Medicare Advantage or Medigap? Here Are 6 Tips To Help You Decide with Tom Qualley

Check out Jeremy’s latest podcast on Medicare by listening on “Apple Podcasts” or “Google Podcasts” or read below for 6 Tips To Help You Choose Between Medicare Advantage and Medigap.

#75 – Whether it’s Medicare Advantage or Medigap, choose your plan wisely. It can affect your healthcare costs for the rest of your life!

Although Medicare allows you to make changes to your plan later, those opportunities might be limited to certain enrollment periods.

Plus, as your health conditions change, it can become difficult to be accepted into your desired plan at a later stage in life.

In part four of this Medicare series, Jeremy Keil speaks with Tom Qualley, the CEO of Sovereign Select, LLC. Together, they list the pros and cons of different Medicare plans and share tips to help you decide what’s right for you — Medicare Advantage or Medicare Supplement (aka Medigap).

Tom discusses:

  • How existing health conditions and income affect your plan choices
  • Situations when Medicare is available before 65
  • Why it’s extremely important to know your coverage network before signing up for a plan
  • Why the two most important factors in your decision are “comfort” and “finances”
  • And more

Medicare Advantage or Medigap? Here Are 6 Tips To Help You Decide

1. Generally speaking, Medigap is more suitable for people with ongoing health issues

Although Medigap premiums cost more, they can potentially provide 100% coverage in many cases. This can be helpful for people with ongoing health issues who incur high healthcare costs every month.

For instance, the expenses from cancer treatment often cause people to hit the maximum out-of-pocket expenses on their Medicare Advantage plans. Having Medigap instead can save them a lot of money.

There are some exceptions to this statement.

Some medical issues (like some milder cases of diabetes) may require only daily medication and occasional follow-up meetings with doctors. In this case, the lower premiums of Medicare Advantage might look more appealing.

On a side note, you can also get Medicare before turning 65. It is available two years after the start of your Social Security disability insurance.

If a medical professional and a judge determine that the disability has existed for at least 24 months before your diagnosis, you can start Medicare as soon as you’re deemed disabled — no need to wait for two years.

2. Beware, Medigap premiums increase as you get older

Medigap premiums are subject to increase every year.

This rise in premiums can be substantial over a period of multiple years. In Wisconsin, Tom estimates we’re averaging nearly 10% increase per year in Medigap premiums.

Now, if your Medigap premiums increase as you grow older, there might come a time when the annual premiums exceed the maximum out-of-pocket expenses in Medicare Advantage.

When this happens, you can consider switching to a Medicare Advantage plan.

3. Don’t rely on Medicare alone. It is risky!

Relying on Medicare alone (i.e., no Advantage or Supplement plans) can be extremely risky.

By doing so, you expose yourself to significant financial risk.

Remember, Medicare covers only 80% of your healthcare expenses, which means you’re on the hook for the remaining 20% (although it’s rare, imagine 20% of a $500,000 bill!). It also has some deductibles that you might need to cover.

If something unfortunate happens and you have to move to a nursing home, Medicare might only cover the costs for the first 20 days. Then, you might be liable to pay $150+ per day for the nursing facility. To put it into perspective, it can add up to $15,000+ in just 3 months!

4. Know that switching to Medigap later can be difficult

When you’re enrolling for Medicare for the very first time during the initial enrollment period, every insurance company has to accept you.

After that, they have the right to deny your application for your desired Medicare plan.

As Medigap offers better coverage, people often try to switch to Medigap after facing a major decline in health to help cover the large medical bills.

That’s why many insurance companies might reject you when you try to switch from Medicare Advantage to Medigap.

Many retirees worry that if they move to Medicare Advantage, they might not be able to switch back later. However, the federal law provides a 12-month trial period for Medicare Advantage for first-time enrollees.

If you don’t like Medicare Advantage during the trial period, you can easily enroll back into your previous Medigap plan without any problem.

5. Contrary to popular belief, Medicare Advantage could be the better option for frequent travelers

Now, you might think Medigap is better for travelers due to its country-wide coverage.

However, most people don’t use many medical services while on vacation. They are primarily concerned with emergency or urgent care services.

With Medicare Advantage, you can get worldwide emergency and urgent care coverage! It doesn’t have to be based on a specific network.

Plus, Medicare Advantage plans have been expanding their networks throughout the country recently.

So, if you’re looking solely from a travel coverage standpoint, getting the right Medicare Advantage might be a more cost-efficient plan!

6. The special enrollment period that few people know about

As mentioned above, you might find it difficult to switch from Medicare Advantage to Medigap.

However, there is a way to make this transition easier for you.

If you move outside of your existing service network, you can get an opportunity to participate in a special enrollment period which enables you to enroll back into Medigap.

This doesn’t necessarily require you to move to a new state. Coverage networks can often be based on different counties.

So, you can move to a new county, enroll into a new Medigap plan (choosing from those available at your new location), and move back the following year. The Medigap plan will remain even after you move back.


To learn more about Medicare, check out the resources below!

If you have any questions, feel free to contact us or our guest Tom Qualley using 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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