Fast Friday Q&A: 20 Rapid-Fire Medicare Answers You Need Now

Welcome to Real Easy Medicare’s first Fast Friday Q&A with Al Kushner! In this episode, Al tackles 20 real listener questions with quick, actionable advice—no long stories, just straightforward answers to the Medicare issues keeping you up at night.

Enrollment & Timing

• Delaying Part B with employer coverage (20+ employees): obtain creditable coverage proof
• Penalties for missing IEP: 10% per year. Enroll between Jan 1 and Mar 31 for July 1 coverage.
• Spousal death: report to SSA, explore SEP for Advantage or employer coverage changes

Prescription Drug Coverage

• Tier-change appeals: use the doctor’s formulary exception requests
• Donut hole discounts: 75% off brand and generic during gap
• GoodRx vs. Medicare: illegal to use coupons, but you can compare cash vs. plan prices

Medicare Advantage vs. Traditional

• Disenroll MA Jan 1–Feb 14, enroll in Part D separately; Medigap may require underwriting.
• MA plan exists in the area: SEP to choose new MA or return to traditional with guaranteed issue rights

Billing & Coverage Issues

• MRI bills: verify provider accepts assignment and medical necessity; call Medicare for claim review
• Prior authorization: standard 14 days, expedited 72 hours
• Late hospital billing: Medicare claims deadline 1 year; providers may bill later

Preventive Care

• Annual Wellness Visit: free if no new issues addressed; otherwise, cost-sharing applies
• Screening mammograms: covered every 12 months for women over 40

Special Situations

• Moving states: traditional Medicare portable; Part D and MA likely require plan changes via SEP
• Dual eligibility: Medicaid covers premiums and cost-sharing; qualifies for SNPs
• Retiree coverage vs. Medicare: compare costs, benefits, and provider networks before deciding

Additional Q&A Highlights

• Formulary updates and pharmacy network confirmation
• Mail-order pharmacy policies and exceptions
• Hospital stay denials: appeal through level 2 independent review
• Filing plan complaints: contact the plan and CMS via Medicare.gov

Rapid-Fire Tips

1. Review coverage annually during Open Enrollment
2. Keep all Medicare communications and Summary Notices
3. Know your plan’s customer service number
4. Confirm pharmacy network participation
5. Explore assistance programs if you struggle with costs

Next Episode Preview: Navigating Medicare after divorce—protecting your coverage and benefits during life transitions.