Sorry for the feeble attempt at humor. Believe me, for many people there is nothing funny about this time of year.

A.N.O.C. is an acronym for the Annual Notice Of Change that the Medicare Part D and Medicare Advantage plans must mail to each of their subscribers each fall.

If an insurance company decides to leave a marketplace, by law it must give subscribers 90 days written notice. A few large insurance companies are leaving the Medicare Advantage marketplace in 2010 and their subscribers will have received a notice.

One of the largest that we have on the peninsula is Coventry Healthcare, that decided Medicare Advantage plans no longer are a good fit for its business model. Plans from Aetna and a few smaller companies also decided to leave the peninsula.

Is this because of reduced federal reimbursement rates, higher than anticipated claims, a lack of provider networks? The answer probably is a combination of all three plus others we might not be aware of.

So, what are your options? Here I can share some good news:

The federal government requires that if you lose your coverage involuntarily, you have a "guaranteed" right to purchase any plan you choose. This can be a plan similar to the plan you had or one that is different.

For example, if a person had a Coventry Advantra Freedom plan and received notice that his plan will be terminated at the end of the year, his options are as follows:

_ He could purchase a similar Private Fee For Service (PFFS) plan from a company such as Secure Horizons for a relatively low premium. However, these plans probably will go away at the end of 2010 and then he would be back at square one.

_ He could purchase a Preferred Provider Organization (PPO) plan from Regence Med-Advantage. These plans still should be available in 2010 and 2011; however these plans’ costs appear to be rising very rapidly. If he wants drug coverage with a PPO plan, he must purchase it from the same company.

_ Or, he could go back to traditional Medicare and purchase a Medicare Supplement plan or

Medigap plan from a number of plans available in Washington. These are from companies such as AARP, Mutual of Omaha, Regence and Premera, and go by letters A through J. Plans K and L are available, but I never have seen one. With a Medicare Supplement plan, he can choose any Part D drug plan.

Many people who have tried the PFFS plans are quite happy to go back to traditional Medicare and a supplement. They might not have liked the uncertainty of the co-pays or that some Seattle-area hospitals do not accept the plans.

However, many people can’t afford or don’t want to pay the much higher premiums of Medicare Supplement policies. People under age 65 have fewer options because relatively few companies offer Medicare Supplement plans for them.

So, the bottom line is, if you get an "Annual Notice Of Change" letter, read it very carefully because it may contain very important information about the plan benefits in 2010.

Oh yes, do not forget you can review your options at www.Medicare.gov or 800-medicare (800-633-4227), with the local Statewide Health Insurance Benefits Advisors (SHIBA) 452-3221, or your local health insurance agent.

No one can charge for assisting you as you review your options, so please seek help if needed.

Phil Castell is an independent insurance agent in Sequim. He

can be reached at 683-9284 or PhilCastell@msn.com.