Jim Towle, Medicare Insurance Broker
Jim Towle
Coastal Benefits
Medicare Broker Licensed in AL
3+ Years of Experience
Contact Details
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Location
Mobile, AL
About Me
Greetings! I'm Jim, a Medicare insurance agent dedicated to serving your local area. Medicare is my area of expertise, and I'm committed to helping you pinpoint the most suitable plan for your individual needs and budget. I'll handle the research and comparison of plans from top national and local companies, so you can relax. Plus, my assistance comes at absolutely no cost to you. Reach out to me today to discuss your Medicare insurance possibilities, and remember to mention you found me through Medicare Agents Hub!
Q&A with Jim Towle
What do you like most about being a Medicare agent?
Answer: What I like most about being a Medicare agent is the ability to make a real difference in people’s lives. Navigating healthcare options can be overwhelming, especially as people approach retirement age and start looking into Medicare. I enjoy being the person who helps simplify that process, ensuring my clients understand their options, find the best plans for their unique needs, and feel confident in their healthcare decisions. It’s incredibly rewarding to build relationships with clients and know that I’m providing them with a service that directly impacts their well-being. Additionally, I appreciate the constant learning aspect of being a Medicare agent—healthcare regulations and policies are always evolving, which keeps me on my toes and ensures I’m always improving my knowledge. Ultimately, it feels great to be someone people can trust when it comes to such an important part of their lives.
How has telemedicine enhanced personalized healthcare?
Answer: Telemedicine has significantly enhanced personalized healthcare by making it more accessible, efficient, and tailored to individual patient needs. One of the most impactful ways it has done so is by allowing patients to connect with healthcare providers from the comfort of their own homes, breaking down barriers like geographical distance and scheduling challenges. This means people who might have previously struggled to access care—such as those in rural areas or those with mobility issues—can now receive timely, personalized treatment.
Telemedicine also facilitates more continuous and consistent care. With virtual visits, healthcare providers can regularly check in on their patients, monitor ongoing conditions, and make adjustments to treatment plans in real time, without the need for in-person appointments. This leads to a more dynamic approach to care, where treatments can be quickly adapted to the patient’s current needs, rather than relying on periodic check-ups that might not capture the full picture.
Additionally, telemedicine makes it easier for healthcare providers to utilize data from wearable devices, mobile health apps, and other digital tools. These technologies allow for more personalized health insights, helping providers to better understand each patient’s unique health patterns and needs. Whether it's monitoring heart rate, glucose levels, or sleep patterns, this data provides a more comprehensive view of a patient’s health, enabling highly customized care plans.
Overall, telemedicine has helped bridge the gap between patients and providers, making healthcare more personal, proactive, and patient-centric, which ultimately leads to better outcomes and enhanced patient satisfaction.
What is one Medicare trend that you believe is having a positive impact on Medicare affordability? How is it making a difference?
Answer: One Medicare trend that is having a positive impact on Medicare affordability is the expansion of Medicare Advantage (MA) plans. Over the past few years, Medicare Advantage plans have seen significant growth, offering a more comprehensive and cost-effective alternative to traditional Medicare. These plans are managed by private insurance companies, and they often include additional benefits, such as dental, vision, hearing, and wellness programs, which are not typically covered by Original Medicare.
What makes Medicare Advantage plans particularly beneficial for affordability is their caps on out-of-pocket expenses, which provide financial protection for beneficiaries. Many of these plans also have low or $0 premiums, and they often offer more predictable cost structures, which can help beneficiaries manage their healthcare expenses better. Additionally, these plans frequently include prescription drug coverage (Part D), which simplifies the insurance process and often lowers drug costs compared to separate Part D plans.
The rise in value-based care models within Medicare Advantage is also helping reduce overall healthcare costs. These models focus on preventive care and more coordinated management of chronic conditions, which not only improves health outcomes but also reduces the need for more expensive treatments down the line. This trend is helping to lower costs for both beneficiaries and the Medicare system as a whole.
