ToniSays https://tonisays.com/ With Medicare, what you don't know will hurt you Wed, 09 Sep 2026 14:32:12 +0000 en-US hourly 1 https://wordpress.org/?v=7.1 https://tonisays.com/wp-content/uploads/2026/08/cropped-favicon-tonisays-32x32.png ToniSays https://tonisays.com/ 32 32 Understanding Hospice https://tonisays.com/understanding-hospice/ Wed, 09 Sep 2026 14:10:08 +0000 https://tonisays.com/?p=44224 “Hello Toni: I am a critical care nurse. On a daily basis, I advise family members daily who are seeking medical assistance for their elderly parents or spouse during end-of-life...

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Listen to the entire article here.

“Hello Toni:

I am a critical care nurse. On a daily basis, I advise family members daily who are seeking medical assistance for their elderly parents or spouse during end-of-life issues, especially helping them understand hospice.

Can you explain hospice in simple terms for your Toni Says Medicare column readers? I am sure this will help those who are searching for hospice/medical answers for their frail loved ones.


Thanks in advance…”

Sarah from Houston, TX.

 

Sarah:

HOSPICE…is a subject no one wants to discuss with their elderly loved one. But hospice can help a family when a loved one is terminally ill, and the illness takes an emotional toll on the caregiver and family as well as on the patient.

Many wait too long to discuss the benefits of hospice with the patient’s doctor because they believe that this subject is for someone’s last days of life and to help a person die peacefully. They are not aware that hospice can give hope along this journey with education, medication to manage symptoms, support to the patient and family, and counseling services for the patient, family members, and caregivers.

Four years ago, my own mother was diagnosed with dementia that qualified her for hospice, and she passed away peacefully. I, Toni King, have experienced everything that hospice offers. Hospice is truly a blessing for those who have a terminally ill loved one.

Healthcare professionals in the hospice system consist of physicians, nurses, social workers, spiritual counselors, certified nursing assistants, and volunteers. I would advise those who are navigating hospice to talk with a geriatric case manager or geriatric doctor if you have some concerns or need advice with your loved one’s terminal healthcare issue.


On pages 26-27 of the 2026 Medicare & You handbook, hospice is explained. The handbook discusses what hospice is in Medicare terms and what Medicare covers for hospice under Part A of Medicare. A doctor who orders hospice must certify that the patient is terminally ill, meaning a life expectancy of 6 (six) months or less. The handbook states, “When you agree to hospice care, you agree to comfort care (palliative care) instead of care to cure your terminal illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.”

Hospice can be recertified every 6 months by a hospice medical director or hospice doctor if the patient is still terminally ill. Original Medicare will be billed for hospice care. All medical care for terminal illness is covered by hospice. Original Medicare or Medicare Advantage Plan will pay for health problems that are not related to the terminal illness (co-pays will apply). Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing or personal care home.

Sarah, under “Caregiver relief and support” on page 27 of the handbook, it states that Medicare also covers “inpatient respite care” for the client who is receiving hospice care so that the caregiver, which may be a family member or friend, can rest. The person covered by hospice can stay up to 5 days each time they qualify for respite care. The hospice provider is who arranges respite care. I personally experienced “respite care” for my mother, and I was able to have a few days to relax and relieve the stress while she was being cared for in a local nursing home.


Medicare costs under hospice:

  • You pay nothing for hospice care (Medicare pays).
  • You pay a copayment of up to $5 per prescription for outpatient prescription
    drugs for pain and symptom management.
  • You pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare covers up to 5 days for inpatient respite care in a Medicare-approved facility so that the caregiver can have a time of rest.

Email your hospice and Medicare questions to info@tonisays.com or call 832-519-8664.

Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide. Get your Medicare Roadmap (by clicking on the banner below this article) and be ready for the upcoming Medicare Open Enrollment Period.

—–

 

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.

 

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]]> Get ready… Medicare Open Enrollment begins October 15. https://tonisays.com/get-ready-medicare-open-enrollment-begins-october-15/ Wed, 02 Sep 2026 14:06:31 +0000 https://tonisays.com/?p=44209 The post Get ready… Medicare Open Enrollment begins October 15. appeared first on ToniSays.

