The Medicare Archive: Audiobooks & Expert Guides.

*/ ?>

Latest Episodes:

The $50,000 Mistake: Why Waiting Too Long to Enroll in Medicare Can Haunt You Forever Aug 25, 2025

Welcome to the inaugural episode of Real Easy Medicare with Al Kushner! If you've ever felt overwhelmed by Medicare paperwork and confusing jargon, you're not alone. In this foundational episode, Al tackles the biggest and most costly Medicare mistake of all: waiting too long to enroll.

What You'll Learn:

Margaret's Story: How a retired teacher's delayed Part B enrollment led to permanent monthly penalties
James's Dilemma: Why employer coverage doesn't always equal Medicare-creditable coverage
The Part D Trap: How skipping prescription drug coverage can cost you thousands, even if you're healthy
Hidden Scenarios: Lesser-known situations that catch people off-guard, including overseas retirement, military TRICARE coordination, and spousal age differences

Key Takeaways:

Enroll on time - Medicare penalties are permanent and expensive
Verify creditable coverage - Don't assume your employer plan qualifies
Never skip Part D - Future you will thank present you for enrolling in prescription coverage
Dual eligibility requires management - Having both Medicare and Medicaid doesn't mean automatic coordination
Get professional help - Don't rely solely on word-of-mouth advice

Resources Mentioned:

Medicare.gov Plan Finder tool
State Health Insurance Assistance Programs (SHIP) at shiphelp.org
Free community seminars at libraries and senior centers
Al's book: "Virtual Medicare: 10 Costly Mistakes You Can't Afford to Make"

Next Episode Preview: A jaw-dropping story about a family blindsided by a $50,000 hospital bill and how to protect yourself from financial disaster.

The $50,000 Hospital Bill: How Medicare's 'Observation Status' Trap Devastated the Harrison Family Aug 26, 2025

Welcome back to Real Easy Medicare with Al Kushner! In today's episode, Al delivers on his promise from Episode 1 by sharing the jaw-dropping story of Tom and Linda Harrison, a retired mechanic and librarian who ended up with a $47,832 hospital bill despite having Medicare and a supplement plan.

The Harrison Family Story

Tom Harrison, a 38-year veteran mechanic, did everything right with Medicare enrollment. When chest pains landed him in the hospital for three days and nights, he and his wife Linda assumed Medicare Part A would cover the stay. They were devastatingly wrong.

The Observation Status Trap

The difference between being "admitted" as an inpatient versus being held under "observation" as an outpatient can cost you tens of thousands of dollars. Tom received the same care—same bed, same nurses, same monitoring—but was classified as outpatient observation, which falls under Medicare Part B with dramatically different coverage.

Key Lessons for Protection:

Always ask your status when arriving at the hospital—inpatient or observation?
Understand that your status can change during your stay, but hospitals won't always make the switch automatically.
Ask about financial impact upfront—don't wait for the bill to arrive
Don't be afraid to push back if your doctor thinks you should be admitted
Know the skilled nursing trap—Medicare only covers skilled nursing after 3 consecutive inpatient days (observation doesn't count)

The Aftermath

After months of appeals and negotiations, the Harrisons reduced their bill to $28,000 but are still paying it off three years later. The financial stress fundamentally changed their retirement plans.

Special Announcement: Tomorrow launches "Wisdom Wednesday"—a new weekly segment featuring advanced Medicare strategies from Al's 40 years of experience.

Book Mention: Al's gold medal-winning book "Virtual Medicare: 10 Costly Mistakes You Can't Afford to Make" has helped over 100,000 readers navigate Medicare successfully.

Advanced Medicare Strategies You Never Knew You Needed Aug 27, 2025

Welcome back to Real Easy Medicare with Al Kushner! In this special Wisdom Wednesday episode, Al draws on forty years of expertise to share insider tactics and lesser-known tips that can transform your Medicare experience from merely surviving to truly thriving.