By offering more comprehensive benefits, a focus on preventive care, and capping out-of-pocket expenses, Medicare Advantage plans are playing a crucial role in improving affordability for Medicare recipients and ensuring they receive high-quality care without breaking the bank.
How do you educate clients who are completely new to Medicare?
Answer: Educating clients who are completely new to Medicare is a crucial part of my job as a Medicare agent. I approach this process step-by-step, ensuring that they feel empowered and confident in their understanding of the system. Here’s how I typically guide clients through the process:
Start with the Basics: I begin by explaining the fundamentals of Medicare, including its four parts—Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Many clients are unfamiliar with these parts, so I make sure to define each one in simple terms, focusing on what it covers and how it impacts their healthcare.
Clarify Eligibility and Enrollment: I explain the general eligibility requirements for Medicare, such as age 65 or certain disabilities, and walk clients through the various enrollment periods, including the Initial Enrollment Period, Special Enrollment Periods, and General Enrollment Period. This helps them understand when they should sign up to avoid penalties.
Discuss Coverage Options: After covering the basics, I explain the different options available to them:
Original Medicare (Part A and Part B), which provides hospital and medical coverage.
Medicare Advantage (Part C), a bundled alternative offered by private insurers that includes all of the coverage from Part A and Part B, often with additional benefits like dental and vision.
Medicare Supplement (Medigap) policies, which help cover out-of-pocket costs like copayments and deductibles associated with Original Medicare.
Part D for prescription drug coverage, which is essential for clients to understand to avoid high medication costs.
Assess Their Needs: I make sure to ask about their healthcare needs and preferences. Are they looking for a plan with lower premiums? Do they have chronic conditions that require frequent medical care? Do they take prescription medications regularly?
How do discount cards and resources affect my Medicare Prescription Drug plan?
Answer: Discount cards and resources can play an important role in managing prescription drug costs, even for individuals with a Medicare Prescription Drug Plan (Part D). While Medicare Part D offers coverage for prescription medications, there are situations where discount cards or other resources may help lower out-of-pocket costs or provide additional savings. Here’s how they can affect your Medicare Prescription Drug plan:
1. Supplementing Medicare Part D Coverage
Medicare Part D generally helps cover prescription drug costs, but there are times when it may not cover certain drugs or when a medication falls into a high-cost tier. In these cases, discount cards can help reduce the price of medications that aren't fully covered by your Part D plan or medications that fall into the Part D "donut hole" (the coverage gap).
These cards can offer savings on specific drugs, potentially lowering your copayments, coinsurance, or the full retail price of the medication. Some discount cards work with both generic and brand-name drugs, so they can fill the gaps in Part D coverage, especially for drugs that are expensive or not covered by your plan.
2. Savings During the Coverage Gap ("Donut Hole")
If you find yourself in the coverage gap or "donut hole," where you have already reached the initial coverage limit but haven't yet spent enough to get into catastrophic coverage, discount cards can provide relief. In the donut hole, beneficiaries often face higher out-of-pocket costs, and discount cards may offer a better deal on medications, potentially saving money on both generic and brand-name drugs. Some cards can even bring drug prices lower than the prices set by your plan during this gap, helping you save money while you wait for catastrophic coverage to kick in.
3. Medicare Part D and Discount Card Compatibility
While discount cards can offer savings, they generally cannot be combined directly with your Part D plan’s benefits.
What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?
Answer: If you enter a skilled nursing facility (SNF) for rehabilitation but then need long-term care, your Medicare coverage will change depending on the type and duration of care you require. Here’s what happens step by step:
1. Medicare Coverage for Skilled Nursing Facility (SNF) Care (Rehabilitation)
When you first enter a skilled nursing facility for rehabilitation following a hospital stay, Medicare Part A (hospital insurance) will typically cover your care under certain conditions. For Medicare to cover SNF care:
You must have been hospitalized for at least three consecutive days before being admitted to the skilled nursing facility.
Your doctor must certify that you need skilled nursing care (e.g., physical therapy, occupational therapy, or other skilled services) on a daily basis to improve or maintain your condition.
