Is there a specific dental plan that Medicare offers? Please advise me what I should do, Toni.–Faye from Memphis, Tenn.

Hello, Faye: “What ISN’T Covered by Part A & Part B?” is explained on page 55-56 of the 2026 Medicare & You handbook. There it states: “Medicare doesn’t cover everything. If you need certain services Part A or Part B doesn’t cover, you’ll have to pay for them yourself unless:

            ■ You have other coverage (including Medicaid) to cover the costs.

■ You’re in a Medicare Advantage Plan or Medicare Cost Plan that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services.”

Some of the items and services that Original Medicare does not cover on page 55. They include: long-term care, eye examinations (for prescription eyeglasses and corrective contact lenses),  cosmetic surgery, massage therapy, routine physical exams, hearing aids and exams for fitting them, concierge care and covered items or services you get from a doctor or other provider who has opted out of participating in Medicare. (the last item is discussed further on page 60).

On page 56, the Medicare handbook explains that Original Medicare doesn’t cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures. Original Medicare may pay for dental services that are specific to medical procedures such as a heart valve repair or replacement, an organ transplant, and cancer-related treatments. (Chapter 2 of Toni’s “Medicare Survival Guide Advanced Edition” also discusses what is not covered by Medicare.)

Since Medicare does not cover dental care, I would recommend that you talk to your dentist and see which dental insurance plans he/she prefers.

When buying a dental plan, there are two types of dental plans to pick from:(Verify which type of plan your dentist accepts before buying)

• Traditional (or indemnity) dental insurance plans: higher in premium, and the preventive services are usually covered at 100%, basic restorative work is covered up to 80% and major procedures at 50%. Recently, new dental plans have been released which help with the cost of dental claims such as fillings, crowns, and root canals. A major surprise is that these plans begin immediately with no wait.
• Discount dental insurance plans: less expensive than traditional dental plans. These plans provide a discount for services. Your dentist must be part of the plan’s network and agree to give the dental discount.

Faye, you can use either type of dental plan with Original Medicare with or without a Medicare supplement or with a Medicare Advantage plan. Again, make sure that the plan you choose is accepted by the dentist you like.

Another area that Medicare does not cover is vision benefits, which is discussed on page 41 of the 2026 Medicare and You handbook. This is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) from a supplier enrolled in Medicare, after each cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply and after you meet the Part B deductible, you pay 20% of the Medicare-approved amount. Medicare Advantage plans have different costs and copays for vision benefits.

Toni’s new course, “Confused about Medicare” video series, and the “Medicare Survival Guide Advanced Edition” are available at www.tonisays.com. Have a Medicare, Social Security or dental insurance plan question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter on the Toni Says website @ tonisays.com to keep up to date with Medicare changes.

The post Losing COBRA Benefits With Dental And Enrolling In Medicare…What Do I Do? appeared first on Canyon News.

Going through a well-known funeral home in my area, I would have had to pay over $3,000 for cremation plus $7,000 to bury my mother’s urn on top of my father’s casket. To my amazement, I only had to pay a pre-approved price of $995 with a funeral facility that was on this specific hospice company’s approved funeral home list. My mother passed away with no life insurance and our family had to pay for all of the funeral cost out of pocket.

I have turned 65, am retired with high blood pressure and do not have a life insurance policy for my end-of-life issues. I do not want my adult kids to experience what I did when my mother passed away. Please explain which life policy I should consider. Thanks, Toni, looking forward to your answer.–Eva from Boston, Mass.

Hello Eva: I would be honored to help you explore your life insurance options after what you have experienced with your mother. Many Americans wait too long to buy a life policy. They do not realize how their health situations can affect applying for an insurance plan and cannot qualify due to their health issues.

Eva, a life insurance policy, can help cover your end-of-life costs and this plan will help to give peace of mind knowing there will not be a financial strain caused by unforeseen debt that the family may be responsible for paying.

Let’s explore the different life insurance plans available for those age 65 and older and whether health underwriting may be required for you to be accepted and qualify for a lower premium:

• Term Life Insurance: a life policy which offers a 10-,15-, 20-, or 30-year policy period. Term Life insurance premiums are lower and do not increase during the plan’s specific policy period. These plans can be converted to a permanent Whole Life plan while the policy is in force. Purchasing Term Insurance at a younger age and converting to Whole Life past 65 is an option for you to consider.
• Whole Life: a permanent life insurance policy that combines a death benefit, level premiums and cash value growth that can be used for any reason during your lifetime. Whole life policies cost more past 65. Choosing a lower death benefit may control the price and be a good option.
• Final Expense/Burial Insurance: a small Whole Life policy that is designed to help the insured’s family pay for funeral, burial, and other expenses, such as outstanding medical bills, after the insured’s death. Plans typically range from $5,000 to $25,000 in death benefits, depending on which insurance company is chosen.
• Guaranteed Issue Whole Life: a Whole Life policy for those with serious health issues who cannot pass medical underwriting for a typical life insurance plan. The policies range from $2,000-$25,000 in death benefits with no medical exam or health questions to answer. If you die within the first 2 years from natural causes (other than accidental), your beneficiaries will only receive premiums paid, plus interest. After the 2-year waiting period, the full benefit is paid for death due to all causes.

Eva, with a variety of life insurance and final expense plans to meet health and financial needs of those past 65, it is important to take time exploring which way is right for you and your family.

America is accustomed to a certain type of insurance health underwriting while working, and for those who are new to Medicare this underwriting process can be an eye-opening experience. Please take your time when retiring and applying for past-65 life insurance plans.

Remember, with Medicare and Life Insurance plans, it’s what you don’t know that WILL hurt you! Have a Medicare, Social Security, or Life Insurance 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.

The post What Life Insurance Plans Are Offered After 65? appeared first on Canyon News.

Do you have any idea what the 2026 Medicare costs will be? -Carol from Sugar Land, Texas

Hello Carol:

Every year the Medicare & You Handbook is mailed out before October 1to all Medicare beneficiaries to help guide them through the Medicare Open Enrollment Period (OEP) period which ends December 7. This year’s handbook states that at the time of printing, the premiums, and deductible amounts for Medicare Part A, Part B and Part D were not available.

The Centers for Medicare and Medicaid Services (CMS) released the 2026 Medicare costs last Friday, November 14, with an increase for both Medicare Parts A and B premiums and deductibles.

Below are the 2026 Medicare Part A and B premiums and deductibles, as well as information on the 2026 Medicare Part D changes that affect Medicare’s Part D prescription drug costs.

