Real Easy Medicare

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 ProtectionCarry photocopies or phone photos, not your original cardProvider Directory Double-CheckCall offices to confirm plan acceptance and new-patient statusAnnual Wellness Visit TimingSchedule early in the year; a visit doesn’t count toward your deductiblePart D Out-of-Pocket CapTrack spending toward the $2,000 true out-of-pocket limit; gap eliminatedSummary Notice ReviewCompare dates, services, and providers; report billing errors promptlyAppeal Timeline MasteryFile within 60 days of the notice date; use certified mail and keep copiesPrescription Transfer StrategyMove scripts to preferred pharmacy and fill 90-day supplies before Jan 1Emergency Room ApproachPresent all insurance cards; notify MA plans within 48 hoursSpecialist Referral RulesKeep written referrals for MA; Original Medicare requires nonePreventive Service MaximizationUse all covered screenings (mammograms, colonoscopies, etc.) at no costNetwork Exception RequestsAppeal for out-of-network care when in-network access is inadequateOpen Enrollment PreparationStart comparing plans in September; list doctors and drugs firstMedigap Shopping SecretIf denied, try different insurers—underwriting standards varyPart B Premium ReductionFile SSA-44 when income drops post-retirement to lower premiumsTravel PreparationVerify MA coverage areas; carry Medigap and supplemental cards for Original MedicareCustomer Service StrategyCall off-peak, record representative names and reference numbersFraud ProtectionNever share your number with unsolicited callers; report scams to 1-800-MEDICARETechnology OptimizationSet up Medicare.gov and plan portals; use mobile apps for real-time infoNext 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.