For the first 20 days, Medicare covers the full cost of your SNF care. After that, for days 21 through 100, you are responsible for a daily coinsurance (which in 2025 is $200 per day), and Medicare will cover the rest. Beyond 100 days, Medicare will no longer cover the cost of your care in the SNF, and you will be responsible for the full cost.
2. Transitioning from Short-Term Rehab to Long-Term Care
If you enter the SNF for rehabilitation, but during that time it becomes clear that you need long-term care (e.g., assistance with daily activities such as bathing, dressing, or eating), Medicare will stop covering your care after the 100-day limit if you continue to stay at the facility. Medicare is designed to cover only short-term, medically necessary rehabilitation, not long-term custodial care.
For long-term care, you’ll need to explore other payment options:
2.1. Medicaid
Medicare does not cover long-term care for individuals who need it for an extended period, but Medicaid may be available for those who qualify based on their financial situation. Medicaid provides coverage for long-term care in a skilled nursing facility.
I have Medicare Advantage with a PPO, and I'm curious if my annual wellness visit is free or if I'll owe something for it.
Answer: If you have a Medicare Advantage plan with a PPO (Preferred Provider Organization), your annual wellness visit is generally free. However, there are some important details to consider to understand how it works with your specific plan.
What Is an Annual Wellness Visit?
An Annual Wellness Visit (AWV) is a preventive service that Medicare covers to help assess your overall health and identify any potential issues before they become serious. It’s not the same as a routine physical exam, but rather a visit with your primary care doctor to review your health history, risk factors, and create a preventive care plan for the upcoming year. The visit may include:
A health risk assessment.
A review of your medical history and medications.
A list of screenings and immunizations you may need.
A discussion about healthy lifestyle choices.
Coverage Under Medicare Advantage (PPO):
Medicare Advantage plans are required to cover everything Original Medicare covers, including the Annual Wellness Visit. However, because you have a PPO plan, there are a few things to consider regarding how your specific plan works:
Preventive Services Are Typically Covered at No Cost:
Most Medicare Advantage PPO plans will cover the Annual Wellness Visit with no out-of-pocket cost, as long as you stay within the plan's guidelines. This means you should not have to pay a copayment or coinsurance for the wellness visit itself if it’s coded correctly as a preventive service and is not linked to any additional treatment or procedures.
Out-of-Network Providers:
If you see an out-of-network provider for your wellness visit, your PPO plan will likely still cover it, but the cost-sharing might differ compared to seeing an in-network provider. In-network providers typically charge lower copayments, and you may pay more if you see someone out-of-network.
How do Medicare Savings Programs help with Medicare costs?
Answer: Medicare Savings Programs (MSPs) help people with limited income and resources pay for some or all of their Medicare costs. These programs are run by individual states, but they are federally funded and follow national guidelines. There are four types of MSPs, and each provides different levels of assistance. Here's a full explanation of how they help:
What Medicare Costs Can MSPs Help With?
MSPs can help cover:
Medicare Part A premiums (hospital insurance)
Medicare Part B premiums (medical insurance)
Part A and/or Part B deductibles
Coinsurance and copayments
Depending on the program and your eligibility, you might get help with just premiums or with premiums and out-of-pocket costs.
The Four Types of Medicare Savings Programs
Qualified Medicare Beneficiary (QMB) Program
Helps pay: Part A & Part B premiums, deductibles, coinsurance, and copayments
Offers the most comprehensive assistance
Protects you from being billed for services covered by Medicare (except for minimal copays for prescriptions)
Specified Low-Income Medicare Beneficiary (SLMB) Program
Helps pay: Part B premium only
Less coverage than QMB but still reduces monthly costs
Qualifying Individual (QI) Program
Helps pay: Part B premium only
You must reapply each year, and help is first-come, first-served (limited funding)
Qualified Disabled and Working Individuals (QDWI) Program
Helps pay: Part A premium only
Available to certain disabled individuals under 65 who have returned to work and lost premium-free Part A
Who Qualifies for Medicare Savings Programs?
