Dear Toni:
My husband, Jason, is a retired veteran and never enrolled in Medicare because he uses the VA for his medical care and does not have to pay the Medicare premium. He is having heart issues and wants to go to a local cardiologist. The doctor’s office advised that he enroll in Medicare since this office will not bill the VA facility and is not in the VA’s Community Care program.

Social Security told him that he must pay more to enroll in Medicare Part B since he never enrolled when he turned 65 about 10 years ago in 2016.

After reading your Medicare articles in our local newspaper, we need your guidance. Is there a way that he can take Part B without having to pay the extra penalty? Thank you, Toni.

—Marsha from Lake Charles, La.

Hello Marsha:

Since Jason did not enroll in Medicare when he first turned 65 and is no longer working with full employer benefits, I’m afraid he will receive the Part B late enrollment penalty when he enrolls in Medicare Part B during Medicare’s General Enrollment Period from Jan. 1 to March 31. No one ever knows when they will need to receive health care outside of a Veterans Administration Center.

Now is the time for him to enroll in both parts of Medicare, Part A and Part B. He did not enroll in Part B when he was first eligible in 2016, and his “late enrollment” penalty is 10% for each 12-month period that he could have had Part B but did not sign up for it. His penalty will be for 10 full years, or an extra 120% each month for the rest of his Medicare life.

For 2026, Jason’s Medicare Part B penalty will be 120% times $202.90, or an extra $243.48, plus the Part B premium of $202.90, which totals $446.38 per month. (Chapter 1 of the Medicare Survival Guide Advanced edition explains the rules of enrolling in Medicare the right way, especially for those with Veterans’ benefits.)

If he decides to enroll in Medicare Parts A and B for the first time during the 2026 Medicare General Enrollment Period, which will end on March 31, the following Medicare enrollment rules will apply:

—Medicare Supplement Insurance: There is a six-month open enrollment period beginning the first month you’re enrolled in Part B during which the Medicare enrollee will not have to answer health questions for underwriting. After six months, complete underwriting is required.

—Medicare Advantage Plan: You can get a Medicare Advantage Plan that comes with or without prescription drug coverage. With a Medicare Advantage plan there are no health questions, but you may have to pay more. You must have both Part A and Part B to join a Medicare Advantage Plan. Coverage starts the first day of the month after you sign up.
—Medicare Drug Coverage through a Part D Plan: Medicare considers the VA “creditable” coverage,” so there is a happy ending for Jason in this regard: NOT enrolling in a Medicare Part D Prescription Drug plan with a Medicare Supplement or a Medicare Advantage HMO/PPO  is a good possibility. If Veterans with VA benefits do enroll in Part D later, they will not receive the Medicare Part D late enrollment penalty since the VA prescription drug plan is creditable. Veterans are able to keep using the VA for prescriptions.

Marsha, I would recommend to Jason that, if the Medicare premium with penalty is too high, he   remain with the VA medical facility for his care and not pay the Medicare premium. Begin exploring the non-VA medical care options by contacting the local VA facility and asking for referrals that accept VA benefits outside the local VA medical area.

Remember, with Medicare, what you don’t know WILL hurt you! For more Medicare information, email info@tonisays.com or call 832-519-8664. Both of Toni’s books and her new

“Confused about Medicare” online course and Toni Says Medicare Roadmap are available at www.tonisays.com.  Sign up for the Toni Says newsletter on the Toni Says website to keep up Medicare changes.

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Dear Toni:

I turned 65 in February and did not enroll in a Medicare Prescription Drug plan. I have been told that I must wait until October for Medicare’s enrollment time. I need help now because I have been prescribed an expensive brand-name prescription. I thought I could enroll at any time of the year, but the application for Part D was denied by Medicare. What can I do? Thanks, Toni.

-James from Atlanta, Georgia

Hello James:

Medicare’s Open Enrollment Period (OEP)/Annual Enrollment Period (AEP) is for enrolling in or changing a stand-alone Medicare Part D Prescription Drug plan or a         Medicare Part C Advantage plan. *Medicare OEP/AEP does not involve changing or enrolling in a Medicare Supplement.

