Toni Chavez, Medicare Insurance Broker

Answer: Good morning & Happy Sunday!

Since you have Plan G you should only have to pay the annual Part B deductible $240.

Thanks,

Toni Chavez

Medicare Broker

Answer: Serving my clients and providing guided expertise with Medicare. My main purpose is to simplify the complex to empower people to make informed decisions regarding their health insurance.

Answer: Hello! You become eligible for medicare with your Initial enrollment period (IEP). The IEP open enrollment period is 7 months in duration.

3 months before your 65th birthday, your birth month and 3 months after your 65 birthday.

Hope this answer ls your question.

Toni Chavez

Medicare Broker

Answer: Sorry to hear you’re getting a conflicting answer.

Several options call you plan carrier they can advise from the drug formulary.

You should have received the drug formulary in the mail when you received your 2025 Plan Documents.

You can look the drug up on the formulary, it will give you the tier and then you see what the cost is for that tier with your drug plan.

The most you will pay for all drugs out of pocket this calendar year for 2025

Is 2,000

Speak with your broker and they can check

Visit Medicare.gov

My highest recommendation is call your agent, if you don’t have an agent you can always get one so in the future you have an advocate that can assist you.

Hope this helps!

Thanks,

Toni Chavez

Medicare Broker

Answer: Hello,

Thanks for your question.

Center for Medicare Services is always making this better for Medicare Beneficiaries.

Many enhancements are continuously being enhanced just as the Drug Donut Hole was

Eliminated starting in 2025, which now allows for over 3 million medicare beneficiary to afford their drugs.

Be well,

Toni Chavez

Medicare Broker

Answer: That’s a great question, and honestly, it’s something a lot of people have been talking about lately.

There’s been a big increase in Medicare Advantage ads on TV, online, and even through phone calls and mail — and not all of it is helpful or accurate. Some of the marketing can be confusing or even misleading, which is why there’s been more attention on whether there should be tighter rules in place.

In fact, Medicare has already started cracking down a bit by adding more guidelines around how plans and agents can advertise. The goal is to protect people from being misled or pressured into a plan that doesn’t really suit their needs.

That said, I believe there’s a balance. There should be strong protections in place for consumers, but we also don’t want to make it harder for people to get real help from licensed agents who are trying to do things the right way.

When I work with clients, my focus is always on clear information and honest guidance — no pressure, just support.

Thanks,

Toni Chavez

Medicare Broker

Answer: Great question! As with everything there are pros and cons the pro with Medicare advantage is the premium of the plan, which a lot of times is zero monthly cost and you can budget with the plans max out of pocket. Plus most of the plans have additional benefits life dental/vision/hearing/fitness coverage.

The con is using a network, but I don’t really say this is a bad thing as most networks in the major cities have robust network of doctors and specialists.

Original Medicare in my opinion has a big con which is Original Medicare only covers 80%, which leaves you open to a 20% bill everytime. If you have a year where you’ve been sick and have had to visit the doctor multiple times or have a hospital stay that can hit you hard financially. There is no annual or lifetime cap with Original Medicare (Part A & Part B)

Hope this gives some insight.

Be well!

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

I can give you a yes or no response but what I can recommend is talking to a broker who represents the plans in your county. They can compare plans, doctor ls and medications and recommend what is the best for your situation.

Most consumers don’t realize when you call an 800# you will only get the plans for that carrier.

As a broker our services are no cost, and our main job is to make sure we are doing a needs analysis with each client. If you have an agent and they aren’t doing this yearly you have the wrong broker.

Always remember if you sign up for a plan during annual enrollment (Oct 15 - Dec 7) you can switch your MAPD during open enrollment (Jan 1 - Mar 31). I always advise my client that switch plans to try it out for 60 days and if it’s not working we can switch you before March 31st.

Answer: Hello,

I’m not sure I understand your question.

If you’ve lost your MAPD plan it may be the carrier is no longer offering that plan in your area. We did see a lot of this for 2025

Plan year.

I always suggest looking out for your Annual Notice of change (AOC) to keep informed of your specific plan changes.

If you have a broker we normally notify our clients when these things are going to occur way ahead of time.

