5 Things To Know Before Enrolling for Medicare with Tom Qualley

Check out Jeremy’s latest podcast on Medicare insurance by listening on “Apple Podcasts” or “Google Podcasts” or read below for 5 Things To Keep in Mind About Medicare Insurance.

#72 – When you turn 65, you get one of the best birthday gifts of your life — Medicare!

But does it cover everything? What are the different types of insurance plans out there? What are the different enrollment dates?

Find the answers to these questions in today’s episode!

In part one of this series on Medicare, Jeremy Keil speaks with Tom Qualley, the CEO of Sovereign Select, LLC. Tom shares several insights and must-know tips to help retirees find the ideal Medicare insurance plan that meets their unique needs.

Tom discusses:

  • The difference between Medicare Advantage and Medicare Supplement plans
  • Things to monitor every year once you’re enrolled in Medicare
  • Different enrollment dates you should mark on your calendar
  • How to determine the ideal age to enroll in Medicare (it’s not always 65!)
  • And more

About To Enroll in Medicare? Keep These 5 Things in Mind

1. Understand Medicare Supplement vs. Medicare Advantage

Medicare doesn’t cover everything, and you might need to pay out-of-pocket expenses as well. For both part A and part B plans, there are some deductibles that you would be responsible for. Even after those deductibles are met, Medicare covers only 80% of the medical bills.

A Medicare Supplement plan helps you pay for some or all of those deductibles, as well as the remaining 20% of the uncovered bills.

This reduces your out-of-pocket costs to nearly zero. Plus, you can see any doctor in the country that agrees to bill Medicare. Your coverage is the same coast to coast! In return, you need to pay an additional insurance premium for Medicare Supplement (around $150-$200 per month) along with your part B premiums (currently $170.10 per month).

On the other hand, a Medicare Advantage plan increases the variety of benefits. In addition to the part A and part B benefits, it can also cover prescription drugs, dental, vision, and hearing. Some plans even include free gym memberships, transportation to doctor appointments or fitness trackers like Fitbit.

Medicare Advantage plans often include worldwide emergency and urgent care coverage, which is great if you’re traveling for short durations.

Cost-wise, Medicare Advantage plans require the regular part B premiums. For the added benefits, they work on a pay-as-you-go basis. with each service having a specified co-pay amount. The maximum out-of-pocket limit is $6,700. If you don’t use many services during the year, your total out-of-pocket expenses will be low.

2. Things to Monitor After You’ve Enrolled in Medicare

A lot of people buy an insurance policy and never look at it again. It’s a good practice to review your plan regularly, especially with a professional.

For instance, Sovereign Select, LLC reviews plans with clients every September, where they collect information on new medication and doctors, do surveys, and strive to get the most updated information on their clients’ lifestyle.

Find a trusted source or an independent agent to guide you through your review process so that you can adapt your coverage to your changing needs.

Also, insurance companies might change some of their plans once in a while. It’s important to know if any of those changes impact you.

Finally, you should not miss any important enrollment dates (discussed in the next section).

3. Don’t Miss Important Enrollment Dates

When you’re new to Medicare, your first ever enrollment period is called the Initial Enrollment Period (IEP).

The IEP begins three months before your 65th birthday and lasts until three months after your birthday month. If you want to have your coverage set up in advance, make sure you sign up before you turn 65. Your coverage begins on the first day of your birthday month. If your birthday falls on March 15th, Medicare begins for you on March 1st itself.

Next, the special enrollment period generally starts 8 months after you or your spouse stop working or lose group health plan coverage. This is the time when you can sign up for Medicare part B, Medicare Supplement or Medicare Advantage plans.

There are also standard enrollment periods that occur every year. The primary ones include:

  • Open enrollment period (October 15th to December 7th): You can shop around for Medicare Advantage or Part D plans and make the necessary changes.
  • General enrollment period (January 1st to March 31st): If you missed open enrollment or you aren’t satisfied with a decision, you can make one correction to your policy during this period.

4. The Ideal Age for Medicare Is Not Always 65

You don’t “have to” join Medicare at age 65. Most people want to opt for part A at least because it’s free.

However, you can no longer contribute to your health savings account (HSA) after you enroll in Medicare. So, if you want to keep contributing to your HSA, you’ll need to delay Medicare.

If you or your spouse is still working and you believe your group insurance coverage to be better, you can delay your part B premiums, too.

Note that if you are collecting Social Security benefits, the Social Security Administration automatically enrolls everyone in Medicare part A & B. You can’t unenroll from part A, but if you decide it’s better to wait on part B you can unenroll from it. Here’s how: Medicare: How to drop part A and/or B

5. Make Sure You Leverage the Following Resources

Navigating the different Medicare insurance plans can be overwhelming. Luckily, there are many resources to make things easier!


Don’t forget to check out the resources below to learn more about Medicare insurance!

If you have any questions, feel free to contact us or our guest Tom Qualley through the contact information provided below!


Connect With Tom Qualley:

Connect With Jeremy Keil:

About Our Guest:

Tom Qualley is the CEO of Sovereign Select, LLC. In 2006, after studying business in his hometown of Green Bay, Tom began working in the insurance industry. From day one, he specialized in senior market health and life insurance. Tom was later promoted to agent training and eventually sales direct to consumers.



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