This year’s Medicare OEP/AEP enrollment starts on Wednesday, Oct.15, and it will end at midnight Sunday, Dec. 7 (Pearl Harbor Day). All plans will have January 1 as their start date.

This is the time when you can make changes to your Medicare Part D Prescription Drug plan or Medicare Part C Advantage plan, or you can initially enroll if you missed your enrollment time when you were first eligible, as you did, James, when you turned 65. Unfortunately, James, you will receive a Part D penalty for not enrolling at the right time.

Below are the changes that a Medicare beneficiary can make during Medicare’s Open Enrollment Period/Annual Enrollment Period:

• Enroll in a stand-alone Medicare Part D Prescription Drug Plan, if you are like James and never enrolled when your Medicare began.
• Enroll in a stand-alone Medicare Part D Prescription Drug Plan, which can automatically disenroll you from a Medicare Advantage plan (if you need to disenroll from a Medicare Part C Advantage plan and return to Original Medicare.
• Change from one Medicare Part D Prescription Drug Plan to a new Medicare  Part D Prescription Drug Plan.
• Enroll in a Medicare Advantage Part C Plan with prescription drugs benefits.
• Change from one Medicare Advantage Part C Plan (with or without Prescription Drug plan) to a new Medicare Advantage Part C Plan.
• Enroll in a stand-alone Medicare Part D Prescription Drug Plan to return to Original Medicare and purchase a Medicare Supplement.
• Enroll in a Medicare Part D Prescription Drug Plan and return to Original Medicare only.
• Or return to Original Medicare with no Medicare Part D Prescription Drug plan. *Don’t forget there is a penalty for not enrolling in a Medicare Part D Prescription Drug plan when first eligible.

For those who already have either a Medicare Advantage Part C plan with or without prescription drugs or a stand-alone Medicare Part D Prescription Drug plan,        Medicare’s OEP/AEP is the time to make sure your stand-alone Part D prescription drug plan or Medicare Advantage plan still meets your needs, especially if you had any changes to your health.

Confused about whether a new Medicare plan is right for you? Chapter 6 of Toni’s “Medicare Survival Guide Advanced” edition at www.tonisays.com details various situations during Medicare’s Annual Enrollment Period, such as “still working past 65” or “doctor not accepting my Medicare Advantage plan.” Now is the time to explore your OEP/AEP options.

Visit www.medicare.gov to view 2026 Medicare Part D and Medicare Advantage plans, with enrollment starting Oct. 15. The website has a tool for helping you narrow your search for new Medicare Advantage and Prescription Drug plans.

It is wise to verify every year that your prescription drugs are covered on your Part D Medicare Prescription Drug plan. Medicare Advantage or Prescriptions Drug plans can change their prescription drug formulary each year and if your prescriptions are not covered for the next year, you may have to pay 100% of that prescription yourself if it is not covered on your Part D plan.

__________

Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

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Dear Toni:

I am self-employed with an individual health plan and confused about enrolling in Medicare when I turn 65 in July. I cannot find the answer to my situation in the Medicare & You handbook. A business associate who is also self-employed delayed his Part B because he is covered by his wife’s company health benefits. He is sure that I can delay enrolling in Medicare since I am covered by a health insurance plan.

Can you please explain the difference, if there is one, between my situation and my friend’s? I do not want to make a Medicare mistake. Thanks, Toni

–Greg from Corpus Christi, TX

Hi Greg:

This is a great Medicare question, because Americans who are turning 65 are being bombarded by telemarketers who confuse the “turning 65” Medicare rules.

Recently, I consulted with a 66-year-old gentleman who was also self-employed like you, Greg, and was given wrong information about delaying his Medicare Part B. He was surprised to find out that Medicare does not recognize individual plans as “true employer” health benefits to delay Part B. Qualifying group health plans are defined in the Medicare & You handbook as companies with 20+ employees.

The information regarding health insurance is found on page 20 of the 2025 Medicare & You handbook under “Health Insurance Marketplace.” It states that “you should sign up for Medicare when you’re first eligible to avoid the risk of a delay in Medicare coverage and the possibility of a Medicare late enrollment penalty.”