2026 Medicare Parts A and B premiums and costs:      

• Part A Costs (Inpatient Hospital): The new 2026 Part A inpatient hospital deductible will be an increase of $60, from $1,676 in 2025 to $1,736, for 2026. The Part A deductible starts over every 60 days. It is not a once-a-year deductible but six times a year. Skilled Nursing is included under Part A, and the 2026 costs will be $0 copay per day for days 1-20 and $217.00 per day for days 21-100.
• Part B Costs (Medical): The new 2026 Part B medical/doctor deductible will increase by $26 from the $257 deductible in 2025 to $283 beginning Jan. 1, 2026. After the deductible is met, Medicare pays 80% of the Medicare-approved amount and the Medicare beneficiary pays the remaining 20% of the Medicare-approved amount.
• Part B Premium: The premium for 2026 has an increase of $17.90 from $185 in 2025 to $202.90 beginning Jan.1, 2026. Those with an income higher than $109,000 as an individual or $218,000 as a married couple will pay more for their Medicare Part B premium beginning Jan. 1, 2026. The premiums for higher income earners were also released on Nov.14 and can be viewed at www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles.

2026 Medicare Part D costs and co-pays:

• Initial Deductible: will increase by $25 from $590 in 2025 to $615 beginning Jan.1,2026.
• Initial Coverage: has 6 drug-tier stages; the Part D plan pays its share of the cost of your drugs, and you pay your share until the maximum amount of $2,100 out-of-pocket is met. Then you move into the Catastrophic Coverage stage and pay $0.
• Total Out-of-Pocket: Effective Jan. 1,2026, the maximum out-of-pocket will be $2,100.

January 1 of each year, the Part D process starts all over again with a new Medicare Prescription Drug plan and a new initial deductible and maximum initial coverage limit.

Medicare’s Prescription Payment Plan, which began Jan. 1,2025, is a payment option available to help manage the $2,100 maximum out-of-pocket drug costs by spreading your monthly prescription drug costs throughout the year from January to December. For more information about the payment plan, visit www.medicare.gov or call your Medicare Part D plan.

Readers, your prescription drug needs can change with each yearly Medicare Open Enrollment Period. Chapters 5 and 6 of Toni’s Medicare Survival Guide Advanced edition explains Medicare Part D and Medicare Open Enrollment Period in “easy to understand” terms.

Review your Medicare options carefully, because with Medicare, what you don’t know WILL hurt 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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Can you explain hospice and respite care to your readers?  I am sure this will help those who are seeking assistance for their frail loved ones while allowing the caregiver some well-needed rest? Thanks in advance, Toni.–Deidre from Tulsa, Okla.

Deidre: Hospice is a subject no one wants to discuss with an elderly loved one. When a loved one is terminally ill, the illness takes an emotional toll on the caregiver and the family, as well as on the patient.

Many wait too long to discuss hospice benefits with the patient’s doctor because they believe hospice is for the last days to help their loved one 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.

Healthcare professionals in the hospice system consist of physicians, nurses, social workers, spiritual counselors, certified nursing assistants and volunteers. A hospice provider comes to where the patient lives to provide the care.

The 2026 Medicare & You handbook explains 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 a patient is terminally ill and has 6 (six) months or less to live. When a patient agrees to hospice care, they agree to comfort care (palliative care) instead of treatment to cure the illness and must sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness.  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 the hospice care.

Hospice will cover all medical care for terminal illness, and Original Medicare or a 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 the home or other facility, like a nursing or personal care home. (Thursday, Nov. 20, at 4 p.m. CST, Toni will host a “2026 Confused About Medicare” Zoom online workshop for America to explain Medicare and hospice issues as well as the changes for 2026 Medicare’s Part D Prescription Drug plans. Visit www.tonisays.com to register for this online event.)

Medicare costs you will pay with hospice benefits:

• Nothing for hospice care (Medicare pays)
• Co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
• 5% of the Medicare-approved amount for inpatient respite care for the Medicare beneficiary.
• Caregiver relief and support: paying $0 (nothing) for Medicare-approved inpatient respite care, which gives your caregiver (family member or friend) a period of rest of up to a 5-day stay each time you receive respite care in a Medicare-approved facility.

Talk with a geriatric case manager or geriatric doctor if you have concerns or need advice with your loved one’s terminal healthcare issue. More on hospice is explained in Chapter 2 of Toni’s Medicare Survival Guide Advanced edition available at www.tonisays.com.

Three years ago, my mother, Jeanette, 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.

Remember, with Medicare… what you don’t know WILL hurt you! Email info@tonisays.com or call 832-519-8664 with hospice or Medicare questions that you, your friends or family members may have. “Finding the Right Medicare Part D Plan” Video Course has recently been released and is available on the Tonisays.com website.

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Last month, my mother was diagnosed with colon cancer and received a bill from the cancer facility for outpatient care because Medicare has denied her cancer claim since she is not enrolled in Medicare Part B. I contacted the local Social Security office and was told that she must wait until January 1 to enroll in Medicare Part B during Medicare’s General Enrollment Period. The Social Security agent said that my mother had missed her “window of opportunity” by not enrolling when she turned 65 and will receive a Medicare penalty. Please advise me what I can do to help my mother. Thanks, Toni. –Marianne from Baton Rouge, LA.

Oh my, Marianne: Your mother, Sarah, has an extremely serious Medicare issue! She will have to enroll during Medicare’s General Enrollment Period (GEP), which is from January 1 to March 31of each year for those who have never enrolled in Medicare. And she will receive the “famous” Part B penalty for the rest of her Medicare life.

Beginning January 1, 2023, Medicare’s General Enrollment Period January 1-March 31 rules changed that helps Americans who had not enrolled in Medicare when turning 65. Now, when you enroll in January, February or March, your Medicare Part B will begin on the first day of the following month. Wait past March 31 to enroll in Medicare and your Medicare enrollment time will be delayed until January 1 of the next year, receiving a higher Part B penalty that will go all the way back to the month you turned 65.

The Medicare Part B penalty that Sarah will receive when enrolling during Medicare’s GEP is a 10 percent penalty for each 12-month period or year that she did not enroll. Her penalty will be 20 percent (2 years times 10 percent). The penalty stays in effect for the life of the Medicare beneficiary’s Medicare coverage.

Marianne, I do have one good thing to tell you and your mother because now is Medicare’s Open Enrollment Period (OEP) which is from October 15-December 7. This enrollment period is when Sarah can enroll in a Medicare Part D plan that begins January 1, helping with her cancer diagnosis. She may receive a Part D penalty for not enrolling in a Medicare Part D plan when her Medicare Part A began.

During Medicare’s OEP, she cannot enroll in a Medicare Advantage Prescription Drug Plan (MAPD) because she’s not enrolled in Medicare Part B. After January 1, when Medicare’s General Enrollment Period (GEP) begins and she is enrolled in Part B, then your mother can enroll in an MAPD plan if she chooses. During Medicare’s GEP, she can also enroll in a Medicare Supplement without having to answer underwriting questions for a 6-month window because her Part B has just started.

Medicare enrollment periods are listed below:

• Medicare Initial Enrollment Period: 7-month window that begins 3 months before one turns 65, the month turning 65 and 3 months after one turns 65.