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 CostsMedicare’s 80/20 split leaves unlimited 20% liability—plan for out-of-pocket caps or supplemental coverage to avoid financial devastationNetwork ParadoxLarger provider networks don’t guarantee better specialist access—evaluate local depth of specialists, not statewide breadthFormulary ForecastingAnticipate future medication needs (e.g., insulin pumps, new cardiac drugs) when selecting Part D plans to avoid mid-year disruptionsOptimal Medigap TimingIf healthy at 65, secure Medigap coverage immediately for long-term protection; if not, use the six-month open enrollment wiselyAvoid the Premium TrapLow monthly premiums often mean higher deductibles and copays—assess total cost of ownership, not just premiumsProvider Relationship StrategyConsult doctors before enrolling to learn which plans they support and which impose burdensome prior authorization processesEnrollment Window IntelligenceMedicare Advantage OEP (Jan 1–Mar 31) provides a second chance to adjust plans after initial Open EnrollmentRobust Documentation SystemMaintain a dedicated Medicare binder to track cards, correspondence, and annual plan changes for audits and appealsAppeal AdvantageHigh success rates for properly supported appeals—leverage medical documentation and billing corrections to overturn denialsLong-Term PerspectivePlan beyond the next 12 months; account for health changes, income-related premium surcharges, and rising healthcare costsNext 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.Retiree Insurance TrapMartha delayed Part B, relying on retiree coverage, faced a 30% lifetime penalty and gaps because retiree plans aren’t creditableZero-Premium SurpriseRobert’s MA plan had no premium but high copays, network limits, and delays for surgery—total costs far exceeded Medigap alternativesPart D Penalty ProblemSusan skipped Part D when healthy, and later incurred a $12/month penalty for life upon needing diabetes meds.Medigap Timing MistakeDavid waited five years to switch from MA to Original Medicare, was medically underwritten and denied due to preexisting conditions.Network SurpriseLinda 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 VictoryFrank spotted $2,400 in fraudulent charges on his Medicare Summary Notice, reported them, and got full reimbursement after investigatio.nMove That WorkedCarol leveraged her SEP to transition MA plans seamlessly when relocating from Florida to OhioWellness Visit DiscoveryTom’s first free Annual Wellness Visit at 72 uncovered atrial fibrillation—preventing a potential strokeSuccessful AppealNancy appealed an $8,000 cardiac procedure denial with medical documentation and won approval.Coordination SuccessBill and his spouse Sarah, coordinated primary/secondary benefits effectively during cancer treatment, avoiding billing conflictsKey Takeaways:Verify creditable coverage before delaying enrollmentEvaluate total plan costs, not just premiumsUse SEPs and annual wellness visits proactivelyKeep detailed records to spot and correct errorsAppeal denials with thorough documentationNext 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 ErrorsAssuming 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 BlundersChoosing Medicare Advantage solely on zero premiums (check deductibles, networks, and total costs)Picking Medigap Plan F when Plan G offers similar coverage at lower costFailing to review Part D plans annually (formularies and costs change yearly)Coverage MisconceptionsExpecting 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 TrapsMissing 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 deadlinesDocumentation & Communication OversightsDiscarding 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 MisstepsUnderbudgeting for Medicare's premiums, deductibles, and cost-sharingPaying unnecessary Part B penalties when creditable coverage appliedIgnoring free preventive benefits like Annual Wellness VisitsPrevention Tips:Research early using official sources (Medicare.gov, 1-800-MEDICARE)Seek unbiased education without sales pressureAsk questions until you fully understand your optionsNext 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.EnrollmentMissed Part B IEP? Enroll during General Enrollment (Jan 1–Mar 31), coverage begins July 1; 10% penalty per year delayedSwitch MA to Original Medicare during Jan 1–Mar 31 MA OEP or Oct 15–Dec 7 OEPDelay Part B with active employer coverage (20+ employees); retiree plans don’t countCost & CoverageZero-premium MA plans may hike deductibles/copays—always review total plan changesPart D removal: 60-day SEP to change plansMedigap pricing varies by state, age, and plan—shop multiple insurersBenefits & ServicesDental: minimal under Original Medicare; some MA plans include limited dentalAmbulance: covered under Part B with 20% coinsurance after deductibleOut-of-network doctors: Original Medicare pays approved rates; MA requires networkPlan Changes & AppealsUnhappy with MA? Switch during OEP windows; first-year beneficiaries have guaranteed rightsMedigap changes subject to underwriting post-IEP; birthday-month rule in select statesClaim denials: request redetermination within 120 days (Original Medicare) or follow MA appeal processSpecial SituationsMoving states: Original Medicare nationwide; MA/Part D requires new plans via SEPDual VA coverage: VA not creditable for Part B delay; take Part A and consider Part BFinal AdviceKeep personalized Medicare questions coming for future Fast Friday episodesAlways 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.Research EfficiencyEnter all medications into Medicare Plan Finder for accurate cost comparisonsCall provider offices directly to confirm current plan participationMoney-Saving MovesUse mail-order for 90-day Part D supplies to get 3 months for the price of 2Apply for Extra Help online at SSA.gov if income limits qualifyNavigation ShortcutsCall 1-800-MEDICARE early or late for shorter hold timesFind unbiased guidance through your state’s SHIP counseling programEnrollment & Coverage TricksTrigger SEPs by moving ZIP codes to escape unwanted MA or Part D plansLeverage 12-month MA trial rights to switch back to Original MedicareProvider & Hospital TacticsSeek emergency care at the nearest hospital—MA plans must cover true emergencies out-of-networkRequest peer-to-peer reviews on denials for higher approval ratesTech ToolsDownload the official Medicare app for real-time claims and benefits infoKeep an up-to-date medication list on your phone for faster pharmacy and plan reviewsProblem FixesInitiate written redeterminations to start formal appeals on denied claimsIdentify qualifying events for SEPs if you make a regrettable plan choiceNext 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.Medigap Guaranteed Rights63-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 MedicareState-Specific ProtectionsCalifornia’s Birthday Rule: annual Medigap plan changes without underwriting during your birth monthAdvanced Part D TacticsDelay Part D penalty-free with creditable drug coverage from employers, unions, VA, or state programsLeverage the new actual out-of-pocket cap ($2,000) and adjust the timing of high-cost medications.Plan Switching WindowsPart D changes only from Oct. 15 to Dec. 7 OEP; MA-to-MA Open Enrollment Jan. 1–Mar. 31SEP rights when providers leave MA networks and star-rating enrollment escape routesPremium Suspension & CoordinationSuspend Part B when returning to employer coverage to avoid unnecessary premiums.Coordinate spousal enrollment timing for strategic advantageCost-Management StrategiesUse HSA funds tax-free for Part B, Part D, and Medigap premiumsStack state assistance programs (QMB, SLMB, QI) with federal benefits for maximum cost savingsPrevent “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 premiumsSchedule annual reviews to avoid the “set-and-forget” mistakeFollowing 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.Mary’s Advantage Trap (Ohio)Opted for a zero-premium Medicare Advantage plan at 65Plan didn’t cover her rheumatoid arthritis medicationMissed Medigap Open Enrollment, faced underwriting and higher premiumsRobert’s $200/Month Savings (Arizona)Stuck in an expensive Part D plan with Original Medicare + MedigapUsed Medicare.gov Plan Finder to switch to a lower-cost prescription planReduced annual drug spend from $4,800 to $2,400Linda’s Enrollment Penalty (Undisclosed)Delayed Part B after losing spousal employer coverageMissed the 8-month SEP, incurred a permanent 10% premium penalty and coverage gapJames’s Flexibility Strategy (Florida)Enrolled in Part B, Medigap Plan G, and a backup Medicare Advantage planKept Medigap active to retain guaranteed issue rights when switching backPatricia’s Advantage Success (Texas)Verified provider network and prescription formulary before enrollingEnjoys low costs and extra benefits (dental, vision) two years inKey Takeaways:No one-size-fits-all solution—evaluate total costs, not just premiumsTiming and deadlines are critical for enrollment and plan switchingAnnual coverage reviews can uncover significant savingsGuaranteed issue rights preserve your flexibilityNext 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.Creditable Coverage DefinedWorks: employer-sponsored insurance (you or spouse) from companies with 20+ employeesDoesn’t count: individual market plans, ACA marketplace, short-term policies, COBRA (<20 employees), most retiree plans, VA benefitsPenalty Details10% premium increase for each 12-month gap, permanent2025 base premium $185/month; two-year delay → $222/month (+$444/year); five-year delay → $278/month (+$1,116/year)Real-Life ExamplesMark’s individual plan delay led to a 20% penaltyDavid’s ACA delay also triggered a 20% lifetime surchargePrevention StrategiesWhen in doubt, enroll in Part B during your Initial Enrollment PeriodObtain written proof of creditable coverageIf coverage ends, use your 8-month Special Enrollment PeriodNext Up: True Story Tuesday—real beneficiary tales about unexpected Medicare traps and savings opportunities.

