Five things your plan letter won't tell you
October 10, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome to The American Retirement Advisor. I'm Betty, Eddie's here with me in the studio today, and we are talking about something that lands in a lot of mailboxes every fall and gets either immediately opened or immediately set on the counter and ignored for two weeks.
Guilty. I mean, not me personally, but I have heard that story many times.
Sure you have. We're talking about the Annual Notice of Change, the letter your Medicare Advantage or drug plan sends out every fall telling you what's different about your coverage next year. And we're basing today's conversation on a piece written by Ian Schaeffer, our company's COO, who went through the 2027 letters line by line. And Eddie, the framing he opens with is what got me.
What he says is the letter tells you some of what changed. What it cannot tell you is what next year will actually feel like when you fill a prescription or have a bad health year. That distinction matters a lot.
Because you can read the letter and feel like you did your homework, and still be surprised in February at the pharmacy counter.
Right, and that's the whole problem the article is solving. It's not that the letter lies. It's that it leaves things out, and Ian Schaeffer wrote down what those things are so people know what to go looking for.
He covers five specific gaps, five the letter doesn't show you. And he timed it to land five days before the Annual Enrollment Period opens, which is October 15.
That window runs through December 7. That's your chance to make changes. So this is timed to be useful right now.
Okay, so let's go through these. First one, and I want you to just explain what's happening here, because when I read it I thought, wait, how is this even possible. Did your plan add a deductible?
So the letter Ian Schaeffer read didn't show either one. Not the medical, not the drug. And for 2027, more Advantage plans in Maricopa County have a medical version of this. The drug side can reach seven hundred dollars.
That much before your drug coverage even kicks in?
Right, and if that number isn't on the first page of your letter, you might not even know it's there until you try to fill something in January.
That is such a rude way to start a new year.
It really is. And this is specific to Maricopa County, which is the Phoenix metro area, so if that's you, this is not a hypothetical.
So what does someone actually do? How do you find your real numbers if the letter doesn't show them?
Ian Schaeffer walks through exactly where to find them in the article. But the short version is you need to look beyond the summary page. The plan documents go deeper than the letter, and that's where these numbers live.
Okay. Second gap, and this one I think is the one that most people have genuinely never thought to calculate. What's your worst-case year?
This is my favorite one in the piece, honestly, because it reframes the whole exercise. Your letter will list an out-of-pocket maximum. Fine. But that number is not your worst-case cost for the year.
Because it doesn't include everything.
Right. Ian Schaeffer says a real bad year costs you the premium, plus Part B, plus the medical out-of-pocket limit, plus the drug cap. And those are separate buckets. The letter doesn't add them up for you.
So you see one number and you think you know your risk, but you're actually only seeing a piece of it.
It's like reading a recipe that lists the oven temp but not the ingredients. Technically accurate, not actually useful.
Ha, I love that. Did he do the math? Like, does the article show you the full number?
He does the arithmetic for both paths through Medicare, so Advantage and original Medicare with a drug plan. So you can see what a genuinely bad year looks like on each path before you're in it.
That's the kind of thing I wish someone had handed me years ago. Just show me the worst case so I can decide if I can handle it.
And the point isn't to scare you. The point is that once you know the number, you can actually plan around it instead of just hoping you don't have a bad year.
Which is not a strategy.
Not a great one, no.
Third gap, and this one is so relatable. Is your drug plan still the right one?
And that gap between "the letter" and "your actual life" -- well, here's a concrete version of it: the letter can tell you the formulary changed, meaning the list of covered drugs. But it can't tell you what your specific prescriptions will cost at your specific pharmacy next year.
Because that combination is unique to you.
And it can shift from year to year even if neither the drug nor the pharmacy changed. Tier placements move. Cost-sharing structures change. You can be on the same plan doing the same thing and pay significantly more next year.
So what's the fix? Is there actually a quick way to check this?
Ian Schaeffer calls it a ten-minute search, and he shows you what to do. The tool exists, it's not buried, and it gives you your actual number for your actual drugs at your actual pharmacy.
Ten minutes to save yourself a lot of frustration. You'd think more people would do it.
Most folks just assume that if they didn't get a letter saying their drugs changed, they're fine. But silence from the plan is not the same as nothing changed.
That's a really important distinction. Okay, four. Is your doctor still in your plan's network? And I want you to explain why this one keeps tripping people up.
