Business Innovators Radio - Interview with Jack Peregrim Founder of Fourth Quarter Advisors Discussing Medicare Decoded

Episode Date: April 2, 2026

Jack Peregrim is the founder and President of Fourth Quarter Advisors and he has a long career in business and strategy including his 30 years as the founder and owner of PARAGON Development which focused on providing strategic management services to many Fortune 50 global corporations.On his ‘retirement’ he personally recognized the complexity in Social Security options as well as Medicare. And, there is very little support and education available other than that offered by individuals and organization driven by revenue received for selling products and services.Jack and others are trained and committed with Certified Financial Fiduciary® designations. And, we are volunteer presenters for workshops sponsored by a number of non-profits which are non-profit 501(C)3 organizations and support programs in a wide range of retirement issues.Jack is a Certified Financial Fiduciary ™ in addition to his involvement in numerous professional and personal organizations.Learn More: https://www.fourthquarteradvisors.com/Influential Entrepreneurs with Mike Saundershttps://businessinnovatorsradio.com/influential-entrepreneurs-with-mike-saunders/Source: https://businessinnovatorsradio.com/interview-with-jack-peregrim-founder-of-fourth-quarter-advisors-discussing-medicare-decoded

Welcome to influential entrepreneurs, bringing you interviews with elite business leaders and experts, sharing tips and strategies for elevating your business to the next level. Here's your host, Mike Saunders. Hello and welcome to this episode of Influential Entrepreneurs. This is Mike Saunders, the authority positioning coach. Today we have back with us, Jack Paragram, who's the founder of fourth quarter advisors, and we'll be talking about Medicare decoded, how to avoid costly mistakes most retirees make.

Jack, welcome back to the program. Well, thank you. I'm glad to be here. You know, I think that this is a really interesting topic, and I'm sure we could spend three full days on a weekend going over it and still not have scratched the surface on all the variables. So let's look at this topic of Medicare, because I feel like when we mentioned here,

in the opening of costly mistakes. There are some things that really could be costly and then some other things that really need to be taken into consideration. Where do you start when you're talking with your clients to educate them on why Medicare is just so confusing for some people? I usually start by always start at a high level and have people understand what Medicare is. And then you recommend, then I want them to. understand that Medicare is really going to be two parts, two entities, two different sets of rules.

When people are getting their insurance prior to Medicare, it all comes from some commercial insurance company, and it is one plan with one set of rules. Well, you can't deal with one entity now. You have to deal with two of them. And one is the government. So you can understand how bureaucratic and restricted that can be. Yeah. But now you're still going to deal with an insurance company.

So I normally start out by explaining how that works at the higher level. And then you have to drill down to say, okay, what's my best way to get Medicare with the government? And then what are my options to deal with the health insurance companies? So there's a lot of complexity in it because if I take any one of them like what you do with the health insurance companies, there's many different, completely disparate ways to get your health insurance with those people also. Anyway, it starts with drilling down. What is Medicare? And Medicare is basically a government health care system.

And it has basically two parts that we deal with directly with the government. we deal with Medicare Part A and Medicare Part B. Medicare Part A covers hospitalizations. Medicare Part B covers anything that's health care services that are outside of the hospital. Now, these plans are 50-some years old. So what Medicare covers within those plans has limitations because many things that we need today are not even covered in those plans because 50 years ago we weren't dealing with acupuncture and nature paths and chiropractors and different things that are not part of the coverage that we want.

But anyway, Medicare Part A, we don't, in almost all cases, we don't worry about any payments for that because we, that's, we've been paying for that through our income, that little block in our checks when you see them that says Medicare. Basically, it's paying for Medicare Part A. Now, the government started with Medicare, which was A, and some decade later, they recognized that, you know, we really should have something that covers things that are outside of the hospital. So they came out with what became Medicare B. And they couldn't agree on having any more commodity your incomes. So they just basically set up a system where you're going to continue to pay for A,

and that'll be paid up. But when you retire, when you turn 65, or if you're working after 65, when you no longer have employment coverage, you sign up for Part B, and they subsidize Part B for you. So you pay a certain amount for Medicare Part B. There are what they call Irma, IRMA, IRMAA penalties for having higher income and getting Medicare. So there's different amounts that they're going to charge you for Medicare Part B. But you are required by the government if you have no health care coverage to have Medicare Part A and Part B with them. And now what would happen if a husband and wife are both working?

One retires before the other and doesn't sign up for Medicare, but the other, because the other one, you're getting the benefits from work, does that present any issues or can you still have your joint husband and wife coverage through the husband's work, for instance, if the wife retired first? That is not an issue at all. Medicare's requirement is that you have what's called creditable coverage. That means that the coverage from your employer, whether it's spousal, part of a family plan or direct, it has to be equal to or better than Medicare.

