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.

Welcome to Real Easy Medicare’s Fast Friday Q&A with Al Kushner! In this episode, Al delivers rapid-fire solutions to common Medicare dilemmas—no fluff, just straightforward guidance based on 40 years of expertise.

Enrollment

• Missed Part B IEP? Enroll during General Enrollment (Jan 1–Mar 31), coverage begins July 1; 10% penalty per year delayed
• Switch MA to Original Medicare during Jan 1–Mar 31 MA OEP or Oct 15–Dec 7 OEP
• Delay Part B with active employer coverage (20+ employees); retiree plans don’t count

Cost & Coverage

• Zero-premium MA plans may hike deductibles/copays—always review total plan changes
• Part D removal: 60-day SEP to change plans
• Medigap pricing varies by state, age, and plan—shop multiple insurers

Benefits & Services

• Dental: minimal under Original Medicare; some MA plans include limited dental
• Ambulance: covered under Part B with 20% coinsurance after deductible
• Out-of-network doctors: Original Medicare pays approved rates; MA requires network

Plan Changes & Appeals

• Unhappy with MA? Switch during OEP windows; first-year beneficiaries have guaranteed rights
• Medigap changes subject to underwriting post-IEP; birthday-month rule in select states
• Claim denials: request redetermination within 120 days (Original Medicare) or follow MA appeal process

Special Situations

• Moving states: Original Medicare nationwide; MA/Part D requires new plans via SEP
• Dual VA coverage: VA not creditable for Part B delay; take Part A and consider Part B

Final Advice

• Keep personalized Medicare questions coming for future Fast Friday episodes
• Always verify details with 1-800-MEDICARE or consult qualified advisors for complex scenarios

Welcome to Tips & Tricks Thursday on Real Easy Medicare with Al Kushner! In this rapid-fire episode, Al shares practical shortcuts and insider hacks to streamline your Medicare experience and avoid common hassles.

1. Research Efficiency
   • Enter all medications into Medicare Plan Finder for accurate cost comparisons
   • Call provider offices directly to confirm current plan participation
2. Money-Saving Moves
   • Use mail-order for 90-day Part D supplies to get 3 months for the price of 2
   • Apply for Extra Help online at SSA.gov if income limits qualify
3. Navigation Shortcuts
   • Call 1-800-MEDICARE early or late for shorter hold times
   • Find unbiased guidance through your state’s SHIP counseling program
4. Enrollment & Coverage Tricks
   • Trigger SEPs by moving ZIP codes to escape unwanted MA or Part D plans
   • Leverage 12-month MA trial rights to switch back to Original Medicare
5. Provider & Hospital Tactics
   • Seek emergency care at the nearest hospital—MA plans must cover true emergencies out-of-network
   • Request peer-to-peer reviews on denials for higher approval rates
6. Tech Tools
   • Download the official Medicare app for real-time claims and benefits info
   • Keep an up-to-date medication list on your phone for faster pharmacy and plan reviews
7. Problem Fixes
   • Initiate written redeterminations to start formal appeals on denied claims
   • Identify qualifying events for SEPs if you make a regrettable plan choice

Next Episode Preview: Fast Friday Q&A—send your Medicare questions for rapid, expert answers in a dedicated Q&A format.

Welcome to Real Easy Medicare’s Wisdom Wednesday with Al Kushner! In this expert-level episode, Al reveals advanced strategies and hidden rules that only decades of Medicare experience can teach.