• Special Enrollment Period: Enroll after one is 65 and 90 days when delaying Medicare Part B due to working full time with employer health insurance benefits. There is an 8-month window for signing up for Medicare Part B without receiving a Part B penalty when employment or employer health insurance ends whichever happens first.
• General Enrollment Period: January 1-March 31 every year, when one has not enrolled in Medicare and can enroll in Medicare beginning the first of the next month and will receive a Medicare penalty.            

There are millions of Americans receiving Medicare Part B and/or Part D penalties because they did not enroll in Medicare at the right time. Remember with Medicare, what you don’t know WILL hurt you!

On Thursday, November 20, at 4 p.m. CST, Toni will host a “2026 Confused About Medicare” Zoom online nationwide workshop to explain how to enroll in Medicare the right way as well as changes for 2026 Medicare’s Part D Prescription Drug plans. Visit www.tonisays.com to register.

The post What Is Medicare’s “Famous” Part B Penalty? appeared first on Canyon News.

I just received information that my current Part D plan will no longer cover the Humira that I take twice a month as an injection for Crohn’s disease. I have looked at other 2026 Medicare Part D plans on the Medicare.gov site and discovered that there is not one Medicare Part D plan that is covering Humira.

Toni, do you know of another Part D provider you can sign me up for that will cover some or all of the costs for Humira?

Any recommendations you can make will be highly appreciated. Thanks, Toni—-Gene from Sugar Land, Texas.

Gene: I do not have good news about Humira, this important prescription for your Crohn’s. You’re right, Gene. I also searched the Medicare.gov site for Humira without finding a stand-alone Medicare Part D plan that covered it. I saw that on the Medicare.gov site the total cost beginning January 1, 2026, for all 12 months for Humira will be $99,691.68, or $8,307.64 per month.

I did research on Google about “Why is Medicare was not covering Humira for 2026?.” with AI giving this answer. “Medicare Part D plans are not covering Humira in their 2026 formularies because they are increasingly switching to cheaper Humira biosimilars.” AI also said, “While some plans are removing the brand-name drug, they are still providing coverage for the drug class through its biosimilars to help reduce drug spending.”

I have never seen the word biosimilar associated with Medicare Part D prescriptions since Medicare Part D began January 1, 2006, so I also googled “biosimilar prescriptions.” Biosimilar prescriptions are explained as “lower-cost versions of expensive biologic drugs, under Medicare Part B and Part D.” Gene, other prescriptions that are similar to Humira and are less expensive may be covered and are what you might want to change to.

What I would suggest that you do, Gene, is call the physician that has prescribed you Humira and ask what alternatives prescriptions you can be changed to. Also, contact AbbVie, the manufacturer of Humira, at 1-800-222-6885 and ask if you qualify to receive any type of prescription drug assistance or visit the www.AbbVie.com website for more information.

This Medicare Open Enrollment has been the most stressful fall Medicare OEP that I have ever experienced since Open Enrollment began. It is extremely important that the 69 million Americans who are on Medicare visit www.medicare.gov to verify that ALL of their prescriptions are covered whether they have a stand-alone Medicare Part D plan or a Medicare Advantage HMO/PPO plan with a Prescription Drug plan included. (On Thursday, Nov. 20, at 4 p.m. CST, Toni will host a “Confused about Medicare” Zoom online workshop to explain Medicare Part D. Visit www.tonisays.com to register.)

Below are the 2026 Medicare Prescription Drug Costs and maximum-out-of-pocket:

• Initial deductible is $615.
• Initial Coverage Stage: During the initial coverage period with the six drug tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2,100 out-of-pocket is met. Then you move to the catastrophic coverage stage.
• Catastrophic coverage: There is a $0 out-of-pocket once a Medicare beneficiary enters the catastrophic coverage stage. Medicare will pick up all costs of the covered prescriptions whether brand-name or generic with a stand-alone Medicare Part D plan or a Medicare Advantage with a Part D plan included and you will pay $0.

Readers, your prescription drug needs can change every Medicare OEP. Review your options carefully, because with Medicare, what you don’t know WILL hurt you! Email info@tonisays.com with your Medicare questions.

Zoom Live… Confused about Medicare Workshop on Thursday November 20 at 4 p.m. CST to 6 p.m. CST RSVP: www.tonisays.com to reserve a spot for you and your Medicare friends or call 832-519-8664.  Have exciting Medicare questions for Toni to answer!!

The post Help! Brand-Name Prescription Drug Not Covered By Medicare’s 2026 Part D Plans? appeared first on Canyon News.

A friend recently had a skilled nursing stay and was billed more than expected because she did not have the right amount of time as an inpatient during her hospital stay. I cannot remember the specifics about whether Medicare or Jim and I have to pay for a skilled nursing stay which was discussed in a Toni Says Medicare article.

Please explain what I should be aware of for Jim’s skilled nursing stay. Thanks so much, Toni. —-Terry from Tulsa, Okla.

Hi Terry: The Medicare skilled nursing qualification rule is explained on page 28 of the 2026 Medicare & You handbook in the section titled, “Am I an Inpatient or Outpatient?” One must learn that a stay in the hospital does not always mean you are an inpatient and that you qualify for Medicare Part A skilled nursing facility care. If not, you may have to pay 100% out of your own pocket.

The Medicare Outpatient Observation Notice (MOON) went into effect a few years ago and applies to those with an Original Medicare hospital stay. It does not apply to those with Medicare Advantage plans.

The MOON rule is explained in more detail in the handbook, where it says, “Whether you’re an inpatient or an outpatient affects how much you pay for hospital services and if you qualify for Part A skilled nursing facility care.” Staying overnight in a hospital doesn’t always mean you’re an inpatient. You only become an inpatient when a hospital formally admits you as an inpatient, after a doctor orders it. You’re still an outpatient if you haven’t been formally admitted as an inpatient, even if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays.

Important! In the handbook, it states, “Each day you have to stay, you or your caregiver should always ask the hospital and/or your doctor, a hospital social worker, or a patient advocate if you’re an inpatient or an outpatient.” Terry, I advise my clients to do this each day during your, your husband’s or a family member’s hospital stay, since it affects what you pay and can affect whether you’ll qualify for Part A coverage in a skilled nursing facility.

Terry, be sure that you, Jim, or any family members who are on Original Medicare and having a hospital stay are provided the MOON (Medicare Outpatient Observation Notice) in a written form that is signed and dated with an oral explanation from the facility no later than 36 hours from the time the Medicare patient begins receiving outpatient observation services. This time limit is considered the two-midnight-stay observation policy.

Remember, that the first two days of a hospital stay are considered outpatient with a MOON notice. Some may have to pay 100% of their skilled nursing/rehab facility stay if they have not been “formally admitted” as an inpatient with at least a three-day hospital stay with a discharge on the fourth day.