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 & TimingDelaying Part B with employer coverage (20+ employees): obtain creditable coverage proofPenalties 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 changesPrescription Drug CoverageTier-change appeals: use the doctor’s formulary exception requestsDonut hole discounts: 75% off brand and generic during gapGoodRx vs. Medicare: illegal to use coupons, but you can compare cash vs. plan pricesMedicare Advantage vs. TraditionalDisenroll 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 rightsBilling & Coverage IssuesMRI bills: verify provider accepts assignment and medical necessity; call Medicare for claim reviewPrior authorization: standard 14 days, expedited 72 hoursLate hospital billing: Medicare claims deadline 1 year; providers may bill laterPreventive CareAnnual Wellness Visit: free if no new issues addressed; otherwise, cost-sharing appliesScreening mammograms: covered every 12 months for women over 40Special SituationsMoving states: traditional Medicare portable; Part D and MA likely require plan changes via SEPDual eligibility: Medicaid covers premiums and cost-sharing; qualifies for SNPsRetiree coverage vs. Medicare: compare costs, benefits, and provider networks before decidingAdditional Q&A HighlightsFormulary updates and pharmacy network confirmationMail-order pharmacy policies and exceptionsHospital stay denials: appeal through level 2 independent reviewFiling plan complaints: contact the plan and CMS via Medicare.govRapid-Fire TipsReview coverage annually during Open EnrollmentKeep all Medicare communications and Summary NoticesKnow your plan’s customer service numberConfirm pharmacy network participationExplore assistance programs if you struggle with costsNext Episode Preview: Navigating Medicare after divorce—protecting your coverage and benefits during life transitions.

