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.

Welcome to Tips & Tricks Thursday on Real Easy Medicare with Al Kushner! In this episode, Al delivers 19 actionable strategies to streamline your Medicare journey, reduce costs, and safeguard your benefits.

1. Medicare Card Protection Trick
   • Carry copies or phone photos of your card; keep the original safe at home; annotate emergency contacts on copies
2. Provider Network Research Trick
   • Call doctor offices to ask about prior authorization delays, denial rates, and new-patient policies—not just network inclusion
3. Part D Pharmacy Shopping Trick
   • Identify preferred pharmacies for lower copays; compare local versus mail-order pricing for each medication
4. Medigap Shopping Trick
   • Solicit quotes from at least five insurers for identical Plan F coverage; evaluate rate increase histories and household discounts
5. Claims Tracking Trick
   • Maintain a spreadsheet of services and compare against Medicare Summary Notices; set up a Medicare.gov account for real-time monitoring
6. Emergency Preparation Trick
   • Assemble and update tri-location emergency folders containing card copies, medication lists, and provider contacts
7. Annual Review Trick
   • Begin plan comparisons in September; list providers and prescriptions first, then calculate total annual costs
8. Provider Communication Trick
   • Confirm Medicare assignment, request cost estimates before procedures, and obtain copies of all test results
9. Prescription Money-Saving Trick
   • Ask pharmacists about generics, manufacturer discounts, pill splitting, and 90-day supply savings
10. MA Extra Benefits Trick
    • Maximize gym, dental, vision, OTC, and transportation benefits by scheduling early and reviewing benefit catalogs
11. Appeal Process Trick
    • Document all interactions, request written denial explanations, use certified mail, and escalate to supervisors as needed
12. Customer Service Strategy
    • Call during off-peak hours, note representative names and reference numbers, and persist politely
13. Open Enrollment Preparation
    • Research plan changes before October, focusing on network shifts and formulary updates
14. Medicare Advantage Escape Hatch
    • Use MA’s Jan 1–Mar 31 Open Enrollment to switch plans or revert to Original Medicare if dissatisfied
15. SEP Trigger Awareness
    • Recognize moving ZIP codes, losing coverage, or provider exits as SEPs to change MA or Part D plans off-cycle
16. Technology Optimization
    • Utilize Medicare.gov and plan mobile apps for claims tracking, provider searches, and instant benefit checks
17. Fraud Protection
    • Never share your Medicare number with unsolicited callers; report scams immediately to 1-800-MEDICARE
18. Medigap Underwriting Tip
    • If denied coverage, apply to different insurers—underwriting criteria vary significantly between companies

Welcome to Wisdom Wednesday on Real Easy Medicare with Al Kushner! Drawing on four decades of experience, Al reveals elite-level strategies to optimize your Medicare coverage and reduce costs.

1. Hidden 90-Day Benefit Period
   • A single benefit period spans multiple hospital or SNF stays within 60 days, avoiding repeated $1,632 Part A deductibles; track your 60 lifetime reserve days carefully
2. Medicare Secondary Payer Techniques
   • Strategically choose when employer or indemnity insurance pays first to minimize out-of-pocket; stack accident, critical illness, or hospital indemnity policies
3. Medigap Birthday Rule Exploits
   • In states like California and Oregon, switch Medigap plans annually during your birth month without underwriting; intra-company switches may apply elsewhere
4. Network Quality over Quantity
   • Evaluate local specialist depth rather than total network size; identify responsive providers by calling offices about appointment availability
5. True Out-of-Pocket Cap Insight
   • The $2,000 Part D true out-of-pocket cap replaces the donut hole; timing high-cost drug purchases no longer accelerates a gap
6. Appeal Success Path
   • Appeals win rates climb from 20% at level 1 to 60% at ALJ level; persistence and thorough documentation are critical
7. Social Security–Medicare Synergy
   • Coordinate premium deductions, assistance programs (QMB, SLMB, QI), and optimal enrollment timing for tax and cost advantages
8. HSA Continuation Strategy
   • Delay Part A enrollment under HSA-qualified employer coverage to maintain tax-free HSA contributions post-65; requires pre-65 planning
9. Geographic Cost Planning
   • Compare Medicare Advantage and Medigap rates across ZIP codes before relocating; retirement location can double or halve premiums
10. Critical Enrollment Timing
    • Medigap’s six-month guaranteed issue window versus MA’s annual OEP and SEPs; missing these windows locks in coverage

Next Episode Preview: Tips & Tricks Thursday—actionable hacks and shortcuts you can implement immediately to streamline your Medicare journey.