Answer: Thanks for your question!

Your Medicare options stay the same when you move into a CCRC, but the plan that works best for you might change depending on how the facility delivers care. It’s important to make sure your Medicare coverage lines up with how the CCRC provides services so you don’t run into unexpected costs or limited access to care.

Here are a few things I always recommend

Ask the CCRC before moving.

Which Medicare plans work best here?

Do your in-house doctors take

Medicare Advantage plans?

Look over any agreements closely.

Some CCRCs include certain services in your monthly fee, but that doesn’t mean Medicare won’t still be needed for things like hospital or skilled nursing care.

Answer: This is a reflective question not knowing what’s been reviewed with you thus far I’ll do my best to answer.

I would ask if you are still traveling what’s covered in network vs out of network if your looking at a Medicare Advantage Plan (Part C)

I always recommend work with a license broker who will advocate and guide you not only on initial enrollment into Medicare, but for future years to come. Plans could

change every year as well as your health as you get older.

Independent brokers represent the client, not the company which allows us to guide you based on your situation in an unbiased approach.

Our services are no cost to any Medicare beneficiary. We get paid directly from the carrier for the plan we place you in so we are incentivized to make sure we do needs analysis.and recommend the plan. That makes the most sense for your situation at the time of enrollment..

Answer: Thanks for your question.!

I would say if you receive a phone call and that Kaller asked for your Medicare number Social Security number or banking info within the first five minutes of the phone call that’s a red flag for me. I recommend looking for a local broker and you reach out to them directly. That way you know you’re dealing with a professional licensed individual that can help you with your Medicare..

Most beneficiaries don’t realize Medicare brokers offer advice, guidance, and expertise to simplify Medicare at no cost to you.

Answer: Thanks for your question!

This should have any affect

On your medicare Part A & Part B.

Just remember you must always keep these active.

You may or may not know this if your running into financial hardship there are several programs available to medicare eligible beneficiary depending on income that’s can help lower drug costs and deductibles. Also medicare Savings Program can help you Part B.

I recommend speaking to a licensed broker who can guide you on the available programs.

Answer: Thanks for your question!

Guaranteed issue applies to a Medigap policy. It means the insurance company has to accept you cannot deny you due to health conditions - no underwriting required.

1. Your Medigap Open Enrollment Period

• Starts the month you turn 65 and are enrolled in Part B

• Lasts for 6 months

• During this window, you have full GI rights to buy any Medigap plan sold in your state (not just certain ones)

2. Losing Other Coverage (Qualifying Events)

You get Guaranteed Issue rights if:

• You lose employer group coverage (including COBRA)

• Your Medicare Advantage plan leaves your area, ends coverage, or you move out of the service area

• You drop a Medicare Advantage plan or Medigap to try something else, but switch back within 12 months (Trial Right)

• Your current Medigap insurer goes bankrupt, commits fraud, or misleads you

Hope this answers your question!

I recommend speaking to a licensed broker who can answer and guide you with Medicare. Our services are no cost.

Answer: Thanks for your question!

Yes, this can be very confusing and I’ll simplify it the best I can.

If you have a Medicare Advantage plan (Part C), there’s a max out-of-pocket limit — once you hit it, the plan covers 100% of your approved medical costs for the rest of the year.

What counts toward it: things like copays, coinsurance, deductibles, ER visits, hospital stays, and specialist visits.

What doesn’t count: your monthly premiums, prescription drug costs, or extras like dental and vision.

If you have a PPO plan out of network may have a seperate out of network Max out of pocket.

Your max out of pocket for prescription drugs for 2025 is $2,000.

Answer: Thanks for your question!

Medicare Advantage must cover at least the same medically necessary home health care services as Original Medicare. Keep in mind you must use in network providers and usually prior authorization is required before care is provided. Some plans have restrictions, and I would check with your evidence of coverage document for the plan you have. You can always call your agent or carrier for more information regarding your plan.

Enjoy your day!

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

Someone may choose a Part D with higher costs due to the drug formulary, pharmacy preferences, prior authorizations, step therapy and quantity limits restrictions for higher tier drugs.