This gentleman is 66 and will receive not just a 10% penalty due to not enrolling in Part B during his Initial Enrollment Period–his penalty will be 20% (2 years, 65 and 66) each month for the rest of his Medicare life. The 20% penalty usually goes up as the Part B premium usually goes up every Jan.1.

Greg, I would recommend that you enroll in Medicare during your “Initial Enrollment Period,” which begins 3 months before July, so that your Medicare begins July1. You currently have an individual health insurance plan, not “true group” employer health insurance plan, which can cause you to receive a Medicare penalty if you do not enroll in Medicare at the right time. Go online to www.ssa.gov/medicare/signup to apply for Medicare within the 3-month period before turning 65 or up to 90 days after.

Many Americans believe that Medicare is automatic when turning 65. This is correct if you are receiving your Social Security check when turning 65. Not working full-time with “true employer” benefits is what Social Security (the government agency that enrolls those applying for Medicare) searches for when administering the 10% per year or 12-month period for a Medicare Part B penalty.

Your business associate, who is covered under his working spouse’s “true employer” group health benefits, can delay enrolling in Medicare. He must follow Medicare’s enrollment rules as Social Security deems upon losing those benefits.

“Still working” are magic words when it comes to enrolling past 65 due to losing your or your spouse’s employer benefits. The Medicare & You handbook discusses on page 19 under the subtitle, “I have other health coverage. Should I get Part B?” about delaying Medicare Part B when you are leaving employer benefits. The handbook states on page 18 under “Special Enrollment Period” that one can sign up for Part B anytime during the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

During a Toni Says Medicare consultation, we recommend that your and/or your spouse’s Medicare Parts A and B begin the first day that the employer health plan is ending, to be sure there is medical coverage when a medical need occurs.

Remember, with Medicare… what you don’t know WILL hurt you! Need Medicare help? Call the Toni Says Medicare hotline at (832) 519-8664 or on our website www.tonisays.com for assistance. Toni’s new Medicare Survival Guide bundle package is also available on our website.

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Toni:

I turned 65 in June, 2 years ago and did not enroll in Medicare because I do not have any health issues. A friend advised me to enroll in Medicare during Medicare’s Annual Enrollment Period. I received a letter stating that because I did not enroll in Medicare when I turned 65 that I have been denied Medicare.

The letter also stated that I need to enroll in Medicare online during Medicare’s General Enrollment Period which is Jan.1-Mar. 31. I am confused about how I need to do to enroll in Medicare online and what website to use. Can you please explain what I need to do in simple terms and what kind of penalty I can expect. Thanks, Toni

Don from Dallas, TX

Hi Don:

The letter stated you will have to enroll during Medicare’s General Enrollment Period (GEP), which is from Jan.1-Mar. 31each year. This enrollment period is for those who never enrolled in Medicare Parts A and B, but not for those who failed to enroll in a Medicare Part D prescription drug plan. That is what Medicare’s Annual Enrollment Period (AEP), which recently ended Dec.7, is for and you will have to wait until 2025’s AEP which begins on Oct.15 and runs through Dec.7 to enroll in Part D.

Beginning Jan.1, 2023, Medicare’s General Enrollment Period (GEP) rules changed that helping Americans who had not enrolled in Medicare when turning 65. Page 18 of the 2025 Medicare & You handbook under “General Enrollment Period” explains that now when you enroll in January, February, or March, your Medicare Part B will begin the first day of the following month. If you wait past March 31 to enroll, your Medicare enrollment will be delayed until Jan.1 of the next year, and you’ll receive a higher Part B penalty. This penalty goes all the way back to the month you turned 65.

Don, if we were to have a Toni Says Medicare consultation whether in person or online by Zoom, I would advise you to enroll in Medicare Parts A and B during 2025’s Medicare’s GEP which begins Jan. 1 and do not delay enrolling in Medicare.

Yes, Don, you will receive the Part B penalty which is a 10% penalty for each 12-month period (year) that you failed to enroll. Your penalty will be 20% or 30% depending on the number of years you could have had Part B but failed to enroll. The penalty remains in effect for the life of the Medicare beneficiary’s Medicare coverage.