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Listen to the entire article here.

“Dear Toni:

Last week the Toni Says Medicare column was about changes to stand-alone Medicare Part D plans beginning Jan. 1. This caught my attention because I applied for a Medicare Part D plan in July and was denied. Medicare advised me to apply for a Part D plan during Medicare’s Open Enrollment. Help! I don‘t know what to do!

The Part D plan that I had been with since turning 65 decided to cancel the policy for 2026. I did not enroll in another plan during 2025’s Medicare Open Enrollment, so I have been without a stand-alone Part D plan all of 2026.

I need your help because I have been prescribed an expensive brand-name cancer prescription that I am having to pay 100% out of pocket. Please explain what I should do during Medicare’s fall enrollment time. Thanks, Toni.”

Corey from Columbus, Ohio.

 

Hello Corey:

In one of the most important Medicare rules, the Center for Medicare and Medicaid Services (CMS) advises America to watch for changes Part D plans for this year’s Medicare Open Enrollment (OEP) which will be mailed out in September, and to research on www.medicare.gov  after Oct. 1 which stand-alone Medicare Part D plan best meets their prescription drug needs for 2027.

It is equally important for those on Medicare to compare plans during Medicare’s Open
Enrollment Period (OEP) and change to a different stand-alone Part D or Medicare Advantage plan if their prescriptions are not covered. It is wise to verify every year that your prescription drugs are covered on your Medicare Prescription Drug plan. Medicare Advantage or stand-alone Prescriptions Drug plans can change their drug formulary (a list of generic and brand-name prescription medications covered by the plan) each year. If your prescription drugs are not covered for the next year, you may have to pay 100% of that prescription yourself.

Corey, because you did not enroll in a stand-alone Medicare Part D plan during last year’s
Medicare OEP, then this year’s Medicare OEP, which is from Oct. 15- Dec.7(Pearl Harbor Day), will be when you can enroll for your Medicare Part D to begin Jan. 1, 2027. Unfortunately, Corey, 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 (OEP):

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan, if you are like Corey and have let your Part D plan lapse or if never enrolled in a stand-alone Part D plan 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. (Corey failed to enroll in a new Part D plan during last year’s 2025 Medicare OEP. Had he enrolled, he would have avoided a penalty.)
  • Enroll in a Medicare Advantage Part C Plan with prescription drug benefits.
  • Change from one Medicare Advantage Part C Plan (with or without a 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.

Medicare’s OEP 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. Note that enrolling in a Medicare Supplement or changing Medicare Supplement plans is not included in Medicare’s OEP without underwriting;  you have to answer health questions.

Remember, with Medicare, what you don’t know WILL hurt you!

Toni Says Medicare Roadmap

Toni’s “Medicare First Steps”, available at www.tonisays.com, details various situations during Medicare’s Open Enrollment Period, such as “still working past 65” or “doctor not accepting my Medicare Advantage plan.”

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

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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.

 

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]]> Changes to Medicare Part D effective January 1, 2027 https://tonisays.com/changes-to-medicare-part-d-effective-january-1-2027/ https://tonisays.com/changes-to-medicare-part-d-effective-january-1-2027/#respond Wed, 26 Aug 2026 14:29:42 +0000 https://tonisays.com/?p=44188 “Toni: Recently, the Trump Administration announced that the end to Inflation Reduction Act’s Medicare program that is effective on January 1, 2027.  I have searched online at www.medicare.gov to find...

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Listen to the entire article here.

“Toni:

Recently, the Trump Administration announced that the end to Inflation Reduction Act’s Medicare program that is effective on January 1, 2027.  I have searched online at www.medicare.gov to find out what 2027 Medicare Part D plan will be the right option for me but can only find 2026 Medicare Part D plans. 

I have Medicare Supplement Plan G with separate Part D plan, and my sister is on a Medicare Advantage HMO.  I need your advice to know how to choose to correct Part D plan for both of us.  Looking forward to what you have to say about this complicate issue.”

Jennifer from Little Rock, Arkansas.