Below is what you, your family members, or caregivers need to know when having a hospital stay:

1. Remember the MOON rule applies to those on “Original Medicare” and not Medicare Advantage plans. MA Plans have their own rules on inpatient/outpatient services and qualifying for a skilled nursing stay.
2. Discuss the hospital procedure with your physician/surgeon regarding whether this will be an inpatient or outpatient stay.
3. You or a family member should ask the hospital every day if you or your loved one is an outpatient or an inpatient that has been formally admitted.

Chapter 2 of Toni’s Medicare Survival Guide Advanced edition explains Medicare’s Moon rule and skilled nursing three-day rule in easy-to-understand terms. Remember with Medicare, what you don’t know WILL hurt you!

————-

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.

The post Who Pays For A Skilled Nursing Stay… Medicare Or You? appeared first on Canyon News.

I was told that Medicare’s Open 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 what we should do since Medicare’s enrollment period is beginning? –Thank you, Leslie from New Orleans.

Hello Leslie:

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 disenroll properly from their Medicare Advantage plan.

The proper time to disenroll from the Medicare Advantage plan that you and Sonny are currently enrolled in is, as you were told during Medicare’s Open Enrollment Period (OEP) which in the past was called Medicare’s Annual Enrollment Period (AEP). The enrollment period has not changed and is still from October 15 to December 7.

For the two of you to return to Original Medicare and disenroll from your Medicare Advantage plan is very simple. All that you and Sonny have to do is visit www.medicare.gov after October 15 and enroll in the Medicare stand-alone Part D prescription drug plan that is right for you. The new Part D plan will begin January 1, and you will be disenrolled from the Advantage plan and enrolled into Original Medicare. Now the two of you can begin using the Medicare Supplement that you applied for in August because you will be on Original Medicare.

For those who already have either a stand-alone Medicare Prescription Drug (Part D) plan or Medicare Advantage plan, Medicare’s OEP is the time to make sure your drug plan or Advantage plan still meets your needs! Use www.medicare.gov to verify that your prescription drugs are covered in your 2026 Medicare Part D or Medicare Advantage Part D plan formulary. It is very important to verify what prescriptions are covered every year! If your prescriptions are not covered by your existing plan for 2026, you will have to pay 100% of that prescription cost out of your pocket!

–Changes that can be made during Medicare’s Open Enrollment Period (OEP) are as follows:
• Return to Original Medicare: Enroll in a stand-alone Medicare Part D Prescription Drug Plan. (Leslie, this is the Medicare OEP option for you and Sonny to begin using the Medicare Supplement you enrolled in this August.)
• Enroll in a Medicare Part D Prescription Drug Plan for your initial enrollment period or if this is a late enrollment.
• Change from one Medicare Part D Prescription Drug Plan to a new Medicare Part D Prescription Drug Plan.
• Enroll in a Medicare Advantage Plan with Prescription Drugs.
• Change from one Medicare Advantage Plan with or without Prescription Drug plan to a new Medicare Advantage Plan.
• Return to Original Medicare with no Part D plan.

Reader alert: Please enroll in a Medicare Part D plan whether or not you are taking prescriptions. There is a Part D penalty for not enrolling in a Medicare Part D Prescription Drug Plan when you are first eligible. The penalty lasts for the rest of your Medicare life.

Chapter 6 of Toni’s “Medicare Survival Guide Advanced” edition 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.” Now is the time to explore your Medicare Open Enrollment Period options.
———–
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.

The post Help…Need To Disenroll From A Medicare Advantage Plan! appeared first on Canyon News.

Toni, please explain in easy-to-understand terms what I need to do to change to a Part D plan that will cover all of my prescriptions before Medicare’s Open Enrollment Period ends on December 7. I have read your articles for years and now I need your Medicare guidance.

—Tammy from Cypress, Texas

Tammy: The 2026 Part D plans became available to the public at www.medicare.gov on Wednesday, October 1 and there are serious changes with Part D premiums increasing. Medicare.gov is where America can find which Medicare Part D plan is affordable and covers their current prescription drugs.

The good news is that Medicare negotiated directly with manufacturers for the price of certain expensive brand-name Part D drugs and the price change will be effective January 1 for Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp (insulin aspart).

For 2026, Medicare Part D will have three main stages: deductible, initial coverage, and catastrophic coverage. Costs and maximum-out-of-pocket are as follows:

• Initial deductible is $615.
• Six Drug Tiers of Initial Coverage are: Drug Tier 1: Preferred Generic Drugs; Drug Tier 2: Generic Drugs; Drug Tier 3: Preferred Brand Drugs; Drug Tier 4: Non-Preferred Drugs; Drug Tier 5: Specialty Drugs and, beginning January 1, 2026, Drug Tier 6: Select Care Drugs begins for the first time.
• Initial Coverage Stage: During the initial coverage period with the six drug-tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2100 out-of-pocket is met. Then you move to the catastrophic coverage stage.
• Catastrophic coverage: There is a $0 out of pocket when a Medicare beneficiary enters the catastrophic coverage stage. Medicare will pick up all costs of the prescriptions whether brand name or generic with a stand-alone Medicare Part D plan or a Medicare Advantage with a Part D plan included and you will pay $0.
• On January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and new initial deductible and maximum initial coverage limit that leads you to the catastrophic coverage stage.

The Medicare Prescription Payment Plan is a payment option which began January 1, 2025, to help manage your out-of-pocket drug costs by spreading your monthly prescription drug costs throughout the year from January to December. For more information about the payment plan, visit www.medicare.gov or call your Medicare Part D plan.

Toni Says Tips to help you find a Part D plan:

• Visit medicare.gov to view 2026 Medicare stand-alone Part D and Medicare Advantage with Part D plans attached. The website has a tool for helping you narrow your search for a new Medicare Prescription Drug plan.
• Talk to your primary care and specialty doctors about which brand name drugs can be changed to generics.
• Get samples from your doctor to help control costs.
• Search various prescription drug programs such as GoodRx, Single Care or Amazon for less expensive prescription drug costs. Wal-Mart, Kroger, HEB and Costco also have discount prescription drug plans.

Readers, your prescription drug needs can change with each yearly Medicare Open Enrollment Period. Review your options carefully, because with Medicare, what you don’t know WILL hurt you! Email info@tonisays.com with your Medicare questions.

———–

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.

The post Is America Ready For The Changes To 2026 Medicare Part D Plans? appeared first on Canyon News.

I still work and make more income than Social Security allows without having to pay a penalty because I am not at what Social Security calls my full retirement age. So, I can’t start my Social Security check so that my Medicare premium can be deducted monthly. How can I pay that premium amount by the due date? Hope your answer will make this Medicare situation less stressful.

–Valerie from Cleveland, Ohio

Hello Valerie: Guess what?  Medicare offers four ways to pay your premium online and having an HSA account is one of them. Valerie, you should open a www.medicare.gov account since you are not receiving your Social Security check. The ways of paying are using a HSA card, a credit/debit card or a direct payment from your checking or savings account. Medicare’s payment service is free.

