What we do
Annual coverage review
The Annual Notice of Change is the most important envelope you receive all year and the one most likely to go unopened. We read it for you and re-run the numbers.
What you get
Concrete things, not a conversation about a conversation.
Every one of these is included, and none of it is billed to you. Our compensation comes from the carrier you eventually choose — or from nowhere at all, if the right answer is to leave your coverage exactly as it is.
- A read-through of your Annual Notice of Change, translated into what it means for you
- Confirmation that each of your doctors is still in network for next plan year
- A re-run of every prescription against next year’s formulary and tier
- A comparison against the other plans now available in your county
- A clear recommendation: stay, or move, and why
- The switch handled for you if moving is the right call
How it runs
Step by step.
- 01
September — the mail arrives
Your carrier sends the Annual Notice of Change and the next plan year’s Evidence of Coverage. Keep them. This is the raw material for the review.
- 02
October — we re-run everything
Doctors against next year’s network file, prescriptions against next year’s formulary and tier, premiums and cost sharing against this year’s. Anything that moved gets flagged.
- 03
November — we compare the field
If something changed for the worse, we look at what else is now available in your county and price the realistic alternatives on your actual usage.
- 04
Before December 7 — decide
Stay or move, with the reasoning written down. If you move, we handle the enrollment and confirm the January 1 effective date.
What changes on January 1, every year, without fail
None of this requires anything to have changed in your life. A plan that was the right answer last October can be the wrong answer this October purely because the plan itself moved. That is why the review is annual rather than occasional.
- The drug formulary — medications move tiers, get added, or come off entirely
- Tier cost sharing — the same tier can carry a different copay next year
- The provider network — contracts with hospitals and physician groups are renegotiated annually
- Premiums, deductibles and the out-of-pocket maximum
- Prior authorisation, step therapy and quantity limits
- Supplemental benefits — dental, vision, hearing and OTC allowances are re-set
It is not only for Medicare
We do the same exercise for ACA Marketplace clients each Open Enrollment. Carriers change networks, re-price metal tiers, and sometimes exit a county entirely. Auto-renewal will happily roll you into a plan that no longer contains your doctor, and the premium tax credit is recalculated against a new benchmark plan each year.
If your income changed, the subsidy math changed with it. That alone is worth a call before the auto-renewal date.
The autumn calendar
| When | What happens | What you do |
|---|---|---|
| September | Annual Notice of Change arrives | Keep it — it is the input to the review |
| Early October | Next year’s plan data publishes | Gather your drug list and doctor list |
| October 15 | Annual Enrollment Period opens | Book the review |
| October – November | Comparison work | Read the written summary, take a week over it |
| By December 7 | Enrollment deadline | Stay, or switch — either way, decide |
| January 1 | Changes take effect | Confirm your card and pharmacy record |
It is not only for Medicare
We run the same exercise for ACA Marketplace clients each Open Enrollment. Carriers change networks, re-price metal tiers, and occasionally exit a county altogether. Auto-renewal will happily roll you into a plan that no longer contains your doctor.
The subsidy side moves too. The premium tax credit is recalculated against a new benchmark plan each year, so your out-of-pocket premium can change even if your income did not. And if your income did change, that alone is worth a call before the auto-renewal date.
Frequently asked questions
When is the Annual Enrollment Period?
For Medicare Advantage and Part D, October 15 to December 7 each year, with changes effective January 1. There is also a Medicare Advantage Open Enrollment Period from January 1 to March 31 allowing one switch. ACA Marketplace Open Enrollment typically runs November 1 to January 15.
What if I am happy with my plan?
Then the review takes fifteen minutes and confirms it. That is a genuinely good outcome and we do it for a large share of our clients every year. The point is to know, rather than to assume.
Do I need to do anything if I want to stay?
Generally no — Medicare plans auto-renew if they still exist. The risk is not administrative, it is that the plan you are auto-renewed into is not the plan you signed up for. That is what the review catches.
I did not use you to enroll. Will you still review my plan?
Yes. Bring your Annual Notice of Change and your drug list. If the right answer is to stay put, we will tell you that too.
Coverage involved
The products this service touches.
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Medicare Advantage (Part C)
Medicare Advantage (Part C) is a private plan that replaces how you receive your Part A and Part B benefits. Plans usually bundle prescription drug coverage and extras like dental and vision, often carry a $0 monthly premium, and cap your annual out-of-pocket costs — but you use a provider network and pay copays at the point of care.
About this coverage -
Part D prescription drug plans
Medicare Part D is prescription drug coverage sold by private carriers, either as a standalone plan alongside Original Medicare and a Medigap policy or bundled inside a Medicare Advantage plan. Each plan has its own formulary, tiers and pharmacy network, and an annual cap on what you pay out of pocket for covered drugs.
About this coverage -
Medicare Supplement (Medigap)
A Medicare Supplement, or Medigap, is a private policy that pays the deductibles, copayments and coinsurance Original Medicare does not. You keep Original Medicare, see any provider in the country who accepts Medicare, need no referrals, and pay a monthly premium. Prescription drug coverage is bought separately as a Part D plan.
About this coverage -
ACA / Marketplace health plans
An ACA Marketplace plan is individual major-medical health insurance sold under the Affordable Care Act. Carriers cannot decline you or price you on health history, every plan covers the ten essential health benefits, and households under certain income levels receive a premium tax credit that reduces the monthly cost — often substantially.
About this coverage
Related services
Often needed at the same time.
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Prescription drug cost review
Your actual drug list, run against every plan in your county, at your pharmacy.
How it works -
Insurance plan comparison
Every realistic option in your county, compared against your own doctors and drugs.
How it works -
Claims support & appeals
A denial is the start of a process, not the end of one. We stay on it with you.
How it works