Your plan's Annual Notice of Change: 4 lines that predict next year's denials

Track: Medicare Advantage

If you’re in a Medicare Advantage (MA) plan, a thick envelope probably arrived in September. (If you chose email delivery, it came to your inbox.) It’s your Annual Notice of Change (ANOC). Plans must send it by September 30. It lists what changes in your plan on January 1.

Many people skim it for the premium and toss it. Here’s the catch: the ANOC is also a preview of next year’s denials. Every new prior-authorization rule, every network change, every drug that moves to a higher tier is a place where a claim could be denied in 2027.

You don’t need to read every page. You need to read four sections — the four “lines” in this post — with your own care in mind.

Medicare’s Open Enrollment Period, when you can change plans for 2027, runs October 15 – December 7. Checking now gives you time to ask questions before it ends.

First, pull your last 12 months of EOBs

Before you open the ANOC, gather your Explanation of Benefits (EOB) statements from the past year. Your plan mails them, and most plans post them online too.

Make a short list:

Every doctor, specialist, and therapist you saw
Every lab, imaging center, and hospital you used
Every test, scan, procedure, or therapy you had (or expect to have)
Every prescription you fill

That list is your filter. A change only matters if it touches something on your list. Now open the ANOC.

1. Prior authorization and referral changes

Prior authorization means the plan must approve a service before you get it. A referral is a sign-off from your primary care doctor before you see a specialist.

Look for any part of the ANOC that describes changes to prior-authorization or referral rules. Then compare it to your list.

Is a service you get regularly — physical therapy, an imaging scan, an injection, a sleep study — newly on the prior-authorization list?
Does a specialist you see now require a referral?

Why it matters: A service that didn’t need approval this year may need it next year. If your doctor’s office doesn’t know, the claim can be denied for “no authorization on file” — even when the care itself was appropriate.

Action step: Circle any service on your list that picks up a new prior-authorization or referral rule. Tell your doctor’s office before your first appointment in 2027.

2. Provider network changes

MA plans use networks. Doctors, labs, imaging centers, hospitals, and skilled nursing facilities (SNFs) can join or leave from one year to the next.

The ANOC may mention network changes, but it usually won’t list every provider. So check each name on your list against the plan’s 2027 provider directory, not this year’s:

Your primary care doctor and every specialist
The lab you use for blood work
The imaging center where you get scans
The hospital you would go to
Any skilled nursing facility you might need after a hospital stay

Here’s the catch: Directories can be out of date. Call the provider’s office and the plan. Write down the date, the name of the person you spoke with, and what they said.

Why it matters: Seeing an out-of-network provider is one way a claim gets denied in an MA plan. In an HMO (health maintenance organization) plan, out-of-network care generally isn’t covered except for emergencies, urgent care, and a few other situations.

3. Drug formulary changes

The formulary is the plan’s list of covered drugs. Look for three kinds of changes to any drug you take:

Tier changes — a drug moving to a higher tier usually costs you more.
Prior authorization — the plan must approve the drug before it pays.
Step therapy — you must try a different drug first before the plan covers yours.

A drug dropping off the formulary entirely is the biggest red flag.

Action step: If a drug you take picks up a new restriction, ask your prescriber now whether an exception request or a different drug makes sense. You don’t want to find out at the pharmacy counter in January.

Stand-alone Part D plan? Your drug plan sends its own ANOC. Section 3 applies to you: check each drug’s tier and restrictions, your pharmacy, and your premium and copays. Sections 1, 2, and 4 are about MA medical coverage. Your medical care is under Original Medicare, which works differently.

4. Maximum out-of-pocket and cost-sharing

Every MA plan has a maximum out-of-pocket (MOOP) limit — the most you pay for covered in-network medical services in a year. The ANOC shows this year’s number next to next year’s.

Then look at the cost-sharing (your copay or coinsurance) for the services on your list:

Specialist visits
Outpatient surgery and imaging
Hospital stays
Skilled nursing facility days
Physical therapy

Why it matters for denials: Cost-sharing isn’t a denial, but it tells you what an unexpected bill could look like. If your plan raises its limit and you’re likely to need a procedure next year, you’ll want to know before a bill arrives.

Keep the ANOC and the Evidence of Coverage — they’re your evidence

Your plan also publishes an Evidence of Coverage (EOC). It’s the full rulebook: what’s covered, what needs approval, and how appeals work. The ANOC tells you what changed; the EOC tells you the rules. Plans must make the new EOC available by October 15. Many post it online instead of mailing it, so ask for a paper copy if you want one.

Keep both in a folder with your EOBs. If the plan denies something in 2027, your appeal is stronger when you can point to the plan’s own rulebook and say, “Your Evidence of Coverage says this is covered.”

And appeals are worth knowing about. KFF, a nonpartisan health policy research group, looked at Medicare Advantage prior-authorization determinations in 2024. Only 11.5% of prior-authorization denials were appealed — but 80.7% of those appealed were fully or partially overturned. That pattern (few appeals, most of them overturned) held every year from 2019 to 2024.

In an MA plan, you have 65 days from the date on the denial notice to request a reconsideration (the first level of appeal).

Choosing a plan? Talk to your SHIP

This post is about spotting future denials, not picking a plan. Whether to stay or switch is a personal decision that depends on your doctors, drugs, and budget.

For free, unbiased, one-on-one help, contact your State Health Insurance Assistance Program (SHIP). SHIP counselors don’t sell insurance.

What to do this week

[ ] Find your ANOC and your Evidence of Coverage. No ANOC? Call your plan.
[ ] Pull your last 12 months of EOBs and list your doctors, facilities, services, and drugs.
[ ] Line 1: Circle any service on your list with a new prior-authorization or referral rule.
[ ] Line 2: Check every provider and facility against the 2027 directory — then call to confirm. Write down who you spoke with.
[ ] Line 3: Check every drug for tier, prior-authorization, or step-therapy changes.
[ ] Line 4: Compare the maximum out-of-pocket limit and the copays for services you’re likely to use.
[ ] Put the ANOC, EOC, and EOBs in one folder.
[ ] Questions about switching? Call your SHIP before December 7.

Bottom line: Four sections of your ANOC tell you where next year’s denials are likely to come from. Twenty minutes now can save you a surprise in January — and gives you the paperwork you need if you have to appeal.

Got a denial or a confusing notice? Upload it to Medterpret and see what it says, what it means, and what to do next — in plain English. Medterpret drafts; you decide what to send. Appeal a denial →

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Medterpret is independent and not affiliated with or endorsed by Medicare, CMS, HHS, or any government agency. Educational information, not legal or medical advice.

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Sources

“Plan Annual Notice of Change (ANOC),” Medicare.gov (Centers for Medicare & Medicaid Services), accessed Sept. 29, 2026 medicare.gov
42 CFR § 422.111, “Disclosure requirements” (notice of Jan. 1 changes at least 15 days before open enrollment starts; plan description by the first day of open enrollment), Electronic Code of Federal Regulations, current as of Sept. 2026 ecfr.gov
“Joining a plan” (Open Enrollment Oct. 15 – Dec. 7), Medicare.gov, accessed Sept. 29, 2026 medicare.gov
“Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024,” KFF, Jan. 28, 2026 kff.org
“Appeals in Medicare health plans” (65-day deadline), Medicare.gov, accessed Sept. 29, 2026 medicare.gov
“Medicare Help Locator,” SHIP National Technical Assistance Center, accessed Sept. 29, 2026 shiphelp.org