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what is the Medicare annual notice of change letter better known as a n o c the annual notice of change letter is a document you receive in the mail that explains the changes that your Medicare Plan has made all changes whether cost benefit or service area will be listed in detail this letter is sent out annually in the fall around September if you did not receive this important plan document you should contact your plan provider upon receiving the anoc for your Medicare plans you should contact your license agent to review your policy and expected changes