Toni:
When I first enrolled in Medicare in 2019, I picked Medicare supplement Plan F. In February of 2024 I was approached by a telemarketer on my cell phone who talked me into a Medicare Supplement Plan K because this plan had a lower premium than Plan F.  I could change because I was in good health at that time.

March of 2025, I was hospitalized due to cardiac issues because I passed out in the doctor’s office. Now I am having serious heart problems, causing me to need a heart transplant.

Since I have Plan K, I must pay the deductible plus 50% cost until I meet the Medicare Supplement’s maximum out of pocket and for 2026 the cost has exploded to $8,000.  I tried to go back to Plan F, but the agent said I couldn’t because of my heart issue.

I thought with Medicare preexisting conditions did not count. Can you help me to understand this? Your help would be appreciated. Thanks, Toni.

— Jason, Lubbock, Texas

Jason:

What a great question! Americans without health issues need to realize that a health care crisis can happen when you least expect it! And you must answer health underwriting questions to qualify for a new Medicare Supplement.

Jason, you went from the top-of-the-line Medicare Supplement Plan F, where you would have zero out-of-pocket and all Medicare eligible expenses would be covered 100%, to a Plan K with an out-of-pocket of $7220 for covered Medicare expenses for 2025 that has risen to $8,000 for 2026. Because you need to have a heart transplant; qualifying for a new Medicare Supplement is not an option since you cannot pass the health underwriting.

The only thing you can do is to remain on your Medicare Plan K or go with a Medicare Advantage HMO or PPO plan, because it has no health questions. Jason, you can enroll in a Medicare Advantage plan until March 31 since now is the Medicare Advantage Open Enrollment Period.  Wait to enroll after April 1 and then Medicare’s Open Enrollment Period starting October 15-December 7^th  will be the only option for you to change to is a Medicare Advantage Plan because it has no health questions.

I would recommend that you talk with your health care providers about which Medicare Advantage Plan meets their requirements. There are 2 chapters in my Medicare Survival Guide Advanced Edition that explain the difference in Medicare Supplements and  Medicare Advantage  Plans. In chapter 6, I explain what  Medicare Advantage plans (Part C) are and the different type of plans…HMO, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans). In chapter 8, I discuss Medicare Supplements, also known as Medigap policies.

With a Medicare Supplement, the most comprehensive plans covering  your Medicare expenses are Plan F, Plan G and Plan N.

• Medicare Supplement plan F covers comprehensive coverage for Medicare approved amounts with zero out of your pocket, but one must have enrolled in Medicare Part A prior to January 1, 2020, to enroll in Plan F.
• Medicare Supplement Plan G is like Plan “F” and is available to Medicare beneficiaries whose Medicare Part A starts after January 1, 2020. The difference in Plan F and G is that Plan G does not include the Part B deductible of $283 for 2026.
• Medicare Supplement Plan N has lower premiums with higher out-of-pocket costs.  There is a $20 co-pay for a doctor’s visit and a $50 co-pay for the emergency room with the Part B deductible not covered. and, in addition, Part B excess charges are not paid for by the insurance company (which Plan G covers).

Take time to discover which Medicare option is right for 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.

The post Help!! The cost of my Medicare Supplement has exploded!! What can I do? appeared first on ToniSays.

Toni:

We have received a 20% increase for our Plan F Medicare Supplement that is effective October 1. I am a 70-year-old female in good health, but my husband is undergoing cancer treatment. Also, his cardiologist has advised him that he may need a pacemaker.

My friends have advised me that we will have to wait until Medicare Annual Enrollment to change from our current Medicare Supplement plans.

I am concerned that with the Medicare Supplement increase we may not be able to afford the premiums. What should we do? Would a Medicare Advantage plan be a good option to change to with Fred’s cancer issues? Carol from Tampa, FL

Carol:

Carol, receiving your Medicare information from friends can lead you down the wrong path. You were given inaccurate information from a caring friend. I have good news for you because you do not have to wait until Medicare’s Annual Enrollment to change your Medicare Supplement insurance company. You can change your Medicare Supplement any time during the year. Medicare’s Annual Enrollment Period is a time to change your Medicare Advantage plan or Medicare Part D Prescription Drug plan.

