Fast Friday Q&A: Swift Solutions to Your Top Medicare Concerns

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.