Welcome to True Story Tuesday on Real Easy Medicare with Al Kushner! In this episode, Al shares seven authentic beneficiary stories that illustrate how seemingly small decisions can lead to lasting consequences—and how to avoid them.

1. Margaret’s Late Enrollment Disaster
   • Missed Part B IEP, went uninsured for four months after a broken hip, incurred $80,000 out-of-pocket costs and a permanent 10% penalty
2. Robert’s Zero-Premium Trap
   • Chose MA for zero premium, faced network limitations, high copays, and a $7,800 out-of-pocket maximum during heart care
3. James’s Medigap Timing Error
   • Delayed Medigap beyond his six-month window, was medically underwritten and denied coverage after a cancer diagnosis
4. Susan’s Network Nightmare
   • Lost in-network doctor mid-year and surgeon out of network, resulting in $15,000 surprise bills
5. Paul’s SEP Confusion
   • Worked past 65, missed the 8-month SEP after retirement, incurred permanent Part B and Part D penalties, and limited Medigap options
6. Dorothy’s Dual Coverage Mistake
   • Enrolled in Part B unnecessarily while on employer insurance, paid duplicate premiums for eight months
7. William’s Benefit Illusion
   • MA dental and vision benefits fell short of actual needs, and high medical copays led to higher total costs than a Medigap plan

Key Takeaways:

• Enroll within IEP and SEP windows to avoid penalties
• Evaluate total plan costs, networks, and benefits beyond premiums
• Understand guaranteed issue periods for supplemental coverage
• Recognize that MA networks and benefits can change unpredictably

Next Episode Preview: Wisdom Wednesday—uncover advanced strategies and insider insights from Al’s four decades of Medicare expertise.

In this Mistake Monday episode, Al Kushner exposes the most devastating Medicare error: failing to protect against unlimited out-of-pocket costs. Learn why Original Medicare alone leaves you financially vulnerable and how to secure comprehensive coverage.

1. The 80/20 Catastrophe
   • Medicare pays 80%; you’re responsible for the remaining 20% with no annual cap
   • Robert’s $180,000 claim left him $36,000 short
2. Hidden Deductibles & Daily Charges
   • Part A deductible $1,676 per benefit period; $419/day after 60 days; $838/day after 90 days
   • Part B deductible $257, then 20% coinsurance on every service
3. Real-World Impact
   • Sarah’s $300,000 cancer treatment resulted in $60,000 owed
   • Thousands sell assets or face bankruptcy due to unexpected medical bills
4. Two Protective Solutions
   • Medigap Supplement: predictable premiums (~$150/mo.) and near-zero coinsurance (Plan G covers all but the Part B deductible)
   • Medicare Advantage: low premiums, annual out-of-pocket caps ($3,000–$8,000) for total cost control
5. Enrollment Urgency
   • Six-month Medigap open enrollment window guarantees acceptance; missing it risks denial or high rates.
   • Medicare Advantage requires enrollment during designated periods
6. Cost vs. Risk Analysis
   • Compare annual premiums (Medigap $1,800 vs. MA $3,000, including max exposure) against potential unlimited Original Medicare liability.
   • Recognize insurance’s purpose: protection from rare but catastrophic events.s
7. Action Steps
   • Calculate your financial exposure under Original Medicare alone
   • Compare supplemental policy and MA plan costs and out-of-pocket limits
   • Enroll promptly in the option that aligns with your risk tolerance

Next Episode Preview: True Story Tuesday—real beneficiary experiences showing how informed choices avert costly Medicare mistakes.

Welcome to Fast Friday Q&A on Real Easy Medicare with Al Kushner! In this rapid-response episode, Al tackles 16 common Medicare questions with clear, concise guidance drawn from four decades of experience.

1. Plan Changes & Enrollment
   • Change plans only during OEP (Jan 1–Mar 31) or OEP/OE (Oct 15–Dec 7); SEPs apply for qualifying events.
2. Medigap vs. Medicare Advantage
   • Cannot combine both; MA replaces Original Medicare (with built-in gap coverage), Medigap supplements it
3. Provider Participation
   • Non-participating doctors can charge above approved rates; Original Medicare assignment ensures standard reimbursement.
4. Cost Breakdown
   • Part A is free for most; Part B $185/mo. (2025 base); Part D $15–$100/mo.; MA often has a zero premium
5. Missed Deadlines
   • Late penalties are permanent (Part B 10%/year late; Part D penalty based on uncovered months)
6. Benefits Extras
   • Original covers minimal dental/vision; many MA plans include extras—compare total value
7. Travel Coverage
   • Original Medicare + Medigap works nationwide; MA covers emergencies outside the network only.
8. Doctor & Drug Issues
   • Verify doctors via phone; request formulary exceptions or switch plans for uncovered medications.
9. Dual Eligibility
   • Medicaid pays premiums and cost-sharing; contact the state office for eligibility
10. Moving States
    • Triggers SEP; research and enroll in new local plans before moving
11. Appeals Process
    • Five-level appeals: file within 60 days of denial, gather documentation, enlist provider support
12. Working Past 65
    • Employer with 20+ employees allows Part B delay without penalty; verify HR policy
13. Coverage Gap Update
    • Part D “donut hole” eliminated as of 2025; $2,000 out-of-pocket cap then $0 cost share
14. Cost Assistance
    • Medicare Savings Programs and Extra Help reduce premiums and drug costs; SHIP offers free guidance.