The Medicare Supplement renewal increase is more than the public is expecting. In 2015, Congress passed legislation called “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA) to help the medical industry by correcting the “Doc Fix” proposal. MACRA also updated Medicare Supplement’s plans F and C which began January 1, 2020. At that time is when Medicare Supplement plan F and C increases began.

Anyone that wants to change their current Medicare Supplement plan and have been enrolled in their Medicare Part B longer than 6 months must now answer health underwriting questions regarding their current and past health issues. This is what you and your husband will have to do to change Medicare Supplement companies and plans.

Carol, you have an option to change from your current Medicare Supplement Plan F to a different Medicare Supplement company or a different type of Medicare Supplement plan such as plan G or N. Both you and your husband must qualify by answering medical underwriting questions to change Medicare Supplement plans.

If you cannot qualify because of a health issue, then another option may be to search for the right Medicare Advantage plan to fit your medical needs. The only catch to making a change to a Medicare Advantage plan is that you must wait until Medicare Annual Enrollment period which begins October 15^th thru December 7^th every year.

Below is what Medicare Supplement Plans G and N offers to change from a Medicare Supplement Plan F:

• Medicare Supplement Plan G: offer lower rates and the same Medicare benefits as Plan F except the Medicare Part B deductible is not covered and will be paid for by the enrolled Medicare beneficiary. Part B deductible for 2022 is $233.
• Medicare Supplement Plan N: generally, has lower premiums than Plan G with generally more out of pocket. There is a $20 co pay for a doctor visit with $50 co pay for emergency room. Part B deductible is not covered, and Part B excess charges are not paid for by the insurance company which Plan G includes.

Caution:  Do not cancel your existing policy until you have been approved by your new Medicare Supplement insurance company.

Toni Says® announces that Toni King is now nationwide with the new Medicare Moments podcasts. Visit/www.seniorresource.com/medicare-moments to listen to Toni’s podcasts.

Need assistance with Medicare or Senior issues visit www.seniorresource.com to explore Baby Boomer and Senior situations. Toni’s Medicare articles are available at the Senior Resource website.

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

The post Medicare Supplement Premium Is Out-of-Control!! When Can I Change? appeared first on ToniSays.

Dear Toni:

What is the difference between a “Medicare Supplement” and a “Medicare Advantage PPO” plan? I am turning 65 and I am being bombarded with marketing material.

Friends have told me that a Medicare Advantage PPO plan is the same as a Medicare Supplement because both have a network of doctors to pick from. My retiree employer medical plan now has a Medicare Advantage PPO plan, and I am concerned if a medical catastrophic incident happens will the medical providers, I am now seeing accept this Medicare Advantage

PPO plan? Thanks, Stephen from Sugar Land, TX

Stephen:

Your friends have given you WRONG information regarding Medicare. This can lead you to choose the wrong Medicare plan for your medical situation. Medicare Supplements and Medicare Advantage Plans are completely different types of Medicare policies.

With a Medicare Supplement, there is not a network of any kind; you have the freedom to use any healthcare provider/facility that will bill Medicare. The Medicare Supplement will pay for your Medicare out of pocket that Medicare Parts A and B will not pay.

With a Medicare Advantage PPO plan, there are lower cost in-network providers/facilities as well as out of network benefits that will cost you more. In 2022, a popular Medicare Advantage PPO plan has a maximum ranging from $5,400 to $7,550 in-network while out of network costs range from$7,550 to $11,300.

Most never consider they could have an out of network provider/facility for their medical claim, but in these current times many healthcare providers/facilities are out of network with a Medicare Advantage PPO plan.