 

Hi Jennifer:

In early August, the Centers for Medicare and Medicaid Services (CMS) announced the end to the Part D Premium Stabilization Demonstration which is a temporary federal program from the Biden Administration’s Inflation Reduction Act.  This program provided extra funding to private stand-alone Medicare prescription drug plans to keep monthly premiums lower and limit sharp price increases.  This Part D discount program affects stand-alone Part D plans and is what you have, Jennifer  and not Medicare Advantage plans which is what your sister is enrolled in. So this will change your Part D premium, and the discount program will end this year on December 31 for those that have a stand-alone Part D plan.

The changes to 2027 stand-alone Medicare Part D plans will involve monthly premiums rising and CMS is estimating that the average stand-alone Part D premium increase to be around $10.  The 2027 stand-alone Medicare Part D and Medicare Advantage plans and premiums will be released on Thursday, October 1 at midnight (12:00AM).  Your 2027 Medicare & You handbook should be in the mail in late September, or you can download the handbook online around October 1.

Jennifer, no one can make a change to their stand-alone Medicare Part D plan or a Medicare Advantage plan for 2027 until Medicare’s Open Enrollment begins on Thursday, October 15 at midnight (12:00AM) and ends Monday, December 7 at 11:59PM.  You and your sister will have to wait until October 15 to research if you need to keep or make a change your current plan that will  begin January 1, 2027.

What CMS is asking America to do is:

  • Watch your mail in September for your current stand-alone Medicare Part D or Medicare Advantage plan’s Annual Notice of Change (ANOC).  CMS is advising those on Medicare to read it carefully to see the exact 2027 premium, deductible, and list of covered prescriptions drugs. Do not throw it away!
  • Avoid blind auto-renewal because you will want to check if a different plan offers a better price and that your prescriptions are covered under your current plan for 2027.
  • Compare plans during Medicare’s Open Enrollment to change to a different stand-alone Part D plan or change to a Medicare Advantage Plan.

Below are the changes that those with Medicare can make during Medicare’s Open Enrollment Period (aka) Annual Enrollment Period (AEP):

  • Enroll in a stand-alone 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. 
  • 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 Advantage Part C 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.

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.

Remember, with Medicare, what you don’t know WILL hurt you!

Email your Medicare questions to info@tonisays.com or call 832-519-8664.  Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.

—–

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.

 

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]]> https://tonisays.com/changes-to-medicare-part-d-effective-january-1-2027/feed/ 0 Can’t qualify for long-term care due to health issues…What do I do? https://tonisays.com/cant-qualify-for-long-term-care-due-to-health-issueswhat-do-i-do/ Mon, 29 Jun 2026 13:48:51 +0000 https://tonisays.com/?p=25787 Can’t qualify for long-term care due to health issues…What do I do? Morning, Toni: Recently, you wrote a Medicare column about various life policies available after 65 and I have...

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Morning, Toni:

Recently, you wrote a Medicare column about various life policies available after 65 and I have a retirement insurance question.

In January, I’m retiring when I turn 70 and my wife, Anna, will be 68. Our retirement insurance issue is that recently we applied for a long-term care plan and were both denied due to our health issues. I had my prostate removed due to cancer about 5 years with no current issues and Bonnie has AFIB which is under control. The agent writing the long-term care plan said that those past 60 years old find it difficult being accepted by an LTC plan due to health issues like we have.

My brothers and I are paying an Alzheimer’s assisted living facility over $12,000 a month for our father’s care. Are there long-term care options available for Anna and me with our health issues because paying $12,000 a month will drain our retirement.

Thanks, Paul from Tulsa, Okla.

 

Hi Paul:

I’m glad that my article about life insurance plans past 65 caught your attention and you took the time to email me about your long-term care situation. New short-term care plans that have extended care benefits have been developed assisting Baby Boomers when there is a need for extra help with unexpected health or accident issues.

The 2026 Medicare & You handbook, under “Paying for long-term care,” discusses how important it is to plan properly to maintain your independence and receive the proper care in the facility you desire. Medicare only pays for medically necessary skilled nursing facility care or for home health care if you meet certain conditions. Skilled nursing has 100 days of benefit with days 1-20 having a $0 copay per day and days 21-100 with a specified copay per day. If you cannot qualify or do not meet Medicare’s qualification for skilled nursing, you will pay 100% of the cost out of your pocket. Medicare doesn’t cover non-medical long-term care. This is why purchasing a policy to help with a long-term need becomes essential.