Enrolling in Medicare Parts A and B requires you to have an ssa.gov account. You can sign up for Medicare online at https://www.ssa.gov/medicare/sign-up. Don, when you enroll during Medicare’s GEP from Jan. 1-Mar.31, your Medicare will begin the first day of the month following enrollment. This information is what your letter from Social Security stated.

Currently, there are over 7 million Americans on Medicare receiving a Medicare Part B penalty costing on average $5,000 in lifetime penalties because they did not enroll in Medicare at the right time.

Don, you will also be receiving a Part D penalty and should enroll in the next enrollment time for Medicare Part D, which is the 2025 Medicare AEP. Whichever prescription drug plan you pick will start Jan. 1 (2026) with a specific Part D penalty. The penalty is 1% for each month, you failed to enroll in Medicare Part D starting at age 65. This penalty is based upon the national Part D average premium which changes as the national Part D average premium changes.

Readers, when turning 65 and covered by an individual policy or no health insurance, please do not delay enrollment in Medicare, like Don did – because with Medicare, what you don’t know WILL hurt you.

Email info@tonisays.com or call 832/519-8664 with your Medicare questions.

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Toni:

In August, my husband and I enrolled in a Medicare Supplement, which has not paid a medical claim because we are in a Medicare Advantage plan. We could not leave the Advantage plan and return to Original Medicare due to Medicare rules.

I was told that Medicare’s Annual Enrollment is when Sonny and I can disenroll from this Advantage plan and return back to Medicare, but I do not know what to do.

Toni can you please explain in simple terms what we need to do since Medicare’s enrollment period is beginning. Thanks, Laura from Las Vegas

Hello Laura:

The biggest no-no in the Medicare insurance world is when an insurance agent sells a Medicare beneficiary (which is what you and Sonny are) who has a Medicare Advantage plan a new Medicare Supplement without advising the client how to disenrolled properly from their Medicare Advantage plan.

Medicare’s Annual Enrollment (AEP) from Oct. 15 to Dec. 7 is the proper time to disenroll from the Medicare Advantage plan that you and Sonny are currently in by enrolling in a Medicare Part D plan and return to Original Medicare on Jan. 1. At that time is when you can begin to use the Medicare Supplement which you applied for in August.

AEP is the time when one can enroll or change either a standalone Medicare Prescription Drug (Part D) plan or a Medicare Advantage (Part C) plan with or without a prescription drug plan. Enrolling in a Medicare Supplement or changing Medicare Supplement plans is not included in Medicare’s AEP rules. Underwriting rules for Medicare Supplements will apply during AEP.

Below are changes that can be made during Medicare’s Annual Enrollment Period (AEP):

• Return to Original Medicare by enrolling in a stand-alone Medicare Prescription Drug (Part D) Plan. (Laura, this is you and Sonny’s Medicare AEP option to begin using the Medicare Supplement which you enrolled in August.)
• Return to Original Medicare by enrolling in a standalone Medicare Prescription Drug (Part D) Plan and purchase a Medicare Supplement. (underwriting rules may apply)
• Enroll in a Medicare Prescription Drug (Part D) Plan.
• Change from one Medicare Prescription Drug (Part D) Plan to a new       Part D Medicare Prescription Drug Plan.
• Enroll in a Medicare Advantage (Part C) Plan with Prescription Drugs
• Change from one Medicare Advantage (Part C) Plan with or without Prescription Drug plan to a new Medicare Advantage (Part C) Plan.
• Return to Original Medicare only and enroll in a stand-alone Medicare Prescription Drug (Part D) Plan.
• Or Return to Original Medicare with no Part D plan. *Please note there is a penalty for not enrolling in a Medicare Prescription Drug (Part D) plan when first eligible.

For those who already have either a Medicare Advantage (Part C) plan with or without prescription drugs or a standalone Medicare Prescription Drug (Part D) plan, Medicare’s Annual Enrollment is the time to make sure your drug plan or Advantage plan still meets your needs.

It has been acknowledged that some Medicare Advantage and Part D plans have changed for 2025. Use www.medicare.gov to verify that your prescription drugs are covered in your 2025 MAPD or Part D plan formulary. If your prescriptions are not covered for 2025, you will have to pay 100% of that prescription cost out of your pocket.