And normally people will get a letter about their health care coverage in September, October, when they're employed. And somewhere on page two, it'll say that this is deemed creditable for Medicare purposes. and there's no other requirement then. They could be working at 75 and not need to sign it for Medicare because they have creditable coverage. Got it. Okay, good. So talk a little bit about some more of the misconceptions about Medicare coverage because I'm sure that some people think, oh, I sign it from Medicare.

Any kind of medical need I have, it is covered, you know, because they're thinking about their recently deleted, you know, a corporate account that they have. had through whoever, Blue Cross Blue Shield or whoever that might be, and they go in to get their prescriptions or they, you know, have all this coverage and this wonderful. But it's different when you go on Medicare, right? We'll talk a little bit about some of the misconceptions and coverages. Well, to cover the misconceptions, I don't want this discussion to go for about four days. So I'll limit myself to just several of them. One misconception, we have to sign up for Medicare Part A at 65, even if we're working and even if we have coverage. And that's a misconception.

We do not have to sign up. Another misconception that people have, oh, when I retire, I am just going to go on Medicare and Medicare is going to cover everything. That's when we run across all the time. And nothing can be further from the truth. The amount that Medicare doesn't cover, it could bankrupt you. So with any kind of health issues, oh, Medicare will cover everything. No, it doesn't.

It doesn't cover many of the services that we get even while we're healthy, chiropractors, podiatry, anything cosmetic, it doesn't cover dental or vision or hearing. There's so many things that doesn't cover. You can write a book on what it doesn't cover. And the last thing to mention is long-term care. Medicare covers conditions that are considered acute but not chronic. If I have a condition or a disease and it is debilitating and it will only further deteriorate, there is no cure for it, Medicare will cover very small amounts of it.

If I have Alzheimer's and I need care around the clock, they're not going to cover that because there's no way that my coverage is ever going to cure that Alzheimer's. It's just keeping me from hurting myself. So if I needed oxygen, I have C-O-P-D, and if I needed oxygen, it'll cover the oxygen, but it won't cover the people that need to be coming in to visit with me to make sure that, because I can't do the things that I need to. in other ways. It's just not going to cover chronic things.

So long-term care is a huge gap in their coverage. Let me see. Other misconceptions that, oh, number one, it's, I'm just going to go to Medicare and sign up. Well, I don't. I sign up for Medicare through Social Security. The Social Security basically handles the back office and a sign-ups for Medicare. Medicare, all doctors take Medicare. No, they don't.

Not at all. An awful lot of doctors don't take Medicare because the reimbursement rates. So I couldn't begin to tell you all the misconceptions that there are about Medicare. You know, like you said, we don't have four days to cover that one point on misconceptions. And I would venture to say the same statement could be made for the fact that it does not cover long-term care. and I've heard some statistics that a staggering percentage of people at some point will need some type of long-term care, 60, 70% or more. And that is very expensive and can be long-term. And the people that have the misconception that Medicare just covers it is going to be left holding the bag.

That's very true. Now, I will say this, some of the statistics are blown on a proportion. because it is true that, and I thought the percentage I saw was closer to 78% will need long-term care. But that could also mean 14 days in hospice. And that is considered long-term care. But the people that need long-term care that last for years, there's no protection. It will go through your savings. It will go through your protected retirement accounts.

It'll go through your house. Because many of the long-term care needs are 6, 7,000, 10,000 a month, potentially. Oh, in one state, Connecticut, I know of, a private room today in a nursing facility is $20,000 a month. Good night. Your home care is between $7,000 and $10,000 a month. So it can be extremely expensive. and the key is it is not covered. So, and this is only one piece of it.

Sure. But that's a big misconception. It is. It is that. So let's go into some of the other choices as far as you had mentioned, you know, part A, B, C, D, EFG. You know, and I'm being facetious with many of those, but I know that there's many parts, A, B, C, D.

There's also Medicare Advantage, and there's gap and their supplement. Talk a little bit about some of those things and maybe a clear delineation of when to consider them. Well, the time you consider them, there's an initial time and then a moving forward time over time. The initial time is when you have to, when you lose your employer coverage or you turn 65 and you might not even have coverage, but you know, need to get Medicare at age 65. So those are the initial times you consider it. I will, I think the easiest way to explain what is covered and is to understand why things are covered the way they are, and I'll do it briefly historically. And I'm taking latitude on some of the dates just to

to round things off. Around 1960, our government decided that, well, we need to look at offering health care for people that are 65 or older, because if they, especially with hospitalizations, if they went into a hospital, it could decimate them. So that's when they came out with original Medicare. And that's all it covered was 80% of what happened to them when they went into a hospital, and then they paid for that out of their income. Roughly 10 years later, the government recognized that, you know, things outside of a hospital could be decimating too. People that have conditions have to see specialists a lot on the prices that they charge. They have to go in the rehab centers. They have imaging issues.

