Welcome back to Wisdom Wednesday on Real Easy Medicare with Al Kushner! In this episode, Al unveils advanced insights from four decades of Medicare experience, empowering you to make strategic, cost-saving decisions.

1. Prepare for Catastrophic Costs
   • Medicare’s 80/20 split leaves unlimited 20% liability—plan for out-of-pocket caps or supplemental coverage to avoid financial devastation
2. Network Paradox
   • Larger provider networks don’t guarantee better specialist access—evaluate local depth of specialists, not statewide breadth
3. Formulary Forecasting
   • Anticipate future medication needs (e.g., insulin pumps, new cardiac drugs) when selecting Part D plans to avoid mid-year disruptions
4. Optimal Medigap Timing
   • If healthy at 65, secure Medigap coverage immediately for long-term protection; if not, use the six-month open enrollment wisely
5. Avoid the Premium Trap
   • Low monthly premiums often mean higher deductibles and copays—assess total cost of ownership, not just premiums
6. Provider Relationship Strategy
   • Consult doctors before enrolling to learn which plans they support and which impose burdensome prior authorization processes
7. Enrollment Window Intelligence
   • Medicare Advantage OEP (Jan 1–Mar 31) provides a second chance to adjust plans after initial Open Enrollment
8. Robust Documentation System
   • Maintain a dedicated Medicare binder to track cards, correspondence, and annual plan changes for audits and appeals
9. Appeal Advantage
   • High success rates for properly supported appeals—leverage medical documentation and billing corrections to overturn denials
10. Long-Term Perspective
    • Plan beyond the next 12 months; account for health changes, income-related premium surcharges, and rising healthcare costs

Next Episode Preview: Tips & Tricks Thursday—actionable hacks and shortcuts to simplify Medicare management and save you time and money.

Welcome to True Story Tuesday on Real Easy Medicare with Al Kushner! In this episode, Al shares six authentic beneficiary stories that highlight critical Medicare insights and how informed actions make all the difference.

1. Retiree Insurance Trap
   • Martha delayed Part B, relying on retiree coverage, faced a 30% lifetime penalty and gaps because retiree plans aren’t creditable
2. Zero-Premium Surprise
   • Robert’s MA plan had no premium but high copays, network limits, and delays for surgery—total costs far exceeded Medigap alternatives
3. Part D Penalty Problem
   • Susan skipped Part D when healthy, and later incurred a $12/month penalty for life upon needing diabetes meds.
4. Medigap Timing Mistake
   • David waited five years to switch from MA to Original Medicare, was medically underwritten and denied due to preexisting conditions.
5. Network Surprise
   • Linda lost her in-network doctor mid-year and had only 30 days to find a new one, illustrating how MA networks can change unpredictably.
6. Documentation Victory
   • Frank spotted $2,400 in fraudulent charges on his Medicare Summary Notice, reported them, and got full reimbursement after investigatio.n
7. Move That Worked
   • Carol leveraged her SEP to transition MA plans seamlessly when relocating from Florida to Ohio
8. Wellness Visit Discovery
   • Tom’s first free Annual Wellness Visit at 72 uncovered atrial fibrillation—preventing a potential stroke
9. Successful Appeal
   • Nancy appealed an $8,000 cardiac procedure denial with medical documentation and won approval.
10. Coordination Success
    • Bill and his spouse Sarah, coordinated primary/secondary benefits effectively during cancer treatment, avoiding billing conflicts

Key Takeaways:

• Verify creditable coverage before delaying enrollment
• Evaluate total plan costs, not just premiums
• Use SEPs and annual wellness visits proactively
• Keep detailed records to spot and correct errors
• Appeal denials with thorough documentation

Next Episode Preview: Wisdom Wednesday—advanced insider strategies to maximize Medicare benefits and avoid pitfalls.

Welcome to Mistake Monday on Real Easy Medicare with Al Kushner! In this episode, Al highlights the most common—and costly—Medicare mistakes from 40 years of experience, plus actionable prevention strategies.

Enrollment Errors

• Assuming automatic Medicare enrollment at 65 (you must actively enroll unless receiving Social Security)
• Delaying Part B with retiree insurance (not creditable; only active employer coverage, 20+ employees qualify)
• Skipping Part D when healthy (penalties apply for life when you eventually need coverage)

Plan Selection Blunders

• Choosing Medicare Advantage solely on zero premiums (check deductibles, networks, and total costs)
• Picking Medigap Plan F when Plan G offers similar coverage at lower cost
• Failing to review Part D plans annually (formularies and costs change yearly)

Coverage Misconceptions

• Expecting Medicare to cover long-term custodial care (only limited skilled nursing post-hospitalization)
• Assuming all doctors accept Medicare (verify provider participation before appointments)
• Misunderstanding MA network restrictions (referrals required; out-of-network penalties vs. Original Medicare's flexibility)

Timing Traps

• Missing Medicare Advantage Open Enrollment windows (stuck until next OEP without qualifying SEP)
• Waiting until illness to pursue Medigap (6-month guarantee period bypasses health questions)
• Ignoring 60-day Special Enrollment Period deadlines

Documentation & Communication Oversights

• Discarding Medicare correspondence and Summary Notices (essential for tracking and error detection)
• Falling for Medicare fraud calls (never give personal info to unsolicited callers)
• Not reporting fraudulent charges (protect yourself and the system)

Financial Missteps

• Underbudgeting for Medicare's premiums, deductibles, and cost-sharing
• Paying unnecessary Part B penalties when creditable coverage applied
• Ignoring free preventive benefits like Annual Wellness Visits

Prevention Tips:

• Research early using official sources (Medicare.gov, 1-800-MEDICARE)
• Seek unbiased education without sales pressure
• Ask questions until you fully understand your options

Next Episode Preview: True Story Tuesday—real beneficiary experiences showing Medicare successes and challenges in practice.