Below are differences in the two plans:

• Medicare Supplement:
• A Medicare Supplement works directly with “Original Medicare.” Medicare pays its share of the Medicare-approved amount for “medically necessary “covered healthcare costs.
• Your Medicare supplement will pay its share. With a Medicare Supplement, you chose which doctor, hospital, home health agency, skilled nursing facility, etc. that accepts Medicare assignment for your healthcare. You and your healthcare providers are in control of your healthcare.
• The downside to a Medicare Supplement is that you have a monthly premium that may increase the premium rate each year.
• Medicare prescription (Part D) drugs plans are not included, so you may want to enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan.

• Medicare Advantage PPO Plan: 
• To qualify for any Medicare Advantage plan:  a) You must be enrolled in both Medicare Parts A & B. b) Live in the service area 6 months out of a year.
• When you choose a Medicare Advantage Plan, Medicare pays the insurance company a certain dollar amount every month for your care for the plan you are enrolled. Your Part A and Part B must always remain in effect.
• When you go to the doctor, hospital or visit your pharmacist, you must only use your Medicare Advantage Plan insurance card, not your Medicare (red, white, and blue) card. Verify that your specific medical provider is still accepting the MAPD plan that is being enrolled in.
• A Medicare Advantage Plan must provide all your Part A and Part B benefits and some Medicare Advantage Plans have Part D prescription drug plans included. Also, has “extra” benefits such as gym membership, dental and vision.

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.

The post Are Medicare Supplements and Medicare Advantage PPO Plans the Same? appeared first on ToniSays.

Toni:

I have retired effective 1 and now my wife and I are going to travel the US in the new Winnebago that is sitting in my driveway.  I am having a hard time trying to sign up for Medicare since I turn 65 in and really do not know what my address will be since I will be traveling at different times of the year.

I am an insulin-dependent diabetic and will need easy access to a pharmacy while traveling, plus if I have an emergency I do want access to decent medical care anywhere in the US.

Please give me your thoughts on my situation and what would be the best option for me and my wife…Thanks, Joseph from Cypress, TX

Well, Joseph:

Planning your Medicare is an important part of planning your retirement because one wrong move can cause you thousands of your hard-earned retirement dollars.

Many new to Medicare miss a special window of opportunity when they first enroll in Medicare Part B.  This special time is called the Medigap/Medicare Supplement Open Enrollment period and lasts for 6 months beginning the first day of the month in which you are 65 or older and enrolled in Part B.  During this special period, an insurance company can’t use medical underwriting because of any health problems.

Joseph, if you enroll in the special 6-month window, being an insulin-dependent diabetic will not affect your enrolling in a Medicare Supplement.

Touring the US may be another reason to choose a Medicare Supplement because there is not a network and if the healthcare provider or facility is accepting Medicare, then you can receive your care there.

Also, you will want to take time when picking your Medicare Part D plan because you will want access to a nationwide pharmacy that is not only in your Cypress, TX area, but also in other parts of the country.

Another option for both healthcare and prescription drugs is a Medicare Advantage (Part D) plan which may or may not offer the flexibility of easy access to healthcare providers in various areas of the country.

Below are the differences between a Medicare Supplement and a Medicare Advantage Plans:

• Medicare Supplement:
• A Medicare Supplement works directly with “Original Medicare”.
• You chose which doctor, hospital, home health agency, skilled nursing facility, etc. that accepts Medicare assignment for your healthcare.
• There is a monthly premium that may increase the premium each year.
• You may enroll and will pay separately for a “Standalone” Medicare (Part D) Prescription drug plan.
• Medicare Advantage Plan: 
• To qualify for the plan:  a) You must be enrolled in both Medicare Parts A & B.  b) Live in the service area 6 months out of a year or change when you are out of the area…
• You must use your Medicare Advantage insurance card, not your Medicare (red, white, and blue) card.
• A Medicare Advantage Plan must provide all your Part A and Part B benefits and some Medicare Advantage Plans have Part D prescription drug plans included.
• A Medicare Advantage Plan may have zero to low dollar premiums.
• With a Medicare Advantage plan, you may have different co-pays, co-insurance, or deductibles to pay and have maximum out-of-pocket expenses to meet.