Once you open your Medicare account at www.medicare.gov, you can arrange to pay your bill using your HSA, credit/debit cards or bank account by clicking on the box “Pay my premium” under “What do you want to do?” To have your Medicare Part B premium set up to be paid on a monthly basis, visit “Medicare.gov Easy Pay” and elect monthly payments. It takes about 6-8 weeks for the “Medicare Easy Pay” form to process. Be sure that you keep up with your monthly premiums, so your Medicare Parts A and B are not terminated before the Medicare Easy Pay form is activated.

Readers, I urge everyone on Medicare to stay current with your Medicare premium. By missing a premium payment, Medicare beneficiaries can lose their benefits and may be charged a penalty when they reenroll.

To create a Medicare.gov online account, you must have applied for Medicare Part A and have your assigned Medicare number. On your Medicare account is information such as:

• Your Medicare Part A and B enrollment dates
• What Medicare Part D prescription drug plan or Medicare Advantage plan you are enrolled in
• Options to pay your Medicare premium, Medicare claims, print your Medicare card and much more.

The Medicare Part D prescription drug plan premiums are managed by the Medicare Part D prescription drug company. Medicare beneficiaries can pay their Medicare prescription drug premium either directly to the prescription drug company by check or credit card or by deductions from their Social Security payments.

Like Valerie, many Americans do not realize that they can pay their Part B premiums monthly when not receiving their Social Security check by following the rules governed by Medicare. Take your time and study this Medicare rule.

I always advise readers enrolling or already enrolled in Medicare to visit www.medicare.gov to open a Medicare account. (Chapter 1 of Toni’s Medicare Survival Guide Advanced edition explains how to enroll in Medicare properly and receive your Medicare number to open a Medicare.gov account whether turning 65 or past 65 and still working.)

Remember, with Medicare it’s what you DON’T know that WILL hurt you! Medicare is not cookie cutter…One size does not fit everyone!! If you have a Medicare question, email info@tonisays.com or call 832-519-8664.

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.

The post How Do I Pay A Medicare Premium When Not Receiving Social Security? appeared first on Canyon News.

I’m not sure when is the right time to enroll and what happens if I don’t enroll in a Medicare plan during fall’s enrollment. Looking forward to your answer. Thanks, Toni.

–Scott from San Antonio, Texas

Scott, The answer to your question is you do NOTHING!!! NADA!!! during Medicare’s Open Enrollment Period (OEP) because you are not 65 yet and have not enrolled in Medicare. Nothing will happen to you if you do not enroll during this year’s OEP.

Next year’s fall Open Enrollment Period (OEP) — which is every year from Oct. 15 to Dec. 7– is when you can make a change to your Part D plan and change or enroll in a Medicare Advantage plan with or without a Medicare Part D prescription drug plan.

Scott, since you are turning 65 in January, you will be in your Medicare Initial Enrollment Period which is a seven-month period that begins three months prior to January, the month of January and three months after. October is three months prior to January and is a good time to begin enrolling in Medicare. At this time, you can explore which Medicare option best fits your specific medical and prescription drug needs. Wait past the final three-month period and Part B and D penalties can begin. (Chapter 1 of Toni’s Medicare Survival Guide Advanced edition explains enrolling in Medicare in detail. Email your enrollment questions to info@tonisays.com)

Below is the Medicare Initial Enrollment Period (IEP) seven-month timeline schedule explained:

• Enrolling anytime three months before turning 65, Medicare begins the first day of the month you turn 65. Since Scott will turn 65 on Jan. 5, 2026, he can enroll in Medicare Parts A and B in October, November, or December (three months prior) for a January 1 effective date.
• Enroll the month you turn 65, then Medicare will begin the first of next month. If Scott enrolls in January, his Medicare will begin February 1.
• Enroll one month after you turn 65, your Medicare will begin first of the next month. If Scott enrolls in February, his Medicare begins March 1.
• Enroll two months after you turn 65, your Medicare will begin the next month. If Scott enrolls in March, his Medicare will begin April 1.

• Enroll three months after you turn 65, your Medicare will begin the next month. If Scott enrolls in April, his Medicare will begin May 1.

Scott, I would discuss with your medical provider what type of Medicare plan–whether it is Original/Traditional Medicare with a Medicare Supplement and a stand-alone Medicare Part D plan or Medicare Advantage plan HMO/PPO with prescription drug plan– is the right plan for your health situation with the prescriptions you are taking.

**Reader Alert: During Medicare’s Open Enrollment Period you do not have to make a change if you are pleased with your current plan, such as a Medicare Advantage plan or stand-alone Medicare Part D Prescription drug plan. It is important to always check during every OEP that your current Medicare Part D plan will cover all of your prescriptions, and your doctors or medical facilities will be in the Medicare Advantage plan’s network for the next year.**

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.

The post Turning 65 In January … Does Medicare’s Fall Enrollment Affect Me? appeared first on Canyon News.

-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.

The post October 15 Is Coming…. Know Your Medicare Open Enrollment Period Options!! appeared first on Canyon News.

Now I am experiencing a Medicare issue and need guidance, Toni. In July, I applied on medicare.gov for a Medicare Part D plan to begin Aug. 1 because I am now taking an expensive blood pressure prescription that GoodRX does not cover which costs over $650 a month.

I just received a notice from Medicare saying they do not have a record of me having prescription drug coverage that “met Medicare’s minimum standards” from 5/1/2024 to 7/31/2025, and I will receive a Part D late enrollment penalty. What does this mean?

Toni…Thank you in advance,

Don from Charlotte, NC

Don: I do not have good news for you. You have a Medicare Part D prescription drug penalty problem because you did not enroll in a Medicare Part D plan at the right time when your Part A began 5/1/2024. Unfortunately, prescription discount programs — such as GoodRx, Single Care, AmazonRX or store prescription memberships such as Walmart, Kroger, etc., are not considered “creditable” coverage which is why you will be receiving Medicare’s late enrollment penalty (LEP).

The Medicare & You handbook states: Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or individual health insurance coverage. If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.

So, Americans with “creditable” coverage can apply for a Medicare Part D plan at a later date without paying a penalty. (Chapter 5 of the Medicare Survival Guide Advanced edition explains Medicare Part D and how to avoid Part D penalties).

The Late Enrollment Penalty (LEP) when applying for Medicare Part D can be applied if:

— You are older than 65, retiring and leaving employer benefits and waited more than 63 days without creditable prescription drug coverage to enroll in Part D. (Filing Medicare forms with Social Security does not inform Medicare that you had creditable prescription drug coverage. Do not wait to enroll in a Part D plan.)

–Your prescription drug benefit (not health benefits) is not creditable as Medicare defines it.

–You never enrolled in Medicare Part D when first eligible for Medicare.

Medicare calculates the Part D penalty by multiplying 1% of the “national base beneficiary premium” ($36.78 in 2025) by the number of full, uncovered months you didn’t have either Part D or creditable coverage and rounding to the nearest 10 cents. That amount is added to your monthly Part D premium.