Next Episode Preview: Mistake Monday—deep dive into the hidden costs of Medicare’s coverage gaps and how to avoid them.

Welcome to Tips & Tricks Thursday on Real Easy Medicare with Al Kushner! In this episode, Al delivers 18 immediately actionable strategies to streamline your Medicare experience and protect your health and wallet.

1. Medicare Card Protection
   • Carry photocopies or phone photos, not your original card
2. Provider Directory Double-Check
   • Call offices to confirm plan acceptance and new-patient status
3. Annual Wellness Visit Timing
   • Schedule early in the year; a visit doesn’t count toward your deductible
4. Part D Out-of-Pocket Cap
   • Track spending toward the $2,000 true out-of-pocket limit; gap eliminated
5. Summary Notice Review
   • Compare dates, services, and providers; report billing errors promptly
6. Appeal Timeline Mastery
   • File within 60 days of the notice date; use certified mail and keep copies
7. Prescription Transfer Strategy
   • Move scripts to preferred pharmacy and fill 90-day supplies before Jan 1
8. Emergency Room Approach
   • Present all insurance cards; notify MA plans within 48 hours
9. Specialist Referral Rules
   • Keep written referrals for MA; Original Medicare requires none
10. Preventive Service Maximization
    • Use all covered screenings (mammograms, colonoscopies, etc.) at no cost
11. Network Exception Requests
    • Appeal for out-of-network care when in-network access is inadequate
12. Open Enrollment Preparation
    • Start comparing plans in September; list doctors and drugs first
13. Medigap Shopping Secret
    • If denied, try different insurers—underwriting standards vary
14. Part B Premium Reduction
    • File SSA-44 when income drops post-retirement to lower premiums
15. Travel Preparation
    • Verify MA coverage areas; carry Medigap and supplemental cards for Original Medicare
16. Customer Service Strategy
    • Call off-peak, record representative names and reference numbers
17. Fraud Protection
    • Never share your number with unsolicited callers; report scams to 1-800-MEDICARE
18. Technology Optimization
    • Set up Medicare.gov and plan portals; use mobile apps for real-time info

Next Episode Preview: Fast Friday Q&A—send your Medicare questions for swift expert answers and join our Facebook community “Social Security Retirement and Medicare Q and A” for ongoing peer support.

Welcome back to Wisdom Wednesday on Real Easy Medicare with Al Kushner! In this episode, Al unveils advanced insights from four decades of Medicare experience, empowering you to make strategic, cost-saving decisions.

1. Prepare for Catastrophic Costs
   • Medicare’s 80/20 split leaves unlimited 20% liability—plan for out-of-pocket caps or supplemental coverage to avoid financial devastation
2. Network Paradox
   • Larger provider networks don’t guarantee better specialist access—evaluate local depth of specialists, not statewide breadth
3. Formulary Forecasting
   • Anticipate future medication needs (e.g., insulin pumps, new cardiac drugs) when selecting Part D plans to avoid mid-year disruptions
4. Optimal Medigap Timing
   • If healthy at 65, secure Medigap coverage immediately for long-term protection; if not, use the six-month open enrollment wisely
5. Avoid the Premium Trap
   • Low monthly premiums often mean higher deductibles and copays—assess total cost of ownership, not just premiums
6. Provider Relationship Strategy
   • Consult doctors before enrolling to learn which plans they support and which impose burdensome prior authorization processes
7. Enrollment Window Intelligence
   • Medicare Advantage OEP (Jan 1–Mar 31) provides a second chance to adjust plans after initial Open Enrollment
8. Robust Documentation System
   • Maintain a dedicated Medicare binder to track cards, correspondence, and annual plan changes for audits and appeals
9. Appeal Advantage
   • High success rates for properly supported appeals—leverage medical documentation and billing corrections to overturn denials
10. Long-Term Perspective
    • Plan beyond the next 12 months; account for health changes, income-related premium surcharges, and rising healthcare costs

Next Episode Preview: Tips & Tricks Thursday—actionable hacks and shortcuts to simplify Medicare management and save you time and money.