For assistance with enrolling and personalizing your Medicare contact the Toni Says® office at 832/519-8664.

Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question? Call 832/519-8664 or email info@tonisays.com.

The post Medicare and Traveling the US? appeared first on ToniSays.

Toni:

We have received a 20% increase for our Plan F Medicare Supplement that is effective May 1.  I am a 70-year-old female in good health, but my husband is undergoing cancer treatment at MD Anderson. Also, his cardiologist has advised him that he may need a pacemaker.

My friends have advised me that we will have to wait until…

The post Medicare Supplement Rate Increase is Outrageous! appeared first on ToniSays.

2 Weeks until Thursday, October 15-Medicare Annual Enrollment-

Toni:

We have received a 20% increase in our Plan F Medicare Supplement. I am a 70-year-old female in decent health, but my husband is undergoing cancer treatment at MD Anderson. Also, his cardiologist has advised him that he may need a pacemaker.

I’ve understand told that Medicare Annual Enrollment is our time to change our Medicare Supplement plans. I’m concerned that with the Medicare Supplement increase that we may not be able to afford the premiums with future increases. Would a Medicare Advantage plan be a good option to change to…

The post Did Changes to Plan F Cause My Medicare Supplement Premiums to Rise? appeared first on ToniSays.

Dear Toni:

I am turning 65 in July and my husband is retiring January 2021. Both of us are covered by his company health plan.

I am being bombarded by Medicare marketing material regarding different types of Medicare plans that are either HMO or PPO. Friends have told me that a PPO plan is the same as a Medicare Supplement because if your doctor is not in the network, then you can go out of network. With my husband and I visiting doctors in a certain hospital network, it is vital that we keep our doctors. Please explain as I do not want to make a serious mistake in choosing the right type of plan for our Medicare needs. Thanks, Josie from Tampa, Florida

Josie:

You were given WRONG information!  Medicare Supplements and Medicare Advantage PPO plans which your friends are referring to are completely different types of Medicare policies.

The post Does A Medicare Supplement Have A PPO Network? appeared first on ToniSays.

Morning Toni:

            I am turning 65 in March and am searching for the right Medicare Supplement to cover my health needs. I have been told from patients at the cancer center where I go to receive my cancer treatment that Plan F is the plan to choose. I have been “Googling” enrolling in Plan “F” and discovered that it is not available for me. I would like to know WHY because I do not need to make a serious Medicare mistake. 

 Thanks, Sam from Clear Lake area

Sam:

Effective as of January 1, 2020, Medicare Supplements Plan F and C are no longer available to those who are turning 65 or those older than 65 whose Medicare Parts A with an effective date beginning January 1, 2020.  Those who you are discussing Medicare Supplements with must have their Medicare Part A before January 1, 2020.

The post Turning 65 in March…Why Can’t I apply for Medicare Supplement Plan F? appeared first on ToniSays.

Hello Toni:

I recently attended a Medicare Advantage meeting because my Medicare Supplement Plan F is costing me $220 a month and was going to join. A friend introduced me to your articles explaining the different Parts and Plans of Medicare. Now I am having second thoughts.

My question is if I change to an Advantage plan and find out it’s not working for me.  1) Can I return to regular Medicare and apply for a new Medicare supplement? 2) Will I be able to enroll in a Medicare Part D plan…

The post Can I Change My Medicare Advantage Plan After the Dec. 7th Deadline? appeared first on ToniSays.

            Will be eligible for Medicare in July and am now receiving breast cancer treatment from MD Anderson.  I am currently on my ex-employer’s COBRA and searching for dental care when I go on Medicare in July.  The only dental/vision plans I am finding are in Medicare Advantage plans, but MD Anderson has advised me to not go in that direction because many Medicare Advantage plans are no longer accepted at their facility.

             Is there a dental plan that Medicare offers? 

Please advise. 

Tammy from Alvin, TX

Tammy:

             “What’s NOT Covered by Part A & Part B?” is explained on page…

The post What…Medicare Doesn’t Pay For Dental!!! appeared first on ToniSays.