Your late enrollment period (LEP) does not begin from the day you lose or leave your company health plan, but from the month your Medicare Part A started. So, Don, your 14 months without creditable coverage will cost you an extra $5.15 per month plus the Part D premium for 2025. The national base amount can change each year, so your penalty will change and NEVER go away.

Remember with Medicare what you don’t know that WILL hurt you!  Please enroll in Medicare Part D whether you are taking prescriptions or not.

__________

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.

The post Why Am I Receiving A Part D Penalty? appeared first on Canyon News.

I know that I will be bombarded by marketing material, and I would really appreciate any advice that you can give me in advance. Thanks, Toni.

— Sylvester from Richmond, Texas

Hello Sylvester, The 2026 Medicare & You handbook will be mailed to over 65 million Medicare beneficiaries in September to arrive before October. It’s amazing how efficient Medicare is to have these handbooks arrive every year in time for Medicare’s Open Enrollment Period (OEP)/Annual Enrollment Period (AEP).

Sylvester, you have time to do the correct research because Medicare’s OEP/AEP period begins enrolling America Wednesday, Oct.15, and ends enrollment at midnight on Sunday, Dec.7. (Medicare’s OEP/AEP enrollment period is discussed at length in Chapter 6 of my book, Medicare Survival Guide Advanced edition.)

Readers, please take your time researching your options especially if, like Sylvester, you have health issues.

Below are the steps a Toni Says Medicare team member uses when helping clients during Medicare’s OEP/AEP:

Step #1: Decide whether you want “Original Medicare” (Parts A & B) or a “Medicare Advantage” (Part C) plan.

1. Ask your doctor’s office which plan it recommends. Most doctors accept “Original Medicare,” but not all accept Medicare Advantage HMO or PPO plans. If you have a doctor that is in a Medicare Advantage plan’s provider directory, make sure you call to verify that the physician’s office will still be accepting that specific Medicare Advantage plan in the upcoming calendar year.
2. The main difference between “Original Medicare” and Medicare Advantage plans is that “Original Medicare” is administered by Medicare, and the Medicare Supplement plan that’s selected pays the Medicare deductibles or coinsurances. Medicare Advantage plans are administered by private insurance companies that are approved by Medicare.
3. If you choose a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card.

Step #2: Decide whether you need to enroll in or change your current Medicare Part D (prescription drug coverage) plan during Medicare’s OEP/AEP enrollment time.

1. If you want Medicare Prescription Drug coverage to go along with Original Medicare, then you must enroll in a stand-alone Medicare Part D plan and there may be a monthly premium.
2. If you choose a Medicare Advantage plan, make sure that the plan has Medicare Part D Prescription Drug coverage included to keep from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.
3. Whichever plan you chose verify that all prescriptions, both brand name and generic, are covered under the Part D’s plan formulary.

Step #3: Remember, you have from Oct. 15 to Dec. 7 to change or enroll in a new Part D plan for your Medicare Advantage plan or stand-alone Medicare Part D plan which both begin Jan. 1.

1. If you miss the deadline of Dec. 7, you will have to wait until the next year’s Medicare OEP/AEP enrollment time.
2. Medicare’s OEP/AEP is only for enrolling or changing Medicare Advantage Part D or stand-alone Medicare Part D plans. One can change Medicare supplements, long term care, or dental plans any time of year.

Remember…with Medicare, what you don’t know WILL hurt you! Take your time during Medicare’s OEP/AEP to explore your Medicare options. Call the Toni Says Medicare hotline at (832) 519-8664 or email info@tonisays.com for assistance with Medicare issues. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date with Medicare changes.

The post Your 2026 Medicare & You Handbook Is Mailed In September appeared first on Canyon News.

“What if” I did not enroll in Medicare Parts A and B when I should have, because I do not want to pay that extra Part B premium each month? I do not go to the doctor or take any prescriptions. Can I enroll later?

Toni Says: If you are past 65 years and 90 days old, not working full-time with employer benefits and decide to enroll in Medicare Part B, then you will have a big Medicare problem. You must wait until Medicare’s General Enrollment Period (GEP), from January 1 – March 31 each year, to enroll. You will receive the Medicare Part B penalty, which is a 10% increase in your Part B premium for each 12-month period that you could have had Part B. Say you wait 3 years; you will pay a 30% penalty. You will pay this late enrollment penalty for as long as you are on Medicare Part B. But with no Medicare Part B, you will have to pay 100% out of pocket for doctor’s care, whether for an office visit or surgery, and any outpatient care, including MRIs, radiation, chemotherapy, X-rays, etc.

Readers, please enroll in Part B at the right time! Don’t wait to enroll when you are past 65 and not working full-time with employer benefits or you will pay the price.

“What if” I am past 65, am retiring with employer health insurance and need to enroll in Medicare Part B? What do I do?

Toni Says: When you’re retiring or have been laid off past age 65, we advise Toni Says® clients to have their employer sign the Request for Employment Information, form CMS-L564, and attach it to your Application for Employment in Medicare Part B, form CMS-40B. Take both forms to your local Social Security office to enroll in Medicare Part B as quickly as possible. (Chapter 1 of my Medicare Survival Guide Advanced edition explains enrolling in Medicare in detail. Visit www.tonisays.com for more information)

“What if” I did not enroll in a Medicare Part D plan when I turned 65 and now am taking an expensive medication? When can I enroll in a Part D plan?

Toni Says: If you fail to enroll in a Medicare Part D plan at the right time, then Medicare’s Annual Enrollment (AEP), from October 15 to December 7 each year, is when you can enroll in a stand-alone Part D plan or a Medicare Advantage plan with a Part D plan. The new plan will begin January 1, with you receiving a Medicare Part D penalty for not enrolling at the proper time. (For help with prescription drug planning, contact the Toni Says Medicare team at info@tonisays.com or call 832-519-8664.)

“What if” I am on a limited income and cannot afford my Part B premium or prescription drug cost?

Toni Says: Contact or visit the state-specific Medicaid office and see if you qualify for Medicaid’s Qualified Medicare Beneficiary (QMB) program or Specified Low-Income Medicare Beneficiary (SLMB) program. Call your local Social Security office or apply online at www.ssa.gov/medicare/part-d-extra-help if you have a limited income and did not qualify for Medicaid. Each year the income qualifications change. The worst Medicaid or Social Security can say about qualifying for extra financial help is no.

Readers, remember… with Medicare, it’s what you don’t know that will HURT you! Need help with your Medicare “what if” question. Contact the Toni Says Medicare team at info@tonisays.com for your answer.

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.

The post America’s “What if” Medicare Questions Answered appeared first on Canyon News.

What health network does Medicare use? I’m confused about which Medicare option to enroll in because I cannot lose my cardiologist. Should I enroll in Medicare’s network with a Medicare supplement, go with a Medicare Advantage Network plan HMO or PPO, or stay with my current COBRA plan until it ends in about 15 months? I am overwhelmed with the confusing mail and telemarketing I am receiving since it is my time to enroll in Medicare. Thanks, Toni.

