September is when Medicare plan changes start becoming real for your clients. The Annual Notice of Change, or ANOC, explains changes to a client’s Medicare Advantage or Part D coverage for the coming year. That may include changes to costs, coverage, benefits, or other plan details.

But your job isn’t simply to confirm that something changed. It’s to determine whether that change matters to this client. The biggest red flag is not always the biggest change. It’s the change most likely to affect that client.

A higher copay may matter little to one person and significantly affect another. A formulary change may mean nothing to a client who doesn’t take that medication but become a major concern for someone who relies on it every day. As you review ANOCs ahead of AEP, focus on these five areas.

Start with changes that may affect the client’s wallet. Review changes to applicable premiums, deductibles, copayments, coinsurance, and other out-of-pocket costs.

But don’t simply make a list of every number that changed. Connect those changes to how the client actually uses their coverage.

If a specialist copay increases, for example, that change may deserve more attention for someone who sees several specialists throughout the year than for someone who rarely does. The same applies to prescription costs and other services the client uses regularly.

Ask yourself:

Where does this client currently spend money on healthcare, and did any of those costs change?

That turns the ANOC from a document review into a client review.

Prescription coverage deserves its own check. Review the client’s current medications against the new plan-year information available through approved resources.

Look for changes that may affect coverage or cost, such as formulary changes, tier changes, or applicable utilization requirements. Don’t rely on last year’s medication list.

Ask the client whether any prescriptions, dosages, or frequencies have changed. Then use the current list when reviewing coverage for the coming year. A plan can still look familiar while the client’s experience at the pharmacy changes.

If an important medication is affected, flag it for a closer review before discussing the client’s options.

Provider access can quickly turn a routine annual review into a much bigger conversation.

Ask about the providers that matter to the client:

Primary care doctor → Specialists → Hospitals → Facilities

Then verify current network information using approved plan resources. Don’t assume that because a doctor or facility participated this year, the same network status will continue next year.

And don’t stop after checking the primary care provider. A client’s cardiologist, oncologist, hospital, therapy provider, or other facility may be just as important to their healthcare. If network information changes, find out how it affects the client’s actual care before moving forward.

Benefit changes tend to get attention because they’re easy to notice. A plan may change dental, vision, hearing, fitness, transportation, over-the-counter allowances, or other supplemental benefits.

Those changes can matter. But don’t let one attractive benefit or one reduction control the entire conversation. Ask whether the client actually uses the benefit.

If a benefit increases but the client has never used it, that may have little impact on their decision. If a benefit they rely on changes significantly, it deserves more attention. This is also a good reason to avoid comparing plans based on one feature. Look at the client’s full healthcare picture.

This is the check that ties everything together.

After reviewing costs, drugs, networks, and benefits, stop looking at the ANOC for a moment.

Look at the client.

How often do they see doctors?

Which specialists matter most?

What prescriptions do they take?

Which benefits do they actually use?

What healthcare expenses have mattered most over the past year?

What has changed in their health or daily life?

Two clients enrolled in the same plan can read the same ANOC and have completely different concerns. That’s why the goal isn’t to identify the plan’s “biggest” change.

It’s to identify the change with the greatest potential impact on the individual client. That is where an agent adds value.

Don’t finish an ANOC review with a pile of highlighted documents. Turn what you find into action. For each client, identify whether there are changes that deserve a closer review during AEP.

A simple system could look like:

Green: No major client-specific concerns identified based on current information.

Yellow: One or more changes deserve discussion.

Red: A change may significantly affect the client’s prescriptions, providers, costs, benefits, or other priorities and needs prompt review.

The purpose isn’t to make a plan decision before you’ve completed a full comparison. It’s to prioritize your workload.

When AEP begins, you’ll already know which clients may need the most attention instead of treating every annual review exactly the same.

A good ANOC review isn’t about finding the longest list of changes. It’s about finding the changes that matter.

One client’s red flag may be a prescription. Another client’s may be a specialist. For someone else, it may be a cost change tied to a service they use frequently.

That’s why reviewing the document alone isn’t enough. You need the ANOC and an understanding of the client. Put those together, and the document becomes much more useful.

• Use the Medicare ANOC as a starting point for the client’s annual plan review.
• Review changes to costs based on the services the client actually uses.
• Check important prescriptions for coverage or cost changes.
• Verify providers, specialists, hospitals, and other important facilities.
• Review benefit changes in the context of what the client actually values and uses.
• Don’t assume the largest plan change is automatically the most important one.
• Use your findings to prioritize clients who need closer attention during AEP.

Your value as an agent is helping turn that information into something the client can understand and use.

Remember:

The biggest red flag is not always the biggest change. It’s the change most likely to affect that client.

Review the costs. Check the drugs. Verify the network. Look at the benefits. Then connect all of it to how that person actually uses their coverage. Insurance Advisors Direct helps independent Medicare agents prepare for AEP with training, compliance resources, quoting tools, technology, carrier support, and experienced people to turn to when questions come up.

With more than 30 years of experience, 30+ carriers, and 15+ product lines, IAD gives agents the support and systems they need to serve clients throughout the year.

Visit iadbrokerage.com to learn more about the resources available to IAD agents.

We don’t just support agents. We partner with them.

Compliance Reminder: Medicare plan benefits, costs, formularies, provider networks, and other coverage details can change from year to year. Agents should use current, approved plan materials and follow applicable CMS and carrier requirements when discussing plan changes or coverage options. Individual needs and eligibility should be reviewed before making plan-specific recommendations.