With Medicare, it’s what you DON’T know that will HURT YOU! Need Medicare help? Call the Toni Says Medicare hotline at (832) 519-8664 or email info@tonisays.com for assistance. Toni’s books are available at www.tonisays.com with a bundle discount for Toni Says® readers.

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Toni:

Last year during Medicare’s Annual Enrollment, both my husband and I qualified for a Medicare Supplement Plan G over the phone from a telemarketing call. The supplement has never paid a dime! We still must use the same doctor and get referrals from our Medicare Advantage HMO. We can’t get the Medicare Supplement to pay because no one advised us how to stop the Medicare Advantage plan.

We have spent over $250 a month since January and the Medicare Supplement Plan G has never been used. How can we get out of this Medicare Advantage plan and return to Original Medicare to use the Medicare Supplement purchased last November?

Looking forward to your answer, Toni. Laura from Tampa, Fla.

Hello Laura:

The biggest no-no in the Medicare insurance world is when an insurance company or agent sells a Medicare beneficiary (which is what you and your husband are) who has a Medicare Advantage plan a new Medicare Supplement without advising the client how to disenrolled properly from their Medicare Advantage plan.

Laura, as you are now finding out, because the agent who sold you the Medicare Supplement failed to inform you and your husband how to disenroll properly from your Medicare Advantage plan, you and your husband have not been in Original Medicare for the last year and could not use the Medicare Supplement benefits you are paying for.

The change would have been a simple one because you both qualified medically for the new Medicare Supplement. All the agent needed to do was enroll you and your husband in a standalone Medicare Part D prescription drug plan. This simple step would have cancelled your Medicare Advantage HMO Plan effective January 1 and returned you and your husband to Original Medicare with a Medicare Supplement and a new Medicare Part D prescription drug plan.

You need to enroll in the standalone Medicare Part D plan that covers you and your husband’s current prescription drugs as soon as possible or no later than midnight December 7th or you will remain in the same situation that you are in right now, Laura.

Readers, this is what Medicare Annual Enrollment Period (AEP) from October 15 to December 7 is all about! It’s the time to enroll in a new Medicare Part D prescription drug plan or Medicare Advantage plan. (Chapter 6 of Toni’s Medicare Survival Guide Advanced Edition explains Medicare’s AEP rules in detail.)

If you are changing to a Medicare Supplement, you need to have passed the medical underwriting process and be approved for the Medicare Supplement before enrolling in a standalone Part D plan, which will automatically cancel your Medicare Advantage Plan. If you are not approved for a Medicare Supplement before you sign up for Part D and you miss the December 7^th deadline, all costs that Original Medicare does not pay will become your financial responsibility without a Medicare Supplement.

Insurance agents who are properly trained regarding Medicare Advantage rules know that those enrolled in Medicare Advantage plans should enroll in a standalone Medicare Part D plan by midnight December 7^th to be disenrolled properly from a Medicare Advantage plan once the Medicare Supplement is approved.

Most Americans do not realize that they cannot have both Original Medicare and a Medicare Advantage plan at the same time. Medicare will pay the Medicare Advantage plan for your care. Original Medicare and a Medicare Advantage plan cannot pay at the same time. Confusing… I know! Remember – with Medicare, it’s what you DON’T know that will HURT YOU!

Have a Medicare question, call Toni Says at (832) 519-8664 or email info@tonisays.com. Toni’s books are available for purchase at www.tonisays.com with a special bundle discount for Toni Says® readers.

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Toni

I have a quite different Medicare problem concerning how to enroll in Medicare than any enrollment problem that I have read in your Medicare column. I understand from an email a friend received from Medicare.gov that starting January 1, there are new turning 65 Medicare enrollment rules.

I have rheumatoid arthritis and my prescriptions are expensive. I turn 65 on February 20^th and need my Medicare to begin May 1^st. My husband is retiring and losing his company benefits effective May 1^st.

I am a non-working spouse and do not have enough work quarters to receive Medicare on my own. I do not know how to apply using my husband’s Medicare benefits. What do I do? Mary Ann, Oakland, CA

Mary Ann:

It is so especially important to plan to be sure that you are enrolling in Medicare correctly. (Chapter 1 of my Medicare Survival Guide Advanced edition explains enrolling in Medicare in detail.)

