“Fast Friday Q&A: Expert Answers to Your Top Medicare Questions
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About this listen
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 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
- Keeping Your Doctor
- Original Medicare + Supplement: see any provider accepting Medicare
- MA: must use network doctors except emergencies; verify participation by phone
- 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
- 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
- MA vs. Medigap
- MA: lower premiums, network restrictions, built-in gap coverage
- Medigap: higher premiums, provider freedom, separate Part D required
- Drug Coverage Solutions
- Request formulary exceptions with medical justification
- Pay cash price toward OOP cap if necessary before switching plans
- Plan Change Rules
- MA and Part D: open enrollment only or SEP
- Medigap: change anytime but underwritten after IEP unless guaranteed issue
- Dental & Vision
- Original covers minimal emergency services
- MA plans often include dental and vision extras; evaluate plan specifics
- Appeals & Denials
- Start level-1 redetermination within 60 days of denial; escalate through five levels with stronger documentation
- Working Past 65
- Employer with 20+ employees: delay Part B penalty-free; enroll in Part A at 65; eight-month SEP after coverage ends
- 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
- Doctor & Plan Matching
- Use Physician Compare and office referrals; always verify network status and new-patient openings
- Part D Coverage Gap Update
- As of 2025, Part D donut hole will be eliminated; $2,000 true OOP cap then $0 cost share
- 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.
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