 

Let’s discuss options that can help to protect your finances from excessive long-term care costs. Especially for those who have health issues that can keep one from being accepted by a long-term care plan.

  • Short-term care insurance plans have a simple health questionnaire with yes/no questions, making it easy to qualify. These policies will assist paying for nursing home, assisted living and personal care home as facility care with benefits for care in your house. Providing various options ranging from $50-$400 per day with benefit periods ranging from 1 or 2 years depending on plans. Allowing one to not drain their retirement dollars due to a serious illness recovery.
  • Life and Annuity Policies are insurance policies that have a provision if you need long-term care; you can receive a certain amount of long-term care with your life/annuity policy’s face (Health questions may keep one from qualifying.)
  • Aid and Attendance benefits is a VA benefit that can help Veterans with long-term care issues. There is over $20 Billion dollars available for long term care pension money just waiting for America’s Veterans to apply for their Aid and Attendance benefits. The must be a long-term care issue to qualify.

 

Important note: If you are under 60 and in good health, please take your time to apply for a traditional long-term care policy. It is easier to qualify and receive a lower premium whether annual or monthly. Most Americans retiring are concerned about a chronic illness being their biggest retirement expense if not planned for properly.

If you have long-term care or Medicare questions, please feel free to reach out to the Toni Says Medicare team at 832/519-8664 or send an email to info@tonisays.com. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide

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]]> Help…employer health plan denies payment for my cancer claim! https://tonisays.com/helpemployer-health-plan-denies-payment-for-my-cancer-claim/ Mon, 29 Jun 2026 13:47:03 +0000 https://tonisays.com/?p=25785 Help…employer health plan denies payment for my cancer claim! Dear Toni: I need your assistance to enroll in Medicare because I am past 65 and still working full-time with employer...

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Help…employer health plan denies payment for my cancer claim!

Dear Toni:

I need your assistance to enroll in Medicare because I am past 65 and still working full-time with employer benefits.  Sherry, the office manager, from my cancer doctor’s office, said that the employer’s health plan denied the recent claim for my cancer treatment. The health plan considers it to be “experimental” and will not approve paying for this care.

The specific cancer treatment costs me over $15,000, which I had to pay on Friday from my 401k.  This amount will drain what I need for retiring.  To remain as a full-time employee, I am having to use my 12 weeks of vacation time for this cancer treatment and receive my full pay.

Sherry said her office currently has patients on Original Medicare with a Medicare Supplement that is paying for this cancer claim. She files their claims without a problem. Toni, I need to know how to begin my Medicare benefits as quickly as possible. Please advise me what I need to do. Thanks, Toni.

— Brent from Nashville, Tenn.

Hello Brent:

A health care professional advised me that many of the new cancer procedures are not approved by individual and employer group health insurance plans. The doctor said that these procedures are generally approved with “Original Medicare.”  He agreed with me that enrolling in Medicare past 65 and employed is complex, especially when an employee has the health issues you are currently experiencing, Brent.

Below are Medicare scenarios for enrolling in Original Medicare past 65, while employed and leaving employer benefits.  They are the same whether you’re still working, laid off or retiring:

  • Health issues are not covered by an employer health plan: You (or your spouse) are still working with health issues (like Brent), and the employer health insurance plan is not covering the doctor’s procedure. Even though you are not retiring, you need to enroll in Medicare.
  • Laid off: You (or your spouse) are laid off and need to enroll in Medicare.
  • Retiring past 65: You (or your spouse) decide to retire past 65 and need to enroll in Medicare.