Eligibility is based on income and asset limits, which vary slightly by state and program. As of 2025 (approximate figures, may vary):
Income limits range from about $1,275 to $1,660/month for individuals
Asset limits range from about $9,430 to $9,940 for individuals
(These limits are higher for married couples.)
States may have different rules, and some may not count all income or assets in the same way.
I can help you apply.
I'm retiring next year - do I need to do anything with my Medicare?
Answer: Will you be 65 or older when you retire?
Do you already have Medicare (Part A, Part B)?
Are you currently covered by employer health insurance?
Is your employer coverage through a company with 20+ employees?
Scenario 1: You’re Retiring at 65 or Later & Don’t Have Medicare Yet
You must enroll in Medicare when you retire (or lose employer coverage), or you may face late penalties.
Enroll in Medicare Part A and Part B:
You get a Special Enrollment Period (SEP) of 8 months after your employer coverage ends.
During the SEP, you can sign up for Part B without a penalty.
Consider Additional Coverage:
Part D (prescription drug plan) – to avoid a penalty if you don’t have other creditable drug coverage.
Medigap (Supplement Plan) or a Medicare Advantage Plan – for additional benefits.
Important: If you already have premium-free Part A, sign up for Part B before your employer plan ends to avoid any gap in coverage.
Scenario 2: You Already Have Medicare Part A (but not B)
If you delayed Part B because you had employer coverage, you must now enroll in Part B as your retirement ends your “creditable” coverage.
Fill out Form CMS-40B (Application for Part B).
Submit with Form CMS-L564 (proof of employer coverage), signed by your employer.
Send to your local Social Security office.
Scenario 3: You're Already on Medicare A & B Before Retirement
Decide if you want to add:
Part D drug coverage, if you don’t already have it.
Medigap or Medicare Advantage, depending on your preferences and needs.
Drop your employer plan (if it doesn't coordinate well with Medicare).
Update Social Security if you plan to have Medicare premiums deducted from your benefits.
Scenario 4: You’re Retiring Before Age 65
Medicare won’t start until you turn 65 (unless you qualify for disability-based Medicare). So until then:
Use COBRA, Marketplace insurance, or a spouse’s plan for coverage.
If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?
Answer: Yes, you may qualify for Medicare insurance if you’ve been on disability due to an accident — but it depends on how long you've been receiving Social Security Disability Insurance (SSDI) and a few other factors.
Here’s a full explanation:
Medicare Eligibility for People on Disability
General Rule:
If you’ve been receiving Social Security Disability Insurance (SSDI) benefits for 24 months, you automatically qualify for Medicare, even if you’re under age 65.
What Matters Most
1. Are You Receiving SSDI?
If yes, and you’ve received it for at least 24 months (not necessarily in a row), you are eligible for:
Medicare Part A (hospital insurance) – usually premium-free
Medicare Part B (medical insurance) – has a monthly premium
You’ll be automatically enrolled in Medicare starting in the 25th month of SSDI benefits.
You’ll get a Medicare card in the mail before coverage begins.
2. If You’re Not Receiving SSDI:
You must be approved for Social Security Disability Insurance to become eligible for Medicare.
Private disability income, workers’ comp, or other non-SSDI programs do not qualify you for Medicare.
3. Are There Exceptions to the 24-Month Waiting Period?
Yes. You may qualify for Medicare immediately (no waiting) if:
You have Amyotrophic Lateral Sclerosis (ALS) – Medicare starts the same month your SSDI starts.
You have End-Stage Renal Disease (ESRD) – you may qualify for Medicare a few months after starting dialysis or getting a kidney transplant, even without SSDI.
What You Need to Do
If You Are Already Receiving SSDI:
You don’t need to apply for Medicare — enrollment is automatic in your 25th month.
You’ll receive a red, white, and blue Medicare card in the mail a few months before coverage begins.
If You’re Not Yet on SSDI:
Apply through Social Security as soon as possible.
Once approved, keep track of your monthly benefit dates to know when Medicare will begin.