What on earth is an ANOC and why should you care?

If you are a Medicare member you are likely very familiar with your Annual Notice of Change – or ANOC for short. If you are not, now is the time to change that. The ANOC is a detailed document your Medicare Advantage plan provider sends you prior to open enrollment each fall. It contains very important information about your benefit plan and key changes for the coming year.

Not reading your ANOC closely can mean you miss learning about information and changes that could have a significant impact on the cost of your health care in the coming year.

Take a look at these key terms from your ANOC to find valuable information:

Premiums:

Premiums* are your monthly coverage cost. This is what you pay to your Medicare Advantage plan provider in order to have benefits. They can vary widely, and often change from one year to the next. Many providers, including Regence, also offer $0 premium plans. It is important to look closely at your premium costs each year, and any changes, because it will impact how much you will have to budget in order to keep your Medicare plan coverage.

Maximum Out-of-Pocket Costs (MOOP):

The maximum out-of-pocket is the most you would have to pay in a given calendar year for the covered health care services you use, such as doctor’s office or hospital visits, and lab or diagnostic tests. Once you meet your out-of-pocket maximum for the calendar year, your plan pays all costs for most covered services for the remainder of the calendar year. Some benefits, such as Part D prescription drugs, don’t count toward your out-of-pocket maximum.

Any change in your MOOP can have a significant impact on your costs for the health care you need because it means you could have a greater total cost-sharing for the year. The MOOP can also vary depending on the provider you use and whether they are in-network or out-of-network, which we will get to in a moment.

Co-pays and Co-Insurance:

Co-pays and co-insurance are fundamentally the same thing – what you pay as your share of the cost for services you use, such as when you go to a doctor’s office. However, co-pays are usually a flat amount while co-insurance is a percentage of the cost that your provider bills your insurance provider. It is important to understand the difference, because a co-insurance can vary depending on the provider, the type of service and whether they are in-network or out-of-network, especially for Medicare Advantage PPO plans.

In-Network and Out-of-Network costs:

Insurance providers, such as Regence, negotiates with providers, such as doctors, hospitals and others, to obtain lower rates for our  members so that we can offer high-quality benefits that are cost-effective. Providers who agree to these rates are considered part of the network or – in-network. In general, using an in-network provider means you pay a smaller share of the cost. Co-pays and co-insurances for in-network providers are usually lower for Medicare Advantage PPO plans.

Generally, HMO plans do not have a different in-network and out-of-network cost-sharing.

Deductibles:

Deductibles usually apply to the Part D – or prescription drug benefit – portion of your plan. Generally, you have to meet your prescription drug deductible (pay the full deductible amount out-of-pocket) before the plan pays any portion of covered drug costs. After you meet your deductible, you are responsible for a portion of the drug cost.

There are many other important considerations in determining which Medicare Advantage plan is right for you, including lab and diagnostic coverage, and drug formularies. All this information is included in your ANOC.

So once you receive your ANOC, remember to review it carefully. If you or a loved one have not received an ANOC before Open Enrollment begins, or if you have questions about your benefits and cost, please be sure to contact your plan. Regence members can call the number on the back of their cards to reach our Member Services team.

To review available plans with Regence visit regence.com/medicare.

 *You must continue to pay your Medicare Part B premium.