 

The process to enroll in Medicare past 65 must be followed correctly , and is listed below:

  1. Two(2) Social Security forms to file: 1) Medicare Request for Employment Information (CMS-L564) must be signed by the employer’s human resource representative for you and/or your spouse covered by employer benefits. 2) Request for Enrollment in Medicare Part B (Medical Insurance)(CMS-40B) must be filled out and signed by you (and your spouse if they are also enrolling in Medicare). These two forms are available at the Social Security website (www.ssa.gov/forms).
  2. At the top each of these forms1) Request for Employment Information (CMS-L564) and Request for Enrollment in Medicare Part B (Medical Insurance)-(CMS-40B) form, it is very important to write “Special Enrollment Period” to inform the Social Security agent processing the form that you are signing up at the right time and prevent a Medicare Part B penalty. *If you have had two or more jobs since turning 65, then each of those companies must sign a CMS-L564 form.*
  3. Always make copies of your completed forms CMS-L564 and CMS-40B and be sure to write “Special Enrollment Period” at the top of each application.
  4. It is important to deliver the original forms to your local Social Security office especially when you want your Medicare to begin ASAP. There can be a delay in processing the forms when they are emailed or faxed. Keep your copies of the paperwork in case the paperwork is lost at the Social Security office.

 

Brent, as I have explained that there are options for enrolling in Medicare that many needing Medicare help are not aware exist. Because with Medicare, what you don’t know will HURT you!

Contact the Toni Says Medicare team at info@tonisays.com or call (832) 519-8664 for assistance or to answer Medicare questions. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.

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]]> I need an “Emergency Evacuation Plan” for my parents? https://tonisays.com/i-need-an-emergency-evacuation-plan-for-my-parents/ Mon, 29 Jun 2026 13:44:19 +0000 https://tonisays.com/?p=25780 I need an “Emergency Evacuation Plan” for my parents?                                           ...

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]]> I need an “Emergency Evacuation Plan” for my parents?                                                                                                                        

Dear Toni,

My parents went into a local independent living facility, and I have received an email from the facility’s executive director with information detailing how to draw up an emergency evacuation plan. The executive director asked that those living in the facility submit a personal “Emergency Evacuation Plan” by June 1 because that is when hurricane season” begins for America.

We need your guidance to prepare an emergency evacuation plan to submit to the executive director .  Thanks, Toni.

Andy from Beaumont, Texas

 

Hello Andy:

Monday, June 1 is when the 2026 hurricane season begins nationwide and it does not end until Monday, November 30. As America gets deeper into the season, the storms can get stronger. No one expects life to change in an instant, but it can.

Everyone in a position to be affected should have a family emergency evacuation plan for hurricanes, tornadoes, earthquakes, and other disasters. A plan is crucial for the elderly or those who are disabled, that are dependent on different types of medical needs or assistance such as kidney dialysis, oxygen, wheelchairs, walkers, etc., for their life support or ongoing medical treatment.

Below are a few questions to help you to prepare for designing your family’s emergency evacuation plan for any type of an emergency, disaster, or hurricane/tornado:

  • Do I stay or go? This will depend on where you live. If you live in a city or other highly populated area, leave early. During past storms such as Beryl in the Houston area, people were caught in massive traffic jams, waiting on the highway for hours or days to evacuate. Leaving early will help you avoid serious delays and avoid running out of gas while stuck in traffic.
  1. a) Make sure you have a sufficient supply of prescriptions and always bring a list of current prescriptions for elderly family members and yourself.
  2. b)   Have a copy of medical records for those with critical medical conditions. Keep the medical records in a safe place that you can get to immediately when evacuating.
  3. d) Include all legal documents such as Medical Power of Attorney and Living Will.
  4. c) Have a backup plan in case you are out of town during an emergency, so other family members can help take over the proper care for your elderly or disabled loved ones.
  • Do I have access to clean water? If you do not have access to clean water, then any crisis becomes critical within a few days. Remember, you may not have access to a grocery store, or, even if you do, its supplies may be depleted. Start stocking up on bottled water.
  • Do I have an adequate food supply? Most households have a few days of food already available, but the best way to stock up on additional food and supplies is to add a little bit extra each week. Remember that during an emergency, the power may be out, so cook your frozen and refrigerated food first. Have extra propane tanks for a gas grill available.
  • Do I have enough cash on hand? Keep your parents or your current checkbook with you in case you run out of cash and the ATMs are not operating.
  • Does my family know where to meet? It is important that all family members and loved ones know where to meet in a disaster.

