Advanced Medicare Strategies You Never Knew You Needed

Welcome back to Real Easy Medicare with Al Kushner! In this special Wisdom Wednesday episode, Al draws on forty years of expertise to share insider tactics and lesser-known tips that can transform your Medicare experience from merely surviving to truly thriving.

1. Strategic Plan Switching
   • Shop every year during Annual Open Enrollment (Oct. 15–Dec. 7)
   • Compare Maximum Out-of-Pocket (MOOP) limits, not just premiums and deductibles
2. Hidden Medigap Enrollment Rights
   • Guaranteed issue periods when retiree coverage ends or you move out of plan service areas
   • Act promptly to avoid medical underwriting
3. Network Realities in Medicare Advantage
   • “Acceptance” doesn’t guarantee availability—call providers to confirm they’re taking new patients
   • Specialist access can be particularly limited
4. Part D Formulary Vigilance
   • Research a plan’s history of formulary changes
   • Use appeals and exception requests to lower drug tier costs
5. Dual Eligibility Maximization
   • Leverage Special Needs Plans (SNPs) for extra benefits
   • Understand Medicare-first vs. Medicaid-first payment rules
6. Appeals and Reviews Unveiled
   • Level 1 redetermination vs. Level 2 independent review—don’t stop after the first denial
   • Expedite reviews for medically necessary services in Medicare Advantage
7. Coordination with Social Security
   • Align Part B enrollment with Social Security claiming strategy to optimize benefits
8. Skilled vs. Custodial Care
   • Document medical necessity to qualify for covered skilled services in long-term care settings
9. Technology Tools
   • Use Medicare.gov Plan Finder for network, mail-order, and coverage-gap insights
   • Track claims and plan changes via MyMedicare.gov
10. Employer Coverage Nuances
    • For companies with 20+ employees, employer plans may pay first even after age 65
    • Get payment-order agreements in writing
11. State Assistance Programs
    • SHIP counseling, pharmaceutical assistance, and Medicare Savings Programs with higher income limits
12. Annual Medicare Checkup Ritual
    • Conduct a full benefits review every November with your healthcare, legal, and tax advisors