Hope this answers your question.

Enjoy your day!

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

If you’ve worked at least 10 years (that’s 40 quarters), Part A usually kicks in automatically the month you turn 65.

You can hold off on Part B if you’re still working and have credible coverage through your employer — but keep in mind, employer coverage is often more expensive than Medicare. I always do a comparison for my clients to see what actually makes the most sense financially.

If you don’t have employer coverage or any other creditable coverage, it’s important to enroll in Medicare at 65 — otherwise, you could face lifetime penalties.

When you’re ready to retire, I always recommend working with a broker (like me!) to help you apply for Part B. There are forms that need to be filled out and sent to Social Security, and I help walk my clients through that step-by-step — no cost to you.

Once you’ve got Part B in place, I can help you compare all the Medicare plan options in your area and get you enrolled in a plan that fits your needs and budget.

Working with a broker gives you peace of mind — not just when you first enroll in Medicare, but every year after that.

Hope this helps.

Be Well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

Several ways if you enroll in a Medicare Advantage plan usually these are additional benefits that are included in the plan. Keep in mind not every plan provides this.

Or you can buy these as a standalone policy.

You can work with a broker like me to get options to compare.

My services are no cost to you and many options are available to fit your needs and budget.

Hope this answers your questions!

Be Well,

Toni Chavez

Medicare Broker

Answer: My clients rarely have regrets when it comes to their Medicare coverage — and that’s because I check in every year, do a full need review, and help them make changes if needed. It gives them peace of mind knowing they’re still in the right plan and fully covered.

That’s the value of working with a broker — and the best part? My help doesn’t cost you a thing.

A lot of Medicare beneficiaries don’t even realize they have access to an experienced, local broker (like me!) who can walk them through all the confusing parts of Medicare. I’m here to make it simple and make sure you’re protected.

If you do have regret, you have the option every Annual Enrollment or Open Enrollment to enroll in a new plan if you are on a Medicare Advantage Plan.

Hope this answers your question.

Be Well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

Yes, actually today I am helping a client submit a claim form to get reimbursed for his quarterly exercise benefit his plan gives him. He has peace of mind knowing as his broker he doesn't have to call an 800# to get it his issue resolved. Most Medicare beneficiaries don't realize using a local broker is no-cost to you.

Hope this answers your question.

Be well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

There are many reasons, but here are a few.

It’s Free Help

Working with an agent costs you nothing — seriously. You don’t pay more for your plan, and there's no fee for guidance.

We Make Medicare Make Sense

Turning 65? Already on Medicare and confused? We break it all down in plain English so you actually know what you're signing up for.

Personalized Advice

We don’t just throw you into a plan — we look at your doctors, your prescriptions, your needs, and help find the best fit for you.

Year-Round Support

We’re not a 1-800 number. We’re real people you can call, email, or meet with — even after enrollment.

Plan Comparison Made Easy

There are dozens of plans. We compare them side by side so you don’t waste hours trying to figure it out on your own.

Help with Enrollment (and the Forms!)

Enrolling in Medicare Part B? Need to switch plans? We walk you through it — step by step, no stress.

We’re Local (and We Care)

You get someone who understands your area, your doctors, your pharmacy — and who actually cares about your outcome.

Hope this answers your questions.

Be well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

If you're under 65 now but getting close to your 65th birthday, your Medicare enrollment timeline stays the same — you can sign up during the 7-month window: 3 months before your birthday, your birthday month, and 3 months after.

Where you live don’t affect when you enroll, but it does affect what plans are available to you once you have Medicare.

Part D or Part C you have a 2-month special enrollment period to switch plans to your local plan options.

If you have Original Medicare Only (Part A & Part B) this follows you everywhere and no action is needed.

Good luck on your move.

Be well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question!

In most cases Original Medicare (Part A & B) does not pay for groceries it's designed to cover medical services.

However, some Medicare Advantage (Part C) plans may offer extra benefits that included help with groceries under certain conditions. These tend to be for people with chronic health conditions or those that qualify for Medicare + Medicaid.