 

After Hurricane Beryl devastated the Houston area on July 8, 2024, Texans learned that we cannot take storms and natural disasters lightly. Limited access to essential supplies such as water, groceries and baby formula affected us. I personally lost power for over a week and had to stay at my son’s house, sleeping on the couch because he did have power.  What a true blessing!

Questions? Contact the Toni Says Medicare team at info@tonisays.com or call (832) 519-8664 for assistance or to answer Medicare questions. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.

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]]> America…Medicare fraud is EXPLODING!! https://tonisays.com/americamedicare-fraud-is-exploding/ Thu, 02 Apr 2026 13:52:43 +0000 https://tonisays.com/?p=25254 America…Medicare fraud is EXPLODING!! Toni: On March 5, I received a Medicare.gov newsletter by email, and I am worried that I may have fraud on my Medicare.gov account. I received...

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Toni:

On March 5, I received a Medicare.gov newsletter by email, and I am worried that I may have fraud on my Medicare.gov account. I received my current Medicare summary by mail with a Medicare claim from a medical office that I am not aware of visiting. I’m not sure what to say or how to appeal the claim when I reach out to Medicare.

Also, I am going to receive the new plastic Medicare card because I received a call a few weeks ago about it. But I’ve searched Medicare.gov website, only finding my current card. I did not give out my personal information when I received the call and just hung up like you say to do.

Please advise me how I should contact Medicare because it is difficult to know what’s the right thing to do when it involves a government agency. Thanks, Toni.

—Meredith from Katy, Texas

Meredith:

I am also on Medicare and I received the Medicare.gov newsletter about how Medicare fraud is exploding. The newsletter stated, “Check your Medicare statement for charges you don’t recognize.” It warned against scammers trying to con those on Medicare out of their information and money.

Below are three tips the newsletter presented to protect everyone from scams:

  1. If you get a call, text or email asking for your Medicare Number, don’t respond. NEVER give your Medicare card or number to anyone except your medical provider/facility or anyone you know should have it.
  2. Check your Medicare Summary Notices (MSNs) or claims statements carefully for possible fraud. Meredith, this is your Medicare situation, because you see a charge for a service you don’t remember getting. To appeal this medical claim, contact Medicare at 1-800-Medicare (1-800-633-4227).
  3. Guard your Medicare card. It is like your Social Security card or a credit card. Treat your Medicare card like it is gold!

Finally, Meredith … guess what? There is no new plastic Medicare card like a credit card. This is another scam that is targeting America’s Medicare population. Your Medicare card is still the same card you currently have.

Again, if you suspect that you are experiencing Medicare fraud, call and report your issue to Medicare at 1-800-Medicare (1-800-633-4227).  Explain to the Medicare agent what has happened and have your Medicare corrected ASAP.

Medicare and Social Security will never randomly call your home or office and ask for your personal or banking information. Medicare already has all the information they need about you.  If information were needed, a letter would be sent advising you what a specific government agency such as Medicare needs and to contact them for additional information.

Medicare fraud is estimated to cost more than $60 billion a year. Fraud hurts America because when thieves steal from Medicare, there is less money available for health care that one really needs.

Let your friends know what I have just told you about fraud. We need to stand together and stop those who only want to make a “fast dollar” from Medicare, your checking account/credit card and most of all from you!

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.

 

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]]> Social Security account is locked…How do I enroll in Medicare? https://tonisays.com/social-security-account-is-lockedhow-do-i-enroll-in-medicare/ Mon, 16 Mar 2026 13:56:49 +0000 https://tonisays.com/?p=25250 Social Security account is locked…How do I enroll in Medicare?   Hi Toni: Turning 65 in May and having an issue trying to enroll in Medicare since my Social Security...

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]]> Social Security account is locked…How do I enroll in Medicare?

 

Hi Toni:

Turning 65 in May and having an issue trying to enroll in Medicare since my Social Security account is locked.  Two years ago, someone falsely filed a tax refund with my Social Security number. Now anything that involves me or my spouse’s Social Security number, credit report or IRS information is locked and cannot be accessed.