Mary Ann because you are short the 40 quarters of working and paying taxes to qualify under your Social Security number for your Medicare, you will have to qualify under your husband’s Social Security number for your Medicare to begin if he has the 40 quarters to qualify.

Call your local Social Security office or Social Security’s main 800 # at 1/800-772-1213 to arrange an appointment either over the phone or at a local Social Security office and ask how to apply under your husband’s work record. You will need an “original” certified marriage license to show Social Security that you are currently married.

Set up a www.ssa.gov account prior to talking with a Social Security representative. Social Security may want you to enroll in Medicare online by visiting www.ssa.gov/benefits/medicare or go online and enroll in Medicare when talking with the representative that is guiding you through this process. With you being short 40 work quarters, the process is a little bit complicated, than when someone is turning 65 and applying using their own benefits.

On November 17,2022, Medicare did send out an email saying that there are changes to enrolling in Medicare when turning 65 beginning January 1, 2023. Medicare’s Initial Enrollment Period (IEP) is the 7-month period which occurs 3 months before turning 65, the month you turn 65 and 3 months after turning 65.

Below is a summary of the Medicare Initial Enrollment Period 7-month timeline schedule:

• If enrolling anytime 3 months before turning 65, your Medicare begins the first day of the month you turn 65. Since you, Mary Ann will turn 65 on February 20, you can enroll in Medicare Parts A and/or B in November, December, or January (3 months prior) for a February 1^st effective date.
• If enrolling the month, you turn 65, then Medicare will begin the 1^st of the next month. Mary Ann, you can enroll in February; and your Medicare will begin March 1^st.
• If enrolling 1 month after you turn 65, your Medicare will begin 1^st of the next month. Mary Ann enrolls in March; her Medicare begins April 1^st.  
• If enrolling 2 months after you turn 65, your Medicare will begin the next month. Mary Ann enrolls in April; her Medicare will begin May1^st 

• If enrolling 3 months after you turn 65, your Medicare will begin the next month. Mary Ann enrolls in May (3 months after the month you turn 65); her Medicare will begin June 1^st.

Mary Ann, since you want your Medicare to begin May 1^st, I would advise you to enroll in Medicare in April and that is when you would want to schedule your appointment with Social Security to explain your enrollment situation of not having enough quarters.

Visit www.seniorresource.com/medicare-moments to listen to Toni’s Medicare Moments podcast. Email Medicare questions to info@tonisays.com or call 832/519-8664.

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Dear Toni:

I turned 65 in February and did not enroll in a Medicare Prescription Drug plan. I’ve been told that I must wait until October for Medicare’s Annual Enrollment time. I need help now because I have been diagnosed with Parkinson’s and my brand name prescription is very expensive. I thought I could enroll at any time of the year.  What can I do? James…Memorial area

Hello James:

Medicare’s Annual Enrollment involves only enrolling in a standalone Part D Medicare Prescription Drug plan or a Part C Medicare Advantage plan with or without Medicare Prescription Drug plans. *Medicare Annual Enrollment does not involve changing or enrolling in a Medicare Supplement. * Medicare Annual Enrollment Period is only for enrolling in or changing a Medicare Part C Medicare Advantage Plan or a  Medicare Part D Prescription Drug Plan.

This year’s Medicare Annual Enrollment starts on Saturday, October 15, and it will end at midnight on Wednesday, December 7^th (Pearl Harbor Day). All plans will have January 1^st as their start date.

This is the time when you can make changes to your Medicare Part D Prescription Drug plan or Medicare Part C Advantage plan, or you could enroll if you missed your enrollment time when you were first eligible like you did, James, when you turned 65.