you know, we don't even realize, but a PET scan or an ultrasound stress test is $10,000 today. So, and they're going to cover 20% of that. So, but they recognize that at least we want to cover the 20% and that's where they came out with Medicare Part B. And then the insurance industry looked at and said, you know, 20% of these costs going into a hospital can be decimating. So they came out with what is now referred to as Metagap. And those are plans A through N. So around 1970, we could add A and B with the government. We get a Metagap plan.

Those are plans A through N. And the reason for so many plans is one will cover 50% of the 20% not covered. One covers 75% of the 20% not covered. One covers four things. doesn't cover for others. But basically, there are plans that can cover 100% of what's not covered. So the insurance industry, after you have Medicare A and B, the insurance industry had a way that you can cover what's not covered.

And that's where we were for about 30 years. Then our government recognized that drugs aren't covered in any of this. And drug costs could decimate. people because 30 years from 1970, we have biologics and treatments and expensive drugs that are on patent that are costing a fortune. So they came out with Medicare that end up being part D. And they had some rules with donut holes in typical government convoluted approach to it. but basically the insurance industry that was issuing Medigap plans, they came out with Part D plans because the government wasn't handling it directly or adequately.

So our options then were to have our Medicare A and B, just as they are today, get a Medigap plan and add a separate plan for Medicare Part D for drugs. then the insurance industry looked at and said, you know, this is very rigid. Medigap is only allowed to cover what Medicare doesn't. And people want chiropractors. They go to podiatrists. They want things that aren't even,

they want dental and vision and hearing that aren't covered by Medicare at all. So they came out with a completely different approach was his Medicare Advantage. And they structured it differently, where Medigap has a premium that you're going to pay the same premium every month. And if you get a plan that covers everything, that's all you pay is this one premium. And then there's no co-pays or anything else.

Medicare Advantage, they have very low co-pays or zero co-pays. But you're going to pay as you go along. So every time you use the services, you're going to have to pay something. But now they can also include some of the things that weren't covered. Dental vision, hearing, chiropractors, oh, nature paths, a lot of preventative medicine. Did Medicare originally foreign didn't cover preventative medicine? They didn't even understand what it was. So there are things that Medicare Advantage can now cover.

but the two different approaches are radically different in how they work. And now it's important for everyone to understand which of the two approaches. First, you need to understand Medicare, and that's a lesson in itself as to when you need to sign up, how you need to sign up, when you're required to, what you need to do. But you get Medicare, and now I can choose an insurance plan, and now I have two completely different plans, and certain people should be on Medicare Advantage,

other people should be on MediGap, and it would be the right thing for them. Right now, I think for many years, Medicare Advantage had their pluses outweighed the minuses considerably. However, in the last few years, the Medicare Advantage plans are much less attractive because the companies offering them had been fighting for market share and increased benefits and decreased co-pays. And they wanted to make it really attractive for people to purchase their Medicare Advantage plans. And they're much less attractive now than they were even two years ago.

So I think a trend now is to look at getting on MediGap plans. plans, know what we're going to have, and not have to deal with services being cut. Plus another piece of complexity on that is that in all but three states in the country, if you have Medicare advantage and you want to change in the future to Metagap, you're not allowed to. You'd have to go through underwriting and be denied. See, every year in the fall, we can change our plans. And there's only three states right now that allow you to go from Medicare Advantage to MediGap. So the other states, yes, you can go from one Medicare Advantage plan to a different one, to a different company, have different services covered.

Or you can go from one MediGap plan to another Metagap plan, but you can't switch between them. the three states that allow this are now holding hearings to take that away as well. So a major consideration is do I choose meta-gap so that I reserve my right to be on it in the future where I could pay one premium and have everything covered in case my health changes and I pay a smaller amount, but now my services and my co-pays are going to be considerably higher in the future. There's a lot of tradeoffs and a lot of complexity in it. And you know, there really is.

