Prescription Drug Coverage

Formularies (the list of drugs a plan covers) and drug tiers can shift from year to year [3]. Pull your current medication list and check:

Is each medication still on the plan's formulary for next year?
Has any medication moved to a higher-cost tier?
Are there new coverage rules, like prior authorization or quantity limits, that weren't there before?

Factor In Any Health Changes

Finally, think about the year you've actually had. This isn’t only a healthcare decision, this is a healthcare finance decision. New diagnoses, new medications, or planned procedures can all change what "the right plan" looks like for you going into next year, even if nothing about your plan itself has changed.

Reviewing all of this on your own can feel like a lot, especially with the ANOC's dense formatting. SGIA Medicare Consulting can walk through your ANOC and current coverage with you and help you decide what, if anything, needs to change.

We're scheduling appointments now for AEP (October 15 – December 7), and you can start the conversation with us as early as October 1. Visit sgiamedicare.com/schedule-appointment or call 888-284-3314.