—Kenneth from Tulsa, Okla.

Hello Kenneth, I have good news for you and the Toni Says Medicare column readers who are turning 65 or older and enrolling in Medicare for the first time, because there is NO network of hospitals, doctors, or any other medical providers for Original Medicare. I repeat … there is NO NETWORK!!

Kenneth, you do not have to worry about finding a network provider or facility if you decide to enroll in Original Medicare with a Medicare Supplement and leave the employer COBRA plan that your cardiologist is in. Your medical providers must be willing to bill Medicare. How easy is that?

Medical facilities, doctors, and providers who accept Medicare are available nationwide. When you are traveling throughout the U.S. and need medical care, you are covered.

You asked me about enrolling in a Medicare Advantage plan. I recently had a phone call from a frantic daughter who was trying to help her father, who had been diagnosed with pancreatic cancer. He had chosen a Medicare Advantage HMO when he turned 65. Now her father must wait until Medicare’s Annual Enrollment Period (AEP) in the fall from October 15–December 7 to make a change back to Original Medicare, since the cancer facility he is using is not in that MA plan’s HMO network. For her father to qualify for a Medicare supplement, he must answer underwriting questions, and this will not be an easy process, and he can be turned down now.

It won’t be hard for you, Kenneth, since you are turning 65 in September, when your Medicare Supplement/Medigap Open Enrollment period begins. The best time for someone to purchase a Medicare Supplement is during the Medicare Supplement/Medigap Open Enrollment period beginning the first day of the month in which you are 65 or older and have just enrolled in Medicare Part B for the first time. During this special Open Enrollment period, you may enroll in a Medicare Supplement without having to answer ONE health question to be accepted.

If you decide not to keep your COBRA plan and enroll in a Medicare Supplement, you do not have to worry about your medical care being taken care of because you are in your unique six-month Medicare Supplement/Medigap Open Enrollment Period.

You should be aware that after the six-month window, you will have to submit a completed underwritten application answering health questions for a Medicare Supplement to be approved. Kenneth, you mentioned that you had about a 15-month window before your COBRA plan ends. If you choose to stay on COBRA past Medicare Supplement/Medigap’s 6-month Open Enrollment window, then you will have to answer health questions that can keep you from being approved by the specific Medicare Supplement insurance company chosen. I would not advise you to consider this option.

Always discuss with a medical professional who knows your specific health situation which Medicare plan is the best choice for you, either Original Medicare (with no network) and a Medicare Supplement or Medicare Advantage (MA) plan.

_____

Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 20 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.

The post Is Original Medicare Part Of A Health Network? appeared first on Canyon News.

Our concern is that my two younger brothers and I are paying about $9,000 a month to an Alzheimer’s facility for our father’s care. Can you please explain other long-term care options that we can explore, because my father’s rate of $9,000 per month will drain our retirement! My wife and I do not have a plan in place should we need extra financial help since we were not approved for a long-term care policy. Thanks, Toni.

–Jeff from Dallas, Texas

Hi Jeff: I’m glad you took the time to email me about your situation, because I have an answer to your question. In the past few years, a few new plans with extended health care benefits have been developed, assisting America with unexpected health or accident issues.

In the 2025 Medicare & You handbook, on page 56 under “Paying for long-term care,” discusses how important it is to plan now and in good health to maintain your independence. You will want to receive proper care in the setting you desire, whether at home or in a medical facility such as assisted living, nursing home or a private personal-care home.

America needs to be aware that Medicare only pays for medically necessary skilled nursing facility care or for home health care if you meet certain conditions. Medicare doesn’t cover nonmedical 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 assist with ways to protect your finances from excessive long-term care costs, especially for those with health issues that can keep one from being accepted for a long-term care plan.

1. Short-term care insurance plans: These policies have a simple health questionnaire with yes/no questions, making it easy to qualify. They will assist paying for a nursing home, assisted living or personal care home as “facility care” with additional benefits for care at home. Plans provide various facility care options ranging from $50-$400 per day with benefit periods ranging from 1 to 2 years, depending on the plan specifics. A Short-term care plan can help prevent draining your savings or 401(k) for an illness or accident whether recovering in a facility or at home.
2. Life or Annuity Policies with long-term care benefits: Many life or annuity insurance policies have a provision for long-term care; you can receive a certain amount of long-term care with your life or annuity policy’s face amount. Health issues may keep one from qualifying.

3.Traditional long-term care: If you are under 60 and in good health when you purchase a long-term care policy, it may be easier to qualify with lower premiums. A long-term care plan can help to protect your savings or 401(k). You have to answer health questions to be approved.

Remember, even Christopher Reeve of “Superman” fame didn’t think he would be thrown by a horse, paralyzing him from the neck down and changing his life forever. Always be prepared by planning properly for a long-term care issue. No one knows what the future holds for your medical care.

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.

The post Know Your Options For A Long-term Care Plan When There Are Health Issues appeared first on Canyon News.

To My Readers: This text made me realize that America is not prepared for a life-changing medical need such as a transplant.

Luckily, my client has Original Medicare (Parts A and B) with a Medicare Supplement rather than a Medicare Advantage HMO/PPO, allowing him and his medical team to decide which skilled nursing/rehab facility and home health agency he will use while recuperating from his liver transplant.

In the Medicare & You handbook, under “Transplants and Immunosuppressive drugs, states that “you must have Part A in place at time of the covered transplant and … you must have Part B at the time you get immunosuppressive drugs. You pay 20% of the Medicare-approved amount for the drugs and the Part B deductible applies. Medicare drug coverage (Part D) covers immunosuppressive drugs if Part B doesn’t cover them.”

I would advise Toni Says readers to enroll in Medicare Parts A, B and D (Medicare’s prescription drug plan) when not working full-time and covered under your or your spouse’s employer benefits.

Have a complete Medicare Part D prescription drug planning consultation before enrolling in a Medicare Part D plan whether applying for Original Medicare for the first time or changing your Part D plan during Medicare’s Annual Enrollment Period from October 15 to December 7 every year.

Be sure that the Part D plan you choose covers all your transplant drugs as well as prescriptions you take daily. If your Part D plan does not cover your transplant prescription drugs, then who will pay? You will! (Chapter 5 of Toni’s Medicare Survival Guide Advanced edition explains Medicare Part D in depth and how to enroll properly.)

The Medicare handbook also states, “Medicare covers doctor services for heart, lung, kidney, pancreas, intestine and liver transplants under certain conditions, but only in Medicare- certified facilities.”

The handbook continues, “if you’re thinking about joining a Medicare Advantage Plan and are on a transplant waiting list or believe you need a transplant, check with the Medicare Advantage plan before you join to make sure your doctors, other health care providers, and hospitals are in the plan’s network. Also, check the plan’s coverage rules for prior authorization and coverage for your living donors.”          