Strategic Plan Switching
- Shop every year during Annual Open Enrollment (Oct. 15–Dec. 7)
- Compare Maximum Out-of-Pocket (MOOP) limits, not just premiums and deductibles
Hidden Medigap Enrollment Rights
- Guaranteed issue periods when retiree coverage ends or you move out of plan service areas
- Act promptly to avoid medical underwriting
Network Realities in Medicare Advantage
- “Acceptance” doesn’t guarantee availability—call providers to confirm they’re taking new patients
- Specialist access can be particularly limited
Part D Formulary Vigilance
- Research a plan’s history of formulary changes
- Use appeals and exception requests to lower drug tier costs
Dual Eligibility Maximization
- Leverage Special Needs Plans (SNPs) for extra benefits
- Understand Medicare-first vs. Medicaid-first payment rules
Appeals and Reviews Unveiled
- Level 1 redetermination vs. Level 2 independent review—don’t stop after the first denial
- Expedite reviews for medically necessary services in Medicare Advantage
Coordination with Social Security
- Align Part B enrollment with Social Security claiming strategy to optimize benefits
Skilled vs. Custodial Care
- Document medical necessity to qualify for covered skilled services in long-term care settings
Technology Tools
- Use Medicare.gov Plan Finder for network, mail-order, and coverage-gap insights
- Track claims and plan changes via MyMedicare.gov
Employer Coverage Nuances
- For companies with 20+ employees, employer plans may pay first even after age 65
- Get payment-order agreements in writing
State Assistance Programs
- SHIP counseling, pharmaceutical assistance, and Medicare Savings Programs with higher income limits
Annual Medicare Checkup Ritual
- Conduct a full benefits review every November with your healthcare, legal, and tax advisors

Throwback Thursday: The Evolution of Medicare—From 1965 to Today Aug 28, 2025

Welcome to Real Easy Medicare with Al Kushner! In this Throwback Thursday episode, Al journeys through six decades of Medicare history to explain how past legislation shaped today’s system—and why those origins still matter for your coverage.

1965 Birth of Medicare
- Johnson signs the original law; Truman is beneficiary #1
- Part A & Part B only; $3 Part B premium (~$25 today)
1972 Disability & ESRD Expansion
- Coverage for permanent disabilities and end-stage renal disease
- 24-month Social Security Disability waiting period
1992 Medigap Standardization
- Introduction of Lettered Plans A–J for consistent benefits
- 2020 discontinuation of Plans C & F for new enrollees
1997 Balanced Budget Act
- Birth of Medicare Advantage (Medicare Plus Choice)
- Early struggles paved the way for today’s MA plans covering over half of beneficiaries
2003 Medicare Modernization Act (Part D)
- Creation of outpatient prescription drug coverage
- Initial rollout chaos; eventual elimination of the “donut hole” in 2020
2008 MIPPA
- Required observation-status notice within 24 hours
- Expansion of Medicare Savings Programs
2010 Affordable Care Act
- Preventive services at no cost; Annual Wellness Visits
- Growth of Accountable Care Organizations
Recent Reforms (2018–2024)
- Chronic care management codes; telehealth expansion
- 2025 cap on Part D out-of-pocket costs; drug-price negotiations

Why History Matters: Each addition—Parts A through D, Medigap standardization, MA creation—was a targeted fix layered onto an evolving system. Knowing this helps you navigate today’s rules, deadlines, and plan options with confidence.

Next Up: Fast Friday Q&A—rapid-fire answers to listener questions about enrollment deadlines, prescription coverage, and billing surprises.

Fast Friday Q&A: 20 Rapid-Fire Medicare Answers You Need Now Aug 29, 2025

Welcome to Real Easy Medicare’s first Fast Friday Q&A with Al Kushner! In this episode, Al tackles 20 real listener questions with quick, actionable advice—no long stories, just straightforward answers to the Medicare issues keeping you up at night.

Enrollment & Timing

Delaying Part B with employer coverage (20+ employees): obtain creditable coverage proof
Penalties for missing IEP: 10% per year. Enroll between Jan 1 and Mar 31 for July 1 coverage.
Spousal death: report to SSA, explore SEP for Advantage or employer coverage changes

Prescription Drug Coverage

Tier-change appeals: use the doctor’s formulary exception requests
Donut hole discounts: 75% off brand and generic during gap
GoodRx vs. Medicare: illegal to use coupons, but you can compare cash vs. plan prices

Medicare Advantage vs. Traditional

Disenroll MA Jan 1–Feb 14, enroll in Part D separately; Medigap may require underwriting.
MA plan exists in the area: SEP to choose new MA or return to traditional with guaranteed issue rights