There is a lot of misleading ads on the TV that say you can get money for food; however, that is usually not true unless you qualify. This is one of the BIGGEST questions my clients ask me every year.

This is a good reason to work with a no-cost local broker they can keep you informed of all your options you may be eligible for and compare the plans available in your local area.

I hope this answers your question.

Be well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question.

Not knowing all your options available in your local market. You may be leaving valued added items you're not even aware are available and that equals leaving money on the table.

Medicare is complex and too many plan options to try to compare on your own.

When you are calling an 800# for one carrier they are only going to be able to discuss the plans they offer.

Most Medicare Eligible individuals are unaware there is no-cost local help with a licensed Medicare Broker. We know our market and can recommend plans based on what your needs are.

I encourage you if you don't have a broker you are working with to find one before the next annual enrollment starts October 15th.

I hope this answers your question!

Be Well,

Toni Chavez

Medicare Broker

Answer: Thanks for your question! You would want to check with the specialists you are looking to go see and make sure they offer telehealth visits. You can also call your plan to have them help you locate a specialists that is in network and offers telehealth. Most plans offer this service, but keep in mind it has to be with a doctor in your plan network.

Answer: If you accident-related disability qualifies you for SDDI and you receive your first SDDI payment after the 5-month waiting period, and

You’ve been on SSDI for 24 full months

…then you will be automatically enrolled in Medicare when that 24-month SSDI period ends. Once you have Part A and Part B you qualify for enrolling in a Medicare Advantage Plan (Part C)

If your disability isn’t related to ALS/ESRD, no exceptions apply

Answer: You can get quotes with various carriers, but keep in mind you will most likely have to go through full underwriting. It may or may not be less expensive then you pay now. Word to the wise don't cancel your current plan until you know you are fully approved it you find something less expensive. A broker can help you with shopping various carriers.

Answer: During AEP looking at another Part D plan that may have a better formulary and tier pricing. Find a local broker that can compare plans and costs based on your drugs.

Answer: You can call your plan for information on the hearing benefit and the costs. Remember to find a provider in the network to maximize that allowance.

Answer: It's Free. The Medicare Advantage plans may have no cost for a monthly premium perspective, but you still have to have Part B and there is a cost associated with that.

Answer: Call a local broker! We can look at all your plan options and compare for you. Our professional expertise is NO COST to you. We can simplify and make it less overwhelming for you.

Answer: It all depends on what address you have filed with Social Security. You can always look at a PPO plan or a plan that gives you a travel benefit option for the months you are not in your home state. Call a broker in the main resident state (where you file your taxes) and they can help and guide your options and help you avoid costly mistakes. Our services are no cost to you.

Answer: I'm helping them make sure they are protecting their health with the right plan options! Our service is no-cost to you, and we know the local markets and plans and can recommend based on your needs.

Answer: Thank You for your question. Medicarr Advantage Plansare a great option for seniors, but thrfe a limitations on getting care with doctors in the network. Depending on the state you reside, there are robust networks which doesn’t tend to cause an issue for finding great doctors fir your healthcare needs. It’s always recommended to talk to a broker. They are unbiased and and recommend based on your specific needs. There is no cost to use a broker we are compensated when we enroll you in a plan when I retire to do it needs analysis, which is beneficial for the client and providing solutions based on your needs.

Hope this answers your question.

Have a great day

Answer: Thanks for your question!

You have several options tonget enrolled.

First you need to Confirm you have active Part A & Part B.

Once you confirm this, you have several enrollment options. My recommendation is find a local broker who can assist you with verifying your eligibility, reviewing plan options to maximize all the benefits and enroll you in a plan. This is a no cost service and then you have an advocate moving forward for future years to assist you if any issues arise..

Hope this answer your question. Have a great day.

Answer: Thanks for your question

No, I would say you didn’t make the wrong decision as you have the ability as your situation changes to look at the other options available. I recommend finding a local broker that can look at your situation. Make recommendations compare plans and enroll you if you decide to take one of the other options. There are good PPO options available that do have a travel benefit when you’re outside of your residential state and the good news is you could potentially save on your bottom line.