Because the letter can say the network changed. It can't tell you whether your doctor left.
Wait, really? It just says the network changed?
It may not tell you which doctors are gone. So you could read it, see that the network changed, think okay, and not realize your cardiologist or your primary care doctor is now out of network.
And you'd find out when you show up for an appointment in January.
Or when you get the bill. Ian Schaeffer says there is a specific check you can do, and one phone call that settles it. And I'd add, for anyone whose situation involves multiple specialists or a long-standing relationship with a specific doctor, this is probably the most important check to make.
Especially because changing doctors is not just an administrative hassle. If you've got a chronic condition, if you've been seeing someone for years, that relationship has real value.
It really does. And no plan saves you money if it costs you the doctor managing your health.
That's going on a bumper sticker.
I'll get the vinyl.
Okay, fifth gap. The extras. Dental, vision, hearing. And I want to flag something here because this is the one where I think people get most excited about their plan.
And Ian Schaeffer is pretty direct about this. He says those extras are what subscribers notice first, and the letters rarely show their actual limits. But the bigger point he makes is that the extras should be last on your evaluation list, not first.
Which is the opposite of how most people pick a plan.
It is. Because the dental benefit sounds great in the summary. Then you read the fine print and find out there's a limit that may be a lot lower than you'd expect.
And you've already decided on the plan because of the dental.
Whereas the deductible, the drug cost, the network, those are the things that actually determine what your year costs you. The extras are nice. They're not the foundation.
So where do you find the real limits on those benefits? Because the summary clearly isn't showing them.
Ian Schaeffer points to the plan documents themselves. Not the overview, the actual documents. And the limits on dental, vision, and hearing can each work differently.
It's kind of amazing how much work it takes to understand something that was supposed to simplify your healthcare.
Welcome to Medicare paperwork. It's a whole hobby.
Ha. Okay, so let's step back for a second. Five gaps. Five things the Annual Notice of Change doesn't actually answer for you. If I'm someone listening right now who has that thing sitting on their counter, where do I start? Do I have to tackle all five tonight?
Ian Schaeffer is actually pretty gentle about that. He says you don't have to do it all at once. Pick the one that worries you most and go from there. Then pull out your letter and check that same spot.
One thing. That's manageable.
And once you've done one, the next one is less intimidating. The goal is just not to let October 15 go by without having looked at any of it.
That deadline runs right up to December 7th, and when that date comes, it closes.
And for most people, that's the main window to make a change. So the time to discover that your drug costs are going up or your doctor left the network is now, not in January.
Can I ask you something? If someone reads through the article, does the checklist work for every type of Medicare plan, or are there situations where the specific rules get complicated enough that you'd want to sit down with someone?
The framework works broadly, but the numbers and how they interact, especially the worst-case math across different plan types, that's the kind of thing where I'd say write it down and bring it to one of our advisors. Because those details are where a wrong assumption can cost you real money.
And the situations aren't all the same. Someone with three or four regular prescriptions and a specialist they can't lose, that's a different conversation than someone who is pretty healthy and mostly wants coverage as a backstop.
Completely different. And that's why Ian Schaeffer frames this as bringing your letter with you. The letter is the starting point. The person sitting across from you is what turns it into a decision.
I want to make sure people who are reading the article get everything, because we obviously didn't go through every detail here. The piece covers all five gaps with the specific steps, including where to look for your numbers and how to do that ten-minute drug search. It's all in there.
And it's written in plain English, which I appreciate. No jargon detours.
Coming from the guy who has to be stopped from explaining actuarial tables at dinner, that's high praise.
I don't do that.
You absolutely do that.
I do that.
Okay, let's bring it home. If I had to name the one thing from today that I'd want someone to remember, it's what Eddie said earlier about silence -- that not hearing from your plan doesn't mean everything stayed the same. That idea really stuck with me, because it's so easy to assume no news is good news. But your drugs might cost more. Your doctor might be gone. Your deductible might be new. None of that shows up loudly in the letter.
And the window to do something about it opens October 15 and runs through December 7. That's your time.
Read Ian Schaeffer's piece, pull out your letter, pick one thing that worries you and check it. And if you want to go through it with someone, the number in the article is 602-281-3898. You bring the letter. They bring the coffee.
That's a pretty good deal.
It really is. Don't let this enrollment period go by because the letter felt fine. Take the time to check. Your future self in February will be grateful you did. Thanks so much for spending this time with us today.