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 & TimingDelaying Part B with employer coverage (20+ employees): obtain creditable coverage proofPenalties 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 changesPrescription Drug CoverageTier-change appeals: use the doctor’s formulary exception requestsDonut hole discounts: 75% off brand and generic during gapGoodRx vs. Medicare: illegal to use coupons, but you can compare cash vs. plan pricesMedicare Advantage vs. TraditionalDisenroll 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 rightsBilling & Coverage IssuesMRI bills: verify provider accepts assignment and medical necessity; call Medicare for claim reviewPrior authorization: standard 14 days, expedited 72 hoursLate hospital billing: Medicare claims deadline 1 year; providers may bill laterPreventive CareAnnual Wellness Visit: free if no new issues addressed; otherwise, cost-sharing appliesScreening mammograms: covered every 12 months for women over 40Special SituationsMoving states: traditional Medicare portable; Part D and MA likely require plan changes via SEPDual eligibility: Medicaid covers premiums and cost-sharing; qualifies for SNPsRetiree coverage vs. Medicare: compare costs, benefits, and provider networks before decidingAdditional Q&A HighlightsFormulary updates and pharmacy network confirmationMail-order pharmacy policies and exceptionsHospital stay denials: appeal through level 2 independent reviewFiling plan complaints: contact the plan and CMS via Medicare.govRapid-Fire TipsReview coverage annually during Open EnrollmentKeep all Medicare communications and Summary NoticesKnow your plan’s customer service numberConfirm pharmacy network participationExplore assistance programs if you struggle with costsNext Episode Preview: Navigating Medicare after divorce—protecting your coverage and benefits during life transitions.