1. Medigap Guaranteed Rights
   • 63-day guaranteed Medigap enrollment after losing creditable coverage, even years later
   • “Trial right” to test Medicare Advantage for 12 months with risk-free return to Original Medicare
2. State-Specific Protections
   • California’s Birthday Rule: annual Medigap plan changes without underwriting during your birth month
3. Advanced Part D Tactics
   • Delay Part D penalty-free with creditable drug coverage from employers, unions, VA, or state programs
   • Leverage the new actual out-of-pocket cap ($2,000) and adjust the timing of high-cost medications.
4. Plan Switching Windows
   • Part D changes only from Oct. 15 to Dec. 7 OEP; MA-to-MA Open Enrollment Jan. 1–Mar. 31
   • SEP rights when providers leave MA networks and star-rating enrollment escape routes
5. Premium Suspension & Coordination
   • Suspend Part B when returning to employer coverage to avoid unnecessary premiums.
   • Coordinate spousal enrollment timing for strategic advantage
6. Cost-Management Strategies
   • Use HSA funds tax-free for Part B, Part D, and Medigap premiums
   • Stack state assistance programs (QMB, SLMB, QI) with federal benefits for maximum cost savings
7. Prevent “Research Paralysis”
   • Begin planning research early, but finalize your choices in time to meet enrollment deadlines.
   • Focus on the total cost of care, not just the lowest premiums
   • Schedule annual reviews to avoid the “set-and-forget” mistake

Following Episode Preview: Tips & Tricks Thursday—bite-sized, practical Medicare shortcuts and resources you can apply immediately.

Welcome to Real Easy Medicare’s True Story Tuesday with Al Kushner! In today’s episode, Al shares five authentic beneficiary experiences—each illustrating crucial lessons about choosing and managing Medicare coverage.

1. Mary’s Advantage Trap (Ohio)
   • Opted for a zero-premium Medicare Advantage plan at 65
   • Plan didn’t cover her rheumatoid arthritis medication
   • Missed Medigap Open Enrollment, faced underwriting and higher premiums
2. Robert’s $200/Month Savings (Arizona)
   • Stuck in an expensive Part D plan with Original Medicare + Medigap
   • Used Medicare.gov Plan Finder to switch to a lower-cost prescription plan
   • Reduced annual drug spend from $4,800 to $2,400
3. Linda’s Enrollment Penalty (Undisclosed)
   • Delayed Part B after losing spousal employer coverage
   • Missed the 8-month SEP, incurred a permanent 10% premium penalty and coverage gap
4. James’s Flexibility Strategy (Florida)
   • Enrolled in Part B, Medigap Plan G, and a backup Medicare Advantage plan
   • Kept Medigap active to retain guaranteed issue rights when switching back
5. Patricia’s Advantage Success (Texas)
   • Verified provider network and prescription formulary before enrolling
   • Enjoys low costs and extra benefits (dental, vision) two years in

Key Takeaways:

• No one-size-fits-all solution—evaluate total costs, not just premiums
• Timing and deadlines are critical for enrollment and plan switching
• Annual coverage reviews can uncover significant savings
• Guaranteed issue rights preserve your flexibility

Next Up: Wisdom Wednesday—advanced strategies and insider insights from Al’s 40-year Medicare career.

Welcome to Mistake Monday on Real Easy Medicare with Al Kushner! In this episode, Al uncovers one of the most expensive errors seniors make: postponing Medicare Part B without creditable coverage.

1. Creditable Coverage Defined
   • Works: employer-sponsored insurance (you or spouse) from companies with 20+ employees
   • Doesn’t count: individual market plans, ACA marketplace, short-term policies, COBRA (<20 employees), most retiree plans, VA benefits
2. Penalty Details
   • 10% premium increase for each 12-month gap, permanent
   • 2025 base premium $185/month; two-year delay → $222/month (+$444/year); five-year delay → $278/month (+$1,116/year)
3. Real-Life Examples
   • Mark’s individual plan delay led to a 20% penalty
   • David’s ACA delay also triggered a 20% lifetime surcharge
4. Prevention Strategies
   • When in doubt, enroll in Part B during your Initial Enrollment Period
   • Obtain written proof of creditable coverage
   • If coverage ends, use your 8-month Special Enrollment Period

Next Up: True Story Tuesday—real beneficiary tales about unexpected Medicare traps and savings opportunities.