How I can enroll in Medicare when I cannot open up a “My Social Security” account? This is what the Medicare.gov website advises me to do since I am turning 65 and not on employer’s benefits. I am a self-employed real estate agent with an individual plan. Thanks, Toni, looking forward to your advice.

–Terri from Las Vegas, Nev.

 

Great question, Terri:

Americans who are turning 65 and not receiving a Social Security check, should apply for Medicare by visiting www.ssa.gov/medicare/sign-up 3 months prior to turning 65 for Medicare Parts A and  B to begin the first day of the month turning 65. This information is available on page 17 of the 2026 Medicare & You handbook.

A fraud situation with your Social Security number like you are experiencing, Terri, with your Social Security situation can prevent anyone from opening a “My Social Security Account.” Terri, both you and your spouse’s Social Security numbers and accounts are locked by both Social Security and the IRS, keeping you and your husband (if married) from applying for Medicare online.

Anyone who is locked out of their Social Security account due to fraud, the quickest way to enroll is to visit in person at the closest local Social Security office. You can find your specific Social Security office by searching online with your zip code. This office can unlock your Social Security numbers allowing both you and your spouse to open a “My Social Security” account and can enroll you in Medicare online to begin the first day of the month you turn 65.

Terri, I would advise you and your spouse to not leave that local Social Security office until your “My Social Security” accounts have been either re-opened or new accounts have been created, and your Medicare enrollment is finalized.

Those turning 65 who need to enroll in Medicare and do not have a locked Social Security account, may go online to www.ssa.gov/medicare/sign-up to enroll in Medicare

If you do have a “My Social Security Account”:

  • Have your username and password handy to begin Medicare enrollment.

If you don’t have a “My Social Security Account”:

  • Open a “My Social Security Account” at ssa.gov/myaccount to be prepared to apply for Medicare Parts A and B, when turning 65 and not working full-time with employer health insurance or covered by a spouse’s employer health insurance.

Below are options to apply for Medicare when turning 65: Chapter 1 of Toni’s Medicare Survival Guide Advanced edition at www.tonisays.com explains ways to enroll in Medicare.

  • Turning 65 and Receiving your Social Security check: You should receive your “Welcome to Medicare” kit by mail with your new Medicare card prior to turning 65.
  • Turning 65 and NOT Receiving your Social Security check: (this is Terri’s situation)

You do not get an automatic “Welcome to Medicare” kit with your Medicare card.

You must visit ssa.gov/medicare/sign-up to enroll in Medicare for your Medicare to begin the first day of the month, you turn 65.

  • Turning 65 and still working with employer’s benefits: Social Security and Medicare allow you to delay your enrollment in Medicare if you and/or your spouse are working full-time with employer benefits (not retirement benefits).

The new Toni Says Medicare Roadmap is available by signing up for the Toni Says Medicare Newsletter available at www.tonisays.com. Contact the Toni Says Medicare team at 832/519-8664 or email info@tonisays.com regarding your Medicare options. Both of Toni’s books Medicare Survival Guide and the Maze of Medicare and her new “Confused about Medicare” online course are available at www.tonisays.com.

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]]> Help!! The cost of my Medicare Supplement has exploded!! What can I do? https://tonisays.com/help-the-cost-of-my-medicare-supplement-has-exploded-what-can-i-do/ Mon, 16 Mar 2026 13:51:28 +0000 https://tonisays.com/?p=25247 Help!! The cost of my Medicare Supplement has exploded!! What can I do? Toni: When I first enrolled in Medicare in 2019, I picked Medicare supplement Plan F. In February...

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]]> Help!! The cost of my Medicare Supplement has exploded!! What can I do?

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 7th  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.

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]]> America’s Veterans…Enroll  in Medicare the right way to NOT pay a penalty!  https://tonisays.com/americas-veteransenroll-in-medicare-the-right-way-to-not-pay-a-penalty/ Mon, 16 Mar 2026 13:45:34 +0000 https://tonisays.com/?p=25244 America’s Veterans…Enroll  in Medicare the right way to NOT pay a penalty!  Dear Toni: My husband, Jason, is a retired veteran and never enrolled in Medicare because he uses the VA...

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]]> America’s Veterans…Enroll  in Medicare the right way to NOT pay a penalty! 

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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