Medicare Part D

In Glens Falls, that fall Medicare envelope is the one document to read before Dec. 7

GLENS FALLS, N.Y. — Somewhere in the stack of mail arriving this fall is a plain-looking booklet called the Annual Notice of Change. If you have a Medicare Part D drug plan or a Medicare Advantage plan that includes drug coverage, this is the document that tells you how your plan will work differently on Jan. 1, 2026 — including which of your prescriptions may sit on a different tier, need prior approval, or come with new limits.

Medicare Part DGlens Falls, NY

It is easy to set aside. It should not be. The Annual Enrollment Period runs Oct. 15 through Dec. 7, and that is the window to react if something in the notice does not work for you.

What the ANOC actually is

The Annual Notice of Change is a required document your Part D or Medicare Advantage plan sends every fall, usually landing by Sept. 30. It compares this year's plan to next year's version — premium, deductible, cost-sharing, provider network for Advantage plans, and, importantly, the drug formulary.

Alongside the ANOC you may receive an Evidence of Coverage (EOC), which is the longer rulebook. The ANOC is the shorter "what's different" summary. If you skim only one, skim the ANOC.

Why a drug you take today can look different Jan. 1

Part D plans build a formulary — the list of drugs they cover — and place each drug on a tier. Lower tiers generally mean lower cost-sharing; higher tiers mean more. From one plan year to the next, several things can change:

• Tier placement. A drug can move up or down a tier, which changes what you pay at the pharmacy.
• Prior authorization (PA). The plan may require your prescriber to submit paperwork showing the drug is medically necessary before it will be covered.
• Step therapy. The plan may require you to try a preferred alternative first before it will cover the drug your doctor originally chose.
• Quantity limits. The plan may cap how much you can get in a fill or over a period of time.
• Removals or additions. A drug can drop off the formulary entirely, or a new one can be added.

These tools are called "utilization management." They are allowed under CMS rules, but plans have to tell you before the changes take effect — which is exactly what the ANOC is for.

How to read the notice in about 15 minutes

You do not have to read the whole booklet cover to cover. Focus on three things:

1. Premium, deductible and the drug benefit section. Look for the side-by-side "this year vs. next year" chart. 2. The formulary changes list. Pull out your current prescription bottles. For each drug, check whether the tier is different, whether "PA," "ST," or "QL" appears next to it, and whether it is still listed at all. 3. The pharmacy network. Preferred vs. standard pharmacy status can change, and that affects cost-sharing.

If something looks off, that is your signal to call the plan directly, call 1-800-MEDICARE, or contact your local State Health Insurance Assistance Program (SHIP) — in New York, that is HIICAP — for free, unbiased help.

Program-level numbers to keep in mind for 2026

A few Part D figures apply to every plan, not just one:

• The annual out-of-pocket cap for covered Part D drugs is $2,100 in 2026. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible a plan can charge is $615.
• The old coverage gap ("donut hole") is gone — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly bills instead of paying large amounts at the pharmacy counter. It is optional and free to opt into.
• IRMAA — the income-related surcharge on Part B and Part D — kicks in above $109,000 in income for a single filer in 2026.

What to do if a drug you take is affected

You have options, and none of them require panic:

• Talk to your prescriber. Sometimes a therapeutic alternative on a lower tier works just as well.
• Ask the plan for an exception. If your doctor documents that the preferred drug is not appropriate for you, plans have a formal process to request coverage of a non-formulary drug or a lower tier.
• Use the transition fill. New enrollees, and continuing members whose drug is newly restricted, are generally entitled to at least one 30-day transition supply in the first 90 days of the plan year so you have time to act.
• Shop the market during AEP. Between Oct. 15 and Dec. 7, you can switch to a different Part D or Medicare Advantage plan for a Jan. 1 start. Medicare's Plan Finder at medicare.gov lets you enter your drug list and see how plans available in your area handle each one.

What Glens Falls residents should know locally

Glens Falls is in Warren County, and Medicare plan availability — both stand-alone Part D and Medicare Advantage — is set at the county level by CMS. That means every Warren County resident sees the same menu of plans, whether you live downtown or out toward Queensbury. Your ANOC comes from your specific plan, but the lineup you can switch to during AEP is the countywide one.

If you also have a Medicare Supplement (Medigap) policy plus a stand-alone Part D plan, only the Part D piece is affected by formulary changes; the Medigap side works differently and is regulated by New York State.