“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.Coverage Start DatesPart A/B begin the first day of your 65th birthday month (or prior month if born on the 1st) when enrolled during IEPMA and Part D plans start January 1 during open enrollment; SEP start dates varyKeeping Your DoctorOriginal Medicare + Supplement: see any provider accepting MedicareMA: must use network doctors except emergencies; verify participation by phoneMissed Enrollment WindowsLocked into MA until next OEP (Oct. 15–Dec. 7) unless qualifying SEP; MA OEP (Jan. 1–Mar. 31) allows one changeCost BreakdownPart B: $185/month base premium (2025), $257 annual deductiblePart A: free with 40 work quartersPart D: $15–$100/monthMedigap: $50–$300/month depending on plan and locationMA vs. MedigapMA: lower premiums, network restrictions, built-in gap coverageMedigap: higher premiums, provider freedom, separate Part D requiredDrug Coverage SolutionsRequest formulary exceptions with medical justificationPay cash price toward OOP cap if necessary before switching plansPlan Change RulesMA and Part D: open enrollment only or SEPMedigap: change anytime but underwritten after IEP unless guaranteed issueDental & VisionOriginal covers minimal emergency servicesMA plans often include dental and vision extras; evaluate plan specificsAppeals & DenialsStart level-1 redetermination within 60 days of denial; escalate through five levels with stronger documentationWorking Past 65Employer with 20+ employees: delay Part B penalty-free; enroll in Part A at 65; eight-month SEP after coverage endsTravel & RelocationOriginal Medicare portable nationwide; MA covers emergencies out-of-network onlyMoving triggers SEP for MA/Part D; Medigap guaranteed issue may applyDoctor & Plan MatchingUse Physician Compare and office referrals; always verify network status and new-patient openingsPart D Coverage Gap UpdateAs of 2025, Part D donut hole will be eliminated; $2,000 true OOP cap then $0 cost shareCost Assistance ProgramsMedicare Savings Programs and Extra Help for low-income beneficiariesSHIP offers free state counselingNext Week Preview: A weeklong series on solving Medicare problems—from enrollment hurdles and billing errors to network disputes and prescription challenges.