Below are the changes that a Medicare beneficiary can make during AEP (annual enrollment period):

• Enroll in a Medicare Part D Prescription Drug Plan.
• Change from one Part D Medicare Prescription Drug Plan to a new Part D Medicare Prescription Drug Plan.
• Enroll in a Part C Medicare Advantage Plan with Prescription Drugs
• Change from one Part C Medicare Advantage Plan with or without Prescription Drug plan to a new Part C Medicare Advantage Plan.
• Return to Original Medicare and purchase a Medicare Supplement and enroll in a stand-alone Part D Medicare Prescription Drug Plan.
• Return to Original Medicare only and enroll in a Part D Medicare             Prescription Drug Plan
• Or Return to Original Medicare with no Part D plan. *Don’t forget there is a penalty for not enrolling in a Part D Medicare Prescription Drug plan when first eligible. *

For those who already have either a Part C Medicare Advantage plan with or without prescription drugs or a stand-alone Part D Medicare Prescription Drug plan, Medicare’s Annual Enrollment is the time to make sure your drug plan or Medicare Advantage plan still meets your needs, especially if you had any changes to your health.

Visit www.medicare.gov after Wednesday, October 1^st to view 2023 Medicare Part D and Medicare Advantage plans with enrollment starting Saturday, October 15. The website has a tool for helping you narrow your search for new Medicare Advantage and Prescription Drug plans.

It is wise to verify every year that your prescription drugs are covered on your Part D Medicare Prescription Drug plan. Medicare Advantage or Prescriptions Drug plans can change their prescription drug formulary each year and if your prescriptions are not covered for the next year, you may have to pay 100% of that prescription out of your pocket if it is not covered on your Part D plan.

Have a Medicare concern or question? Please email the Toni Says® office at info@tonisays.com.

Confused about Medicare Zoom Webinar on Wednesday, November 16^th at 4-6:00PM CST.

Visit www.Tonisays.com for the Zoom enrollment link.

Toni King, Medicare author/advocate of the 2022 Medicare Survival Guide® Advanced book available at www.seniorresource.com. Toni’s new Medicare Moments podcasts are at www.seniorresource.com/medicare-moments

The post Know Your Medicare Annual Enrollment Options!! appeared first on ToniSays.

Toni:

Read in your column last week that there is only 3 weeks to the Medicare Annual Enrollment period. I’m really confused on what I need to do.  I am receiving so much mail that I am stressed about making the wrong decision and messing up my Medicare.

Is there a law that I have to change my Medicare?  You helped my husband and me with our Medicare decision in January when my husband retired from his job of 30+ years and now it seems we have to do this all over again. Could you explain what we need to do? Thanks, Alice from Rosenberg, TX

Hello Alice:

Stress is running rampant this Medicare Annual Enrollment season because the price of the economic times that America is experiencing. Many are concerned that they could lose their jobs or better yet not have enough money for retirement because of a personal healthcare crisis.

Good News, Alice because there is not a law that says you must make a change to your Medicare.  You do not have to change your Medicare Supplement, which the Toni Says Medicare team assisted you and your husband to enroll in.   I would advise you to check your Part D plan for any significant changes.  If you see a change to enroll in a new Medicare Part D plan for next year beginning January 1^st, 2023.

Below are a few tips to simplify your Medicare Annual Enrollment or if you are new to Medicare and want to make the correct choice and personalize your Medicare just for you:

• Medicare Tip #1: Learn your Medicare ABC and Ds. Part A is hospital coverage. Part B is for medical/outpatient coverage such as doctor visits and performing surgery. Part C is Medicare Advantage plans that combines both Part A and B benefits with some plans having Medicare Part D included. Part D is for prescription drugs with the “famous” donut hole and can be in Part C or a standalone plan.
• Medicare Tip #2: Know what Original Medicare covers…and what it doesn’t.  What your Part A deductible is and for Part B that Medicare pays 80% of approved charges while you pay 20% and a once-a-year deductible with a monthly premium that depends on your income.
• Medicare Tip #3: Keep in mind not all Medicare plans are created equal. Medicare Supplement works directly with Original Medicare and Medicare Part C Medicare Advantage plans work differently with low or no premiums and different out of pocket than a Medicare Supplement. Do your research especially is you have health issues and may have expensive brand name prescriptions.
• Medicare Tip #4 Research Medicare Part D plans every Medicare Annual Enrollment. Plans can change benefits and the drug formulary for the next year.
• Medicare Tip #5: Don’t choose manly on cost. Make sure there are not any hidden copays or other fees that will end up costing you money.

