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.Plan Changes & EnrollmentChange plans only during OEP (Jan 1–Mar 31) or OEP/OE (Oct 15–Dec 7); SEPs apply for qualifying events.Medigap vs. Medicare AdvantageCannot combine both; MA replaces Original Medicare (with built-in gap coverage), Medigap supplements itProvider ParticipationNon-participating doctors can charge above approved rates; Original Medicare assignment ensures standard reimbursement.Cost BreakdownPart A is free for most; Part B $185/mo. (2025 base); Part D $15–$100/mo.; MA often has a zero premiumMissed DeadlinesLate penalties are permanent (Part B 10%/year late; Part D penalty based on uncovered months)Benefits ExtrasOriginal covers minimal dental/vision; many MA plans include extras—compare total valueTravel CoverageOriginal Medicare + Medigap works nationwide; MA covers emergencies outside the network only.Doctor & Drug IssuesVerify doctors via phone; request formulary exceptions or switch plans for uncovered medications.Dual EligibilityMedicaid pays premiums and cost-sharing; contact the state office for eligibilityMoving StatesTriggers SEP; research and enroll in new local plans before movingAppeals ProcessFive-level appeals: file within 60 days of denial, gather documentation, enlist provider supportWorking Past 65Employer with 20+ employees allows Part B delay without penalty; verify HR policyCoverage Gap UpdatePart D “donut hole” eliminated as of 2025; $2,000 out-of-pocket cap then $0 cost shareCost AssistanceMedicare 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.