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 MedicareJohnson signs the original law; Truman is beneficiary #1Part A & Part B only; $3 Part B premium (~$25 today)1972 Disability & ESRD ExpansionCoverage for permanent disabilities and end-stage renal disease24-month Social Security Disability waiting period1992 Medigap StandardizationIntroduction of Lettered Plans A–J for consistent benefits2020 discontinuation of Plans C & F for new enrollees1997 Balanced Budget ActBirth of Medicare Advantage (Medicare Plus Choice)Early struggles paved the way for today’s MA plans covering over half of beneficiaries2003 Medicare Modernization Act (Part D)Creation of outpatient prescription drug coverageInitial rollout chaos; eventual elimination of the “donut hole” in 20202008 MIPPARequired observation-status notice within 24 hoursExpansion of Medicare Savings Programs2010 Affordable Care ActPreventive services at no cost; Annual Wellness VisitsGrowth of Accountable Care OrganizationsRecent Reforms (2018–2024)Chronic care management codes; telehealth expansion2025 cap on Part D out-of-pocket costs; drug-price negotiationsWhy 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.

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 SwitchingShop every year during Annual Open Enrollment (Oct. 15–Dec. 7)Compare Maximum Out-of-Pocket (MOOP) limits, not just premiums and deductiblesHidden Medigap Enrollment RightsGuaranteed issue periods when retiree coverage ends or you move out of plan service areasAct promptly to avoid medical underwritingNetwork Realities in Medicare Advantage“Acceptance” doesn’t guarantee availability—call providers to confirm they’re taking new patientsSpecialist access can be particularly limitedPart D Formulary VigilanceResearch a plan’s history of formulary changesUse appeals and exception requests to lower drug tier costsDual Eligibility MaximizationLeverage Special Needs Plans (SNPs) for extra benefitsUnderstand Medicare-first vs. Medicaid-first payment rulesAppeals and Reviews UnveiledLevel 1 redetermination vs. Level 2 independent review—don’t stop after the first denialExpedite reviews for medically necessary services in Medicare AdvantageCoordination with Social SecurityAlign Part B enrollment with Social Security claiming strategy to optimize benefitsSkilled vs. Custodial CareDocument medical necessity to qualify for covered skilled services in long-term care settingsTechnology ToolsUse Medicare.gov Plan Finder for network, mail-order, and coverage-gap insightsTrack claims and plan changes via MyMedicare.govEmployer Coverage NuancesFor companies with 20+ employees, employer plans may pay first even after age 65Get payment-order agreements in writingState Assistance ProgramsSHIP counseling, pharmaceutical assistance, and Medicare Savings Programs with higher income limitsAnnual Medicare Checkup RitualConduct a full benefits review every November with your healthcare, legal, and tax advisors

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 StoryTom 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 TrapThe 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 arriveDon't be afraid to push back if your doctor thinks you should be admittedKnow the skilled nursing trap—Medicare only covers skilled nursing after 3 consecutive inpatient days (observation doesn't count)The AftermathAfter 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.

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 penaltiesJames's Dilemma: Why employer coverage doesn't always equal Medicare-creditable coverageThe Part D Trap: How skipping prescription drug coverage can cost you thousands, even if you're healthyHidden Scenarios: Lesser-known situations that catch people off-guard, including overseas retirement, military TRICARE coordination, and spousal age differencesKey Takeaways:Enroll on time - Medicare penalties are permanent and expensiveVerify creditable coverage - Don't assume your employer plan qualifiesNever skip Part D - Future you will thank present you for enrolling in prescription coverageDual eligibility requires management - Having both Medicare and Medicaid doesn't mean automatic coordinationGet professional help - Don't rely solely on word-of-mouth adviceResources Mentioned:Medicare.gov Plan Finder toolState Health Insurance Assistance Programs (SHIP) at shiphelp.orgFree community seminars at libraries and senior centersAl'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.