When one visits, the Toni Says Medicare office to personalize their Medicare situation, we tell them to forget everything they know about their old health insurance plans because

October’s Confused about Medicare Workshops:

• Confused about Medicare Zoom Webinar on Wednesday, October 12^th at 4-6:00PM. Visit Tonisays.com for the Zoom enrollment link.
• LIVE Confused about Medicare Webinar on Thursday, October 13^th at 11:00AM to 1:00PM at St John Presbyterian Church, 5020 West Belfort Blvd, Houston, TX77035

RSVP-832/519-8664.

Visit /www.seniorresource.com/medicare-moments to listen to Toni Says® new Medicare Moments podcasts.

Medicare question? Call 832/519-8664 or email info@tonisays.com.

Toni King, author of the Medicare Survival Guide®, is on sale at www.tonisays.com.  Personal consultations or to have Medicare/Social Security questions answered, please contact Toni at www.tonisays.com/ask-toni or call 832-519-8664.

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Hello Toni:

I am turning 64 soon and have not started receiving my Social Security check. I am still working full time but do not have company benefits. I am confused because I do not have Social Security and not sure how to get my Medicare. Do I call Medicare to enroll? Can you please explain the introductory steps for Baby Boomers who are approaching the time to apply for Medicare when turning 65? Thanks, John from Rosenberg, TX

Hi there, John:

Enrolling in Medicare is very confusing! Most people think that when they turn 65, a magical switch turns on and poof you are on Medicare! Medicare changed the rules during the Clinton administration, when Social Security extended the time for receiving 100% of your Social Security benefits. Social Security does the paperwork for Medicare.

Steps to Enrolling in Medicare:

Turning 65 and Receiving Your Social Security Check:

• You should receive your “Welcome to Medicare” Kit with your Medicare card 90 days prior to turning 65 with Medicare Part A and B.
• Receiving your Social Security check before turning 65 is the easiest, stress-free way to enroll in Medicare if you are not working full-time with employer benefits or covered by your spouse’s employer benefits when turning 65.

Turning 65 and NOT Receiving Your Social Security Check:

• You will Not automatically receive your “Welcome to Medicare” kit when turning 65 with your Medicare card.
• You must enroll in Medicare Parts “A, B and D” to keep from receiving a “late enrollment penalty (LEP).
• You must enroll in Medicare online at www.ssa.gov/benefits/medicare up to 90 days prior to turning 65 for your Medicare Parts A and B to begin the 1^st day of the month you turn 65. Go to Medicare.gov to enroll in your Medicare Part D plan.
• Do Not Wait until right before you turn 65 to enroll in Medicare because it will take time to receive your Medicare card before the 1^st day of the month you turn 65.

Turning 65 and “Still Working Full-Time”:

• Do you have Individual Health Insurance?
• Individual Health Insurance
• Working full-time or contact labor employee with individual health insurance should enroll in Medicare Parts A, B and D when turning 65 to avoid a Medicare Part B and D penalty.
• Medicare does not recognize individual health plans as “creditable coverage.”
• Do you have Qualified Employer benefits and Working Full-Time?
• Medicare allows you to delay your Medicare Parts “A” and/or “B” if you or your spouse are working full-time with employer benefits not retirement benefits and you are covered by that specific employer benefits. “Is still working” are Medicare’s buzz words for delaying your Medicare Part B.
• To enroll in Medicare after 65 and having delayed Medicare Part B due to working full-time with employer benefits, complete Social Security forms CMS-L564 “Request for Employment Information” (signed by the employer or HR) and CMS-40B “Application for Enrollment in Medicare Part B.” Under “Remarks #12” state which month you want your Medicare Part B to start. Take your forms to your specific Social Security office either in person, by fax, or priority mail to enroll in Medicare Part B. Remember to write the words “Special Enrollment Period” across the top of each form to keep from receiving the famous Medicare Part B penalty.

Remember, always make copies of every document given to the Social Security office or received from the Social Security office.

Sign up for the Toni Says® Medicare newsletter explaining Medicare rules at www.tonisays.com. For answers to Medicare questions, email info@tonisays.com or call 832/519-8664.

Toni King, author of the 2022 Medicare Survival Guide® Advanced edition is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com

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