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

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.