Regarding the Toni Says client’s question about Medicare paying for at-home care while he is recuperating from his liver transplant, I did not have good news for him. Original Medicare pays zero for at-home care while recuperating from a transplant or any illness. Medicare will pay for home health visits if there is a doctor’s order, and it meets Medicare’s medical requirements.

Medicare will only pay for skilled nursing or rehab facility care. If you do not meet Medicare’s qualifications for skilled nursing, you will pay 100% of the cost for it out of your pocket.

I have informed the Toni Says client to begin speaking with at-home provider services, friends, and family about receiving their help with round-the-clock care at home to aid him and his wife. If he has a long-term care policy, it may pick up costs not paid by Medicare. In next week’s Medicare column, I will discuss various long-term and short-term care options.

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

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.

The post Is 24/7 Home Care After A Liver Transplant Covered By Medicare? appeared first on Canyon News.

I plan to work through January 2026 to help with the transition of my job responsibilities. I am planning to enroll in Medicare Part A and B during my Medicare enrollment time and not delay Part B. I understand that I will be paying for Part B when I don’t need it because I am still working with employer health coverage.

I wanted to make sure that I am enrolled in Medicare Part B before my turning 65 when Medicare Initial Enrollment Period ends. Then I can begin a Plan G Medicare Supplement policy on February 1 when I retire. Looking forward to your guidance.

—Brad from Louisville, Ky.

Hi Brad:

I have good Medicare news for you, because your “turning 65” Medicare Part B will begin February 1, 2026, and you will not have to pay for your Medicare Part B to begin in October, the month that you turn 65. Also, because your Medicare Part B begins on February 1, 2026, your Medicare Supplement Plan G, for medical care, can start February 1 since you are losing your employer group health insurance January 31.

Medicare’s Initial Enrollment Period (IEP) is the 7-month period that occurs 3 months before you turn 65, the month you turn 65 and 3 months after turning 65. (Chapter 1 of my Medicare Survival Guide Advanced edition explains enrolling in Medicare in detail.)

You must set up a Social Security account prior to enrolling in Medicare when turning 65 by going to www.ssa.gov/medicare/sign-up.

Below is a summary of the Medicare Initial Enrollment Period 7-month timeline schedule:
—If you enroll up to 3 months before turning 65, your Medicare begins on the first day of the month when you turn 65. Since you, Brad, will turn 65 on October 20, you can enroll in Medicare Parts A and/or B in July, August, or September (up to 3 months prior) for an October 1 effective date.

—If you enroll in Medicare the month you turn 65 or up to 3 months after, your Medicare Part A will always begin the month you turn 65. (In Brad’s situation, his Medicare Part A will begin October 1 since that is the month he turns 65.)

—If you enroll in the month you turn 65, then Medicare Part B will begin on the first day of the following month. (Brad can choose to enroll in October and his Medicare Part B will begin November 1.)

—If enrolling 1 month after you turn 65, your Medicare Part B will begin the first of the next month. (If Brad enrolls in November, his Medicare Part B will begin December 1.) 

—If enrolling 2 months after you turn 65, your Medicare Part B will begin the first day of the month after that. (If Brad enrolls in December, his Medicare Part B will begin January 1.) 

—If enrolling 3 months after you turn 65, your Medicare will begin the following month. (So, if Brad enrolls in January, 3 months after the month he turns 65, his Medicare Part B will begin February 1, which is exactly when Brad wants his Medicare Part B to begin, and his Medicare Part A is backdated to October 1.)

Brad, had you begun your Medicare Parts A and B with an October 1 effective date, then your Medicare Part B premium would have begun. Waiting until January saves you on paying the “extra” 3 months.

Many Americans are not aware of Medicare’s turning-65 timeline. Thank you, Brad, for asking this important Medicare enrollment question.

Remember … with Medicare, what you don’t know WILL hurt you! Have a Medicare question? email the Toni Says Medicare team at info@tonisays.com or call 832-519-8664. The Medicare Survival Guide bundle package is available on the tonisays.com website.

The post Knowing Your Medicare Enrollment Options When Turning 65 Can Save You Money! appeared first on Canyon News.

Now, I’m concerned that I could have made a mistake. Should I call and ask if this Medicare service is still available? Thanks, Toni.

–Deidre from Katy, Texas

 Hi Deidre: Don’t stress yourself out, because Medicare is not giving away anything free! This is a new Medicare scam that is targeting America’s Medicare population. Last week, Dr. Mehmet Oz, the administrator for the Centers for Medicare & Medicaid Services, emailed an article with a YouTube video to Americans enrolled in Medicare titled, “Never sign anything in exchange for “free” services—it’s a scam!” You can view the Medicare.gov YouTube video at www.youtube.com/shorts/m0ygedIGFiY.

In the email from Medicare.gov, it says… “Note: Hospice care is for people who are terminally ill and is a serious decision made only between you and your doctor.” If you think that you have experienced “fraud,” call 1-800-MEDICARE (1-800-633-4227) and report your fraud issue to the Medicare agent who answers your call.

Medicare, Social Security and also the IRS will NEVER randomly call your home or cell phone and ask for your personal or banking information. In almost every case, Medicare already has all the information they need about you.  If information is needed, a letter will be sent directing you to the specific government agency you need and telling you to contact them for additional information.

Additional help for Medicare fraud is available at Senior Medicare Patrol (SMP), which helps those on Medicare learn how to detect fraud and abuse.  To report Medicare Fraud or Abuse call the nationwide SMP toll-free number 877-808-2468 or visit the SMP website at www.smpresource.org to locate the closest SMP office in the state where you live.

The SMP website discusses common Medicare Fraud Schemes such as genetic testing, hospice, Medicare card scams, and the list goes on. Below are a few tips to help protect you against Medicare fraud:

–Have a safety script by your phone or front door for solicitors. Tell anyone, especially scammers, you do not give out personal information to anyone who calls or knocks on your front door. (Get your kids or a friend to help you write your script.) Stick to the script no matter what!

–Never give your Medicare or Social Security number to strangers who call you on the phone or come to your door. Just like you tell your grandkids not to talk to strangers, you need not talk to them either. Play the “Stranger Danger” game.

–As Dr. Oz said, Do NOT accept “free” offers in exchange for your Medicare number. Remember, there is nothing “free.”  They will have Medicare pay for whatever they are offering, and they will use your Medicare number to get it paid for!

Medicare fraud is exploding by the billions of dollars not millions and the only way to stop Medicare fraud is to let your friends know what Dr. Oz said on the Medicare.gov YouTube video. America needs 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!

Remember…with Medicare, it’s what you don’t know WILL hurt you! Do you have a Medicare question or want to discuss Toni’s stress-free way to enroll in Medicare? Please email the Toni Says Medicare team at info@tonisays.com or call 832-519-8664. The Medicare Survival Guide bundle package is also available on the tonisays.com website.

The post America…There Is A New Medicare Scam! appeared first on Canyon News.