If you have been on a Medicare supplement, you get what’s known as a trial by right option moving to a Medicare advantage plan you can try out for 12 months. Who qualifies: People who joined a Medicare Advantage plan for the first time ever at age 65. If you do not like it, you can go back on the same plan you were on new rates will apply but no underwriting. the only change if gou go back to the medsupp the current rate will apply.

This is what I recommend to all my clients when they are looking to save money.

Hope this answers your question. Enjoy your day.

Answer: thanks for your question.

You will want to review this and compare any doctor bills from your provider. if you find any discrepancies, call your provider and discuss..

You normally can toss these within 12 months to 24 months, unless you want to keep for longer, it’s up to you.

Hope to answer your question. Have a great day.

Answer: Seniors can get lifetime penalties if they don’t sign up when first eligible for Medicare and didn’t have other medical coverage.

Answer: Yes, Medicare supplements are known as gap coverage or secondary coverage. It basically fills the 20% gap that original Medicare does not cover..

Answer: Your sent a plan formulary every year you can review this. each drug is assigned to drug tier which correlates to a co-pay or coinsurance. You can then determine what your cost will be.

There are several other ways to do it, but just keep in mind. They are estimates using these other tools medicare.gov.

My ultimate recommendation is finding a broker as this is something that is available to all Medicare beneficiaries, and our services are no cost to you. We have the ability to compare plans, drug cost, and make recommendations based on your situation and needs.

Answer: Thanks for your question! I’m not seeing clients leave medicare advantage plans, I am moving people from Medicare Supps to Medicare Advantage plans for the financial savings benefit as well as the value added benefits of OTC, Dental, Vision and hearing.

In Arizona 85% of the market is on medicare advantage plans. In my professional opinion MAPD make sense all the way around.

The advantage for my clients having me as their no cost broker I can review plan options every year and recommend based on their needs and benefits to maximize all offerings.

Hope this answers your question!

Toni Chavez

Answer: It’s live and thriving!

The donut hole

Was removed starting 1/1/2025.

Max out of pocket for all prescriptions drugs is 2k.

Answer: Thanks for your question!

My professional opinion, get a Medicare advantage giveback plan to get the best of both worlds you get money back on your part B as well as in the event you need medical coverage you have that as well. Your out-of-pocket may be higher, but I always say cash is king.!

If you’re not using a broker, I recommend getting one. Our services are no cost to you, and we are able to look at your situation and recommend we are unbiased in regards to carrier selection..

Answer: Thanks for your question! I would listen to either I would recommend speaking to a licensed broker who can review your Sutton and recommend options based on your specific needs. Friends & Family are great, but when it comes to you health and options having a licensed professional assist is the best course of action.

Answer: Thanks for your question!

If you have original Medicare or Medicare supplement, you could get a dental and hearing plan separate separately.

If you have a Medicare advantage plan most plans have a hearing benefit/allowance.

I recommend if you don’t have a license Broker to get one our services are no cost to you and we can compare all plan options for you and recommend based on your specific needs.

Hope this answers your question!

Stay Happy & Healthy!

Answer: Thanks for your question!

Medicare advantage plans usually have comprehensive dental, which includes your cleanings and can be with zero copay.

Medicare advantage plans have lots of benefits to include dental vision, hearing and over-the-counter benefits.

I recommend finding a license broker. We are no cost to beneficiaries and can look at all plan options and compare what’s available in your county and make the recommendation based on your needs..

Hope this answers your question!

Stay happy and healthy

Answer: Thanks for your question!

I’m not sure you’re exact question, but I will try to answer it. You have to have Part A ( hospital) and Part B (doctor visits) which is known as original Medicare if this is what you have, you will always pay a 20% out-of-pocket for all services whether it’s a hospital or just a regular doctors visit.

Your options to not pay the 20% would be to get a Medicare advantage plan also known as part C these plans have a max out-of-pocket and specifically for hospital stays. You may have a co-pay for the first eight days in the hospital, but you can budget any given year by what your max out-of-pocket will be for that plan.

If you don’t use a broker, I recommend we are no cost service and can look at all your options and compare based on your needs and recommendations.

Hope this answers your question be happy and healthy