Billing & Coverage Issues

MRI bills: verify provider accepts assignment and medical necessity; call Medicare for claim review
Prior authorization: standard 14 days, expedited 72 hours
Late hospital billing: Medicare claims deadline 1 year; providers may bill later

Preventive Care

Annual Wellness Visit: free if no new issues addressed; otherwise, cost-sharing applies
Screening mammograms: covered every 12 months for women over 40

Special Situations

Moving states: traditional Medicare portable; Part D and MA likely require plan changes via SEP
Dual eligibility: Medicaid covers premiums and cost-sharing; qualifies for SNPs
Retiree coverage vs. Medicare: compare costs, benefits, and provider networks before deciding

Additional Q&A Highlights

Formulary updates and pharmacy network confirmation
Mail-order pharmacy policies and exceptions
Hospital stay denials: appeal through level 2 independent review
Filing plan complaints: contact the plan and CMS via Medicare.gov

Rapid-Fire Tips

Review coverage annually during Open Enrollment
Keep all Medicare communications and Summary Notices
Know your plan’s customer service number
Confirm pharmacy network participation
Explore assistance programs if you struggle with costs

Next Episode Preview: Navigating Medicare after divorce—protecting your coverage and benefits during life transitions.

“Mistake Monday: Don’t Delay Part B—Avoid Costly Late Enrollment Penalties” Sep 01, 2025

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.

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
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)
Real-Life Examples
- Mark’s individual plan delay led to a 20% penalty
- David’s ACA delay also triggered a 20% lifetime surcharge
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.

True Story Tuesday: Real Medicare Wins and Pitfalls from Five Beneficiaries Sep 02, 2025

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.

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
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
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
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
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.

Wisdom Wednesday: Insider Medicare Secrets from 40 Years of Experience Sep 03, 2025

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.

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
State-Specific Protections
- California’s Birthday Rule: annual Medigap plan changes without underwriting during your birth month
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.
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
Premium Suspension & Coordination
- Suspend Part B when returning to employer coverage to avoid unnecessary premiums.
- Coordinate spousal enrollment timing for strategic advantage
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
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.

Tips & Tricks Thursday: Quick Medicare Shortcuts to Save Time and Money” Sep 04, 2025

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.

Research Efficiency
- Enter all medications into Medicare Plan Finder for accurate cost comparisons
- Call provider offices directly to confirm current plan participation
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
Navigation Shortcuts
- Call 1-800-MEDICARE early or late for shorter hold times
- Find unbiased guidance through your state’s SHIP counseling program
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
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
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
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.

Fast Friday Q&A: Clear Answers to Your Top 20 Medicare Questions Sep 05, 2025

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

Mistake Monday: The Top 15 Preventable Medicare Errors That Cost Thousands Sep 08, 2025

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.

True Story Tuesday: Real-Life Medicare Lessons from Six Beneficiaries Sep 09, 2025

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.

Retiree Insurance Trap
- Martha delayed Part B, relying on retiree coverage, faced a 30% lifetime penalty and gaps because retiree plans aren’t creditable
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
Part D Penalty Problem
- Susan skipped Part D when healthy, and later incurred a $12/month penalty for life upon needing diabetes meds.
Medigap Timing Mistake
- David waited five years to switch from MA to Original Medicare, was medically underwritten and denied due to preexisting conditions.
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.
Documentation Victory
- Frank spotted $2,400 in fraudulent charges on his Medicare Summary Notice, reported them, and got full reimbursement after investigatio.n
Move That Worked
- Carol leveraged her SEP to transition MA plans seamlessly when relocating from Florida to Ohio
Wellness Visit Discovery
- Tom’s first free Annual Wellness Visit at 72 uncovered atrial fibrillation—preventing a potential stroke
Successful Appeal
- Nancy appealed an $8,000 cardiac procedure denial with medical documentation and won approval.
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.

Wisdom Wednesday: Mastering Medicare with Expert-Level Strategies Sep 10, 2025

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.