And I was kind of being facetious saying part ABCD, well, apparently there is a lot of parts and a lot of plans and a lot of choices. What are you finding when you are working with your clients some of the biggest mistakes that they're making when choosing a plan? Because like what you were mentioning, oh, this one pays 50% of the 20%. This one pays four of the, there's got to be some. mistakes that people make, what are you seeing? Again, the list of the mistakes people make could take a couple of hours to go over. But a lot of the mistakes people make are number one, assuming that the plan that they have, which are covered county by county, not state by state, county by county, are going to be the

same as their cousin or their aunt down in a state, three states away, says, well, this is plan you need. It's not the same plan they would have where they are. A Medicare Advantage plan and Texas is going to be different than one in Iowa. And by county, they'll be different. And the cost for Medigap is different by company by the A through N classification. So there are a lot of differences. So many times we listen to people that have done the role.

right thing for themselves, but not in the same zip code. And the recommendations are wrong. So I'll start with that. The second, because we believe, there's a psychology, we believe that Medicare is pretty simple. It's a government program that around. I just sign up for Medicare. And, well, it's going to be easy. I don't have to do much research or homework to understand how I need the best structure. Another thing, the people that we deal with, the insurance agents that are in the business of selling health care plans, in one state, in Connecticut alone, there are 40-some providers providing Medicare Advantage plans, and they might have 15, 20 plans apiece. Now, some of those plans are, and I'll say sold by people that are living on their compensations from selling health care insurance.

And they upsell things. As a matter of fact, many plans, the best ones offered now with some of the most recent changes are considered non-commissionable. So if I'm a health care insurer and I say, all right, I will still offer this really very good plan, but I can't afford to also have my profits erased by the commissions on paying. So this is going to be offered, but it's being non-commissionable. Do you think that if somebody that is living on commissions is even going to let you see that? Probably not. The misconception is that anybody we deal to, we deal with is going to give us absolutely the best plan for us.

And so that's a huge misconception. And you do have people that are independent that represent health care insurers, but they probably deal most of their business with one or two of them. and the more business they do, the more benefits they get by doing it, because what they call their book in business is a lot larger with one company, and they get some benefits out of it. There's a lot of misconceptions that lead to people making decisions that do not support the best thing for them in health care.

Yeah, that's, you know, and I think that this is a great time to bring this up with many of our, you know, the needs in life. Oh, I'll just go Google it. Oh, I'll just go to AI and it'll tell me. Well, that may be a nice step in the right direction to begin your educational process. But when choosing a Medicare plan, there are myriad options and you probably will not get the correct option for your scenario because you personally might have factors that the online tool or AI won't know. So I think you bring up some great points there, Jack. Yeah.

And one of the things I'm big on in, and I, through my whole career, served this well when I dealt with companies, is I'm a big one on criteria. Set a criteria. Understand what you need. And you don't go and say to the people you're dealing with, what do you have? What would you recommend? you go to people, and I don't care if it's financial or health care plans, and you now go and you say, this is what I want. My criteria are that I want something that covers me across the country. I want, you know, national coverage.

I want, and have a list of things before you go to talk to anybody of the things that you want. And until it can be proven you can't get them, that's your feeling. first thing. That's a great first step regardless of this. We're talking Medicare now, but that's a great first step because one of things I would say, I want somebody that has national coverage. If I go visit my cousin someplace or I go down to Florida for a vacation, I want to be covered. Does the network of this company cover me if I go down to a vacation someplace or I go to visit somebody? And that's just one thing. Will this? discover me if I travel internationally.

Will this cover me if? And you decide on the things you need your health care coverage to do. And then that's what you present the people. These are the things I need. It's just a different approach to it, but it's one that people don't take because we don't understand Medicare and the insurance coverages with it because we've never had it before when we retire. It's another transition thing that is a lot different than we realized.

and now we go to people and we don't know what to ask them because it's so completely different. They're the experts and we ask their advice. What would you recommend? And instead we should be going to them and saying, look it, I don't even know how it works, but these are the things that I need. You know, that's an excellent point and kind of having that foresight. So let's kind of wrap up with this thought, Jack. How should someone approach making the right Medicare decision?

decisions from a broad perspective, beginning with what you just said there, but then how do you take that one step further to make sure those decisions are being made properly? The first thing they need to do is recognize how complex it is and go with an open mind and know that they're never going to know everything. So now you set priorities and you say this is, first, I need to know how I get to my end point. And that's all right. In one year, I need health care coverage. It's going to do whatever it is for me. How do I get there? When do I sign up for the various plans? What steps do I take? And I'm going to ask a lot of dumb questions along the way. And don't be embarrassed with it. And don't assume that you could ask 50 questions and it should have been 500. So question and challenge everything. Now, remember it's two steps.

Nobody can give me insurance from a commercial side, which are health insurance companies, until we have Medicare. So I have to understand the bureaucratic restrictions, requirements, and timing of Medicare itself. Once I get Medicare in place, then I can go and have the coverage added to it that I will actually need in my retirement. You know, I think kind of having that plan in place ahead of time, key. Secondly, mapping out your questions that you have, key. And thirdly, having someone that