Medicare Part D

Before Jan. 1, Kearny: What Your Part D ANOC Really Means

KEARNY, N.J. — Fall 2026. If you take a regular prescription and you're on a Medicare Part D plan, one envelope in your mailbox this month matters more than most: the Annual Notice of Change, or ANOC. It arrives by late September and spells out what your plan will look like starting January 1, 2027 — including how your drugs will be covered next year. Every fall, drug lists shift. A medication that sits on one tier today can sit on a different tier in January, or come with new paperwork attached. The ANOC is your heads-up.

Why the ANOC matters in Kearny this fall

Kearny is in Hudson County, where Medicare beneficiaries choose among a wide slate of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. For 2027, the county has 46 Medicare Advantage plans from 9 carriers, down from 48 plans and 10 carriers in 2026. Every one of those plans sends its members an ANOC in the fall. It's a side-by-side comparison — this year vs. next year — for premiums, deductibles, drug tiers, and the rules attached to specific medications.

The ANOC is not marketing. It's the plan telling you, in writing, what's changing. If you skim only one Medicare document this fall, this is the one.

How Part D drug lists change from year to year

Every Part D plan has a formulary — the list of drugs it covers. CMS reviews formularies, but plans have real room to adjust them each January. Here are the four levers that most often move:

Tiers. Formularies are organized into tiers (usually 5 or 6). Lower tiers generally mean lower cost-sharing; higher tiers mean more. A drug can move up a tier, down a tier, or off the list entirely for the new plan year.

Prior authorization (PA). Your plan can require your doctor to submit paperwork explaining why you need a particular drug before it will be covered. A drug that had no PA this year can have one next year.

Quantity limits (QL). Plans can cap how much of a drug you can get in a set period — for example, a certain number of pills per month. Those caps can be added, loosened, or tightened.

Step therapy (ST). The plan may require you to try a lower-cost alternative first before it will cover a more expensive option. Step therapy rules can be added or changed year to year.

Together, these tools are called utilization management. None of them mean a drug is "not covered" — they mean there are hoops before coverage kicks in.

How to read your ANOC in 15 minutes

Open the booklet and go straight to the section titled something like "Changes to our drug coverage" or "Changes to the drug list."

1. Find your drugs by name. Look up every prescription you fill regularly. 2. Check the tier for 2027 and compare it to 2026. 3. Look for the letters PA, QL, or ST next to your drug. Those flags tell you if new rules apply. 4. Scan the premium and deductible changes at the front of the ANOC. 5. Note any pharmacy network changes — the pharmacy you use today may or may not be a "preferred" pharmacy next year.

If anything looks different, that's your cue to compare plans during the Annual Enrollment Period, October 15 through December 7.

The 2027 program facts worth knowing

A few program-wide changes shape every Part D plan next year:

• The out-of-pocket cap on covered Part D drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more for covered drugs the rest of the year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027 (plans can set theirs lower).
• The coverage gap — the old "donut hole" — has been eliminated since 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments instead of paying large amounts at the pharmacy counter. You have to opt in.
• IRMAA surcharges on Part B and Part D premiums begin at incomes above $109,000 for a single filer in 2026.

What to do if your drug's coverage changes

You have options. During the Annual Enrollment Period (Oct. 15 – Dec. 7), you can switch to a different Part D or Medicare Advantage plan for a January 1 start. Medicare Advantage members also have the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) to make one change.

If you stay put and a drug you take is affected, most plans offer a transition fill early in the new plan year — typically a one-time supply — while you and your prescriber work out next steps. That's not a permanent solution; use the time to file an exception request or switch to a covered alternative.

For personalized help in Kearny, the free New Jersey State Health Insurance Assistance Program (SHIP), called SHIP NJ, offers one-on-one counseling at no cost. You can also call 1-800-MEDICARE or use the Plan Finder at medicare.gov to compare plans using your own drug list.