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
Network Paradox
- Larger provider networks don’t guarantee better specialist access—evaluate local depth of specialists, not statewide breadth
Formulary Forecasting
- Anticipate future medication needs (e.g., insulin pumps, new cardiac drugs) when selecting Part D plans to avoid mid-year disruptions
Optimal Medigap Timing
- If healthy at 65, secure Medigap coverage immediately for long-term protection; if not, use the six-month open enrollment wisely
Avoid the Premium Trap
- Low monthly premiums often mean higher deductibles and copays—assess total cost of ownership, not just premiums
Provider Relationship Strategy
- Consult doctors before enrolling to learn which plans they support and which impose burdensome prior authorization processes
Enrollment Window Intelligence
- Medicare Advantage OEP (Jan 1–Mar 31) provides a second chance to adjust plans after initial Open Enrollment
Robust Documentation System
- Maintain a dedicated Medicare binder to track cards, correspondence, and annual plan changes for audits and appeals
Appeal Advantage
- High success rates for properly supported appeals—leverage medical documentation and billing corrections to overturn denials
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.

Tips & Tricks Thursday: 18 Practical Hacks to Simplify Your Medicare Journey Sep 11, 2025

Welcome to Tips & Tricks Thursday on Real Easy Medicare with Al Kushner! In this episode, Al delivers 18 immediately actionable strategies to streamline your Medicare experience and protect your health and wallet.

Medicare Card Protection
- Carry photocopies or phone photos, not your original card
Provider Directory Double-Check
- Call offices to confirm plan acceptance and new-patient status
Annual Wellness Visit Timing
- Schedule early in the year; a visit doesn’t count toward your deductible
Part D Out-of-Pocket Cap
- Track spending toward the $2,000 true out-of-pocket limit; gap eliminated
Summary Notice Review
- Compare dates, services, and providers; report billing errors promptly
Appeal Timeline Mastery
- File within 60 days of the notice date; use certified mail and keep copies
Prescription Transfer Strategy
- Move scripts to preferred pharmacy and fill 90-day supplies before Jan 1
Emergency Room Approach
- Present all insurance cards; notify MA plans within 48 hours
Specialist Referral Rules
- Keep written referrals for MA; Original Medicare requires none
Preventive Service Maximization
- Use all covered screenings (mammograms, colonoscopies, etc.) at no cost
Network Exception Requests
- Appeal for out-of-network care when in-network access is inadequate
Open Enrollment Preparation
- Start comparing plans in September; list doctors and drugs first
Medigap Shopping Secret
- If denied, try different insurers—underwriting standards vary
Part B Premium Reduction
- File SSA-44 when income drops post-retirement to lower premiums
Travel Preparation
- Verify MA coverage areas; carry Medigap and supplemental cards for Original Medicare
Customer Service Strategy
- Call off-peak, record representative names and reference numbers
Fraud Protection
- Never share your number with unsolicited callers; report scams to 1-800-MEDICARE
Technology Optimization
- Set up Medicare.gov and plan portals; use mobile apps for real-time info

Next Episode Preview: Fast Friday Q&A—send your Medicare questions for swift expert answers and join our Facebook community “Social Security Retirement and Medicare Q and A” for ongoing peer support.

Fast Friday Q&A: Swift Solutions to Your Top Medicare Concerns Sep 12, 2025

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 & Enrollment
- Change plans only during OEP (Jan 1–Mar 31) or OEP/OE (Oct 15–Dec 7); SEPs apply for qualifying events.
Medigap vs. Medicare Advantage
- Cannot combine both; MA replaces Original Medicare (with built-in gap coverage), Medigap supplements it
Provider Participation
- Non-participating doctors can charge above approved rates; Original Medicare assignment ensures standard reimbursement.
Cost Breakdown
- Part A is free for most; Part B $185/mo. (2025 base); Part D $15–$100/mo.; MA often has a zero premium
Missed Deadlines
- Late penalties are permanent (Part B 10%/year late; Part D penalty based on uncovered months)
Benefits Extras
- Original covers minimal dental/vision; many MA plans include extras—compare total value
Travel Coverage
- Original Medicare + Medigap works nationwide; MA covers emergencies outside the network only.
Doctor & Drug Issues
- Verify doctors via phone; request formulary exceptions or switch plans for uncovered medications.
Dual Eligibility
- Medicaid pays premiums and cost-sharing; contact the state office for eligibility
Moving States
- Triggers SEP; research and enroll in new local plans before moving
Appeals Process
- Five-level appeals: file within 60 days of denial, gather documentation, enlist provider support
Working Past 65
- Employer with 20+ employees allows Part B delay without penalty; verify HR policy
Coverage Gap Update
- Part D “donut hole” eliminated as of 2025; $2,000 out-of-pocket cap then $0 cost share
Cost Assistance
- Medicare 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.

Mistake Monday: The Million-Dollar Medicare Gaps You Can’t Afford” Sep 15, 2025

In this Mistake Monday episode, Al Kushner exposes the most devastating Medicare error: failing to protect against unlimited out-of-pocket costs. Learn why Original Medicare alone leaves you financially vulnerable and how to secure comprehensive coverage.

The 80/20 Catastrophe
- Medicare pays 80%; you’re responsible for the remaining 20% with no annual cap
- Robert’s $180,000 claim left him $36,000 short
Hidden Deductibles & Daily Charges
- Part A deductible $1,676 per benefit period; $419/day after 60 days; $838/day after 90 days
- Part B deductible $257, then 20% coinsurance on every service
Real-World Impact
- Sarah’s $300,000 cancer treatment resulted in $60,000 owed
- Thousands sell assets or face bankruptcy due to unexpected medical bills
Two Protective Solutions
- Medigap Supplement: predictable premiums (~$150/mo.) and near-zero coinsurance (Plan G covers all but the Part B deductible)
- Medicare Advantage: low premiums, annual out-of-pocket caps ($3,000–$8,000) for total cost control
Enrollment Urgency
- Six-month Medigap open enrollment window guarantees acceptance; missing it risks denial or high rates.
- Medicare Advantage requires enrollment during designated periods
Cost vs. Risk Analysis
- Compare annual premiums (Medigap $1,800 vs. MA $3,000, including max exposure) against potential unlimited Original Medicare liability.
- Recognize insurance’s purpose: protection from rare but catastrophic events.s
Action Steps
- Calculate your financial exposure under Original Medicare alone
- Compare supplemental policy and MA plan costs and out-of-pocket limits
- Enroll promptly in the option that aligns with your risk tolerance

Next Episode Preview: True Story Tuesday—real beneficiary experiences showing how informed choices avert costly Medicare mistakes.

True Story Tuesday: Real Medicare Missteps and Lifelong Lessons Sep 16, 2025

Welcome to True Story Tuesday on Real Easy Medicare with Al Kushner! In this episode, Al shares seven authentic beneficiary stories that illustrate how seemingly small decisions can lead to lasting consequences—and how to avoid them.

Margaret’s Late Enrollment Disaster
- Missed Part B IEP, went uninsured for four months after a broken hip, incurred $80,000 out-of-pocket costs and a permanent 10% penalty
Robert’s Zero-Premium Trap
- Chose MA for zero premium, faced network limitations, high copays, and a $7,800 out-of-pocket maximum during heart care
James’s Medigap Timing Error
- Delayed Medigap beyond his six-month window, was medically underwritten and denied coverage after a cancer diagnosis
Susan’s Network Nightmare
- Lost in-network doctor mid-year and surgeon out of network, resulting in $15,000 surprise bills
Paul’s SEP Confusion
- Worked past 65, missed the 8-month SEP after retirement, incurred permanent Part B and Part D penalties, and limited Medigap options
Dorothy’s Dual Coverage Mistake
- Enrolled in Part B unnecessarily while on employer insurance, paid duplicate premiums for eight months
William’s Benefit Illusion
- MA dental and vision benefits fell short of actual needs, and high medical copays led to higher total costs than a Medigap plan

Key Takeaways:

Enroll within IEP and SEP windows to avoid penalties
Evaluate total plan costs, networks, and benefits beyond premiums
Understand guaranteed issue periods for supplemental coverage
Recognize that MA networks and benefits can change unpredictably

Next Episode Preview: Wisdom Wednesday—uncover advanced strategies and insider insights from Al’s four decades of Medicare expertise.

Wisdom Wednesday: Insider Medicare Tactics You Won’t Learn Anywhere Else Sep 17, 2025

Welcome to Wisdom Wednesday on Real Easy Medicare with Al Kushner! Drawing on four decades of experience, Al reveals elite-level strategies to optimize your Medicare coverage and reduce costs.

Hidden 90-Day Benefit Period
- A single benefit period spans multiple hospital or SNF stays within 60 days, avoiding repeated $1,632 Part A deductibles; track your 60 lifetime reserve days carefully
Medicare Secondary Payer Techniques
- Strategically choose when employer or indemnity insurance pays first to minimize out-of-pocket; stack accident, critical illness, or hospital indemnity policies
Medigap Birthday Rule Exploits
- In states like California and Oregon, switch Medigap plans annually during your birth month without underwriting; intra-company switches may apply elsewhere
Network Quality over Quantity
- Evaluate local specialist depth rather than total network size; identify responsive providers by calling offices about appointment availability
True Out-of-Pocket Cap Insight
- The $2,000 Part D true out-of-pocket cap replaces the donut hole; timing high-cost drug purchases no longer accelerates a gap
Appeal Success Path
- Appeals win rates climb from 20% at level 1 to 60% at ALJ level; persistence and thorough documentation are critical
Social Security–Medicare Synergy
- Coordinate premium deductions, assistance programs (QMB, SLMB, QI), and optimal enrollment timing for tax and cost advantages
HSA Continuation Strategy
- Delay Part A enrollment under HSA-qualified employer coverage to maintain tax-free HSA contributions post-65; requires pre-65 planning
Geographic Cost Planning
- Compare Medicare Advantage and Medigap rates across ZIP codes before relocating; retirement location can double or halve premiums
Critical Enrollment Timing
- Medigap’s six-month guaranteed issue window versus MA’s annual OEP and SEPs; missing these windows locks in coverage

Next Episode Preview: Tips & Tricks Thursday—actionable hacks and shortcuts you can implement immediately to streamline your Medicare journey.

Tips & Tricks Thursday: 19 Proven Hacks to Optimize Your Medicare Experience Sep 18, 2025

Welcome to Tips & Tricks Thursday on Real Easy Medicare with Al Kushner! In this episode, Al delivers 19 actionable strategies to streamline your Medicare journey, reduce costs, and safeguard your benefits.

Medicare Card Protection Trick
- Carry copies or phone photos of your card; keep the original safe at home; annotate emergency contacts on copies
Provider Network Research Trick
- Call doctor offices to ask about prior authorization delays, denial rates, and new-patient policies—not just network inclusion
Part D Pharmacy Shopping Trick
- Identify preferred pharmacies for lower copays; compare local versus mail-order pricing for each medication
Medigap Shopping Trick
- Solicit quotes from at least five insurers for identical Plan F coverage; evaluate rate increase histories and household discounts
Claims Tracking Trick
- Maintain a spreadsheet of services and compare against Medicare Summary Notices; set up a Medicare.gov account for real-time monitoring
Emergency Preparation Trick
- Assemble and update tri-location emergency folders containing card copies, medication lists, and provider contacts
Annual Review Trick
- Begin plan comparisons in September; list providers and prescriptions first, then calculate total annual costs
Provider Communication Trick
- Confirm Medicare assignment, request cost estimates before procedures, and obtain copies of all test results
Prescription Money-Saving Trick
- Ask pharmacists about generics, manufacturer discounts, pill splitting, and 90-day supply savings
MA Extra Benefits Trick
- Maximize gym, dental, vision, OTC, and transportation benefits by scheduling early and reviewing benefit catalogs
Appeal Process Trick
- Document all interactions, request written denial explanations, use certified mail, and escalate to supervisors as needed
Customer Service Strategy
- Call during off-peak hours, note representative names and reference numbers, and persist politely
Open Enrollment Preparation
- Research plan changes before October, focusing on network shifts and formulary updates
Medicare Advantage Escape Hatch
- Use MA’s Jan 1–Mar 31 Open Enrollment to switch plans or revert to Original Medicare if dissatisfied
SEP Trigger Awareness
- Recognize moving ZIP codes, losing coverage, or provider exits as SEPs to change MA or Part D plans off-cycle
Technology Optimization
- Utilize Medicare.gov and plan mobile apps for claims tracking, provider searches, and instant benefit checks
Fraud Protection
- Never share your Medicare number with unsolicited callers; report scams immediately to 1-800-MEDICARE
Medigap Underwriting Tip
- If denied coverage, apply to different insurers—underwriting criteria vary significantly between companies

“Fast Friday Q&A: Expert Answers to Your Top Medicare Questions Sep 19, 2025

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.

Our TOPPODCAST Picks

Follow Us

Stay Connected

The Medicare Archive: Audiobooks & Expert Guides.

Related Podcasts

Links

Stay Connected