UNITED STATES—Toni: I am retiring January 1 and am beginning to search for the right Medicare option for me and my wife, who is having breast cancer treatment at a local cancer facility. Her cancer drugs are expensive, and I am concerned about the Medicare Part D out of pocket. I am a diabetic and using the flex pen with high blood pressure prescriptions. Most of mine are generic, except for the diabetic prescriptions.

Our Medicare Part B will begin January 1 as my company benefits will end December 31 of this year. What should I do to prepare for this medical insurance change? I will be 70 and my wife is turning 65 by the time I retire. I want to be sure I do this correctly. Thanks, Roger, Las Vegas, NV.

Great question, Roger: “Medicare is not cookie cutter…One size does not fit all!” During Toni Says® Medicare consultation, we tailor your Medicare to fit your needs. Everyone’s Medicare health and prescription drug situation is different and your medical situation as well as the prescription drugs that you take should be considered in finalizing your Medicare plan.

The cornerstone of Medicare planning at the Toni Says® office is discussing Medicare Part D prescription drug planning. It is imperative to search for what is the most cost-effective Medicare Part D prescription drug plan that covers all your prescriptions. If a prescription is not covered whether generic or brand-name, then you will have to pay 100 percent of that prescription out of your pocket.

Many are concerned about their doctor and completely miss if their prescriptions are covered under their new Medicare Part D or Medicare Advantage prescription drug plan due to not focusing on proper Medicare Part D planning. To understand Medicare Part D and the famous “Donut hole” visit chapter 5 of the Medicare Survival Guide Advanced edition.

Every Medicare Part D plan has a formulary whether it is a stand-alone Part D plan or Medicare Advantage (Part C) with prescription drug plan. If your drugs are not on that formulary, you will pay 100 percent out of your pocket.

Medicare Part B like “gold” because of what it offers and those receiving Medicare Part B for the first time need to understand the value of the Medigap/Medicare Supplement Open Enrollment Period. In the Medicare and You Handbook, it discusses “When to Buy” a Medicare Supplement. It states that “the best time to buy a Medigap (Medicare Supplement) policy is during the 6-month period which begins the first day of the month in which you’re 65 or older and enrolled in Medicare Part B.”

During this 6-month window you can enroll in any Medicare Supplement/Medigap plan without having to answer any health questions and not be denied coverage. After the 6-month window, then medical underwriting takes place, and you may not qualify for a Medicare Supplement/Medigap Plan.

Many new Medicare beneficiaries explore the option of a Medicare Advantage plan which is known as Medicare Part C. It is a good option and with health conditions such as you, Roger and your wife have, we advise that you speak with your doctor about what plans they accept or if that provider accepts Medicare Advantage plans that you may be exploring.

Understand the complexity of Medicare is exhausting to America and now Toni Says® is expanding with www.seniorresource.com where more Medicare and Boomer/Senior information with podcasts are available. For answers to your Medicare questions/concerns, call the Toni Says Medicare team at 832-519-8664 or email info@tonisays.com.

Medicare AEP Confused about Medicare Zoom Webinar from 4-6 p.m. Wednesday, November 16. Visit www.Tonisays.com for the registration link.