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“Fast Friday Q&A: Expert Answers to Your Top Medicare Questions

“Fast Friday Q&A: Expert Answers to Your Top Medicare Questions

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Welcome to Fast Friday Q&A on Real Easy Medicare with Al Kushner! In this episode, Al tackles a wide range of Medicare questions from enrollment timing to coverage details, providing clear, concise answers you can act on immediately.

  1. Coverage Start Dates
    • Part A/B begin the first day of your 65th birthday month (or prior month if born on the 1st) when enrolled during IEP
    • MA and Part D plans start January 1 during open enrollment; SEP start dates vary
  2. Keeping Your Doctor
    • Original Medicare + Supplement: see any provider accepting Medicare
    • MA: must use network doctors except emergencies; verify participation by phone
  3. Missed Enrollment Windows
    • Locked into MA until next OEP (Oct. 15–Dec. 7) unless qualifying SEP; MA OEP (Jan. 1–Mar. 31) allows one change
  4. Cost Breakdown
    • Part B: $185/month base premium (2025), $257 annual deductible
    • Part A: free with 40 work quarters
    • Part D: $15–$100/month
    • Medigap: $50–$300/month depending on plan and location
  5. MA vs. Medigap
    • MA: lower premiums, network restrictions, built-in gap coverage
    • Medigap: higher premiums, provider freedom, separate Part D required
  6. Drug Coverage Solutions
    • Request formulary exceptions with medical justification
    • Pay cash price toward OOP cap if necessary before switching plans
  7. Plan Change Rules
    • MA and Part D: open enrollment only or SEP
    • Medigap: change anytime but underwritten after IEP unless guaranteed issue
  8. Dental & Vision
    • Original covers minimal emergency services
    • MA plans often include dental and vision extras; evaluate plan specifics
  9. Appeals & Denials
    • Start level-1 redetermination within 60 days of denial; escalate through five levels with stronger documentation
  10. Working Past 65
    • Employer with 20+ employees: delay Part B penalty-free; enroll in Part A at 65; eight-month SEP after coverage ends
  11. Travel & Relocation
    • Original Medicare portable nationwide; MA covers emergencies out-of-network only
    • Moving triggers SEP for MA/Part D; Medigap guaranteed issue may apply
  12. Doctor & Plan Matching
    • Use Physician Compare and office referrals; always verify network status and new-patient openings
  13. Part D Coverage Gap Update
    • As of 2025, Part D donut hole will be eliminated; $2,000 true OOP cap then $0 cost share
  14. Cost Assistance Programs
    • Medicare Savings Programs and Extra Help for low-income beneficiaries
    • SHIP offers free state counseling

Next Week Preview: A weeklong series on solving Medicare problems—from enrollment hurdles and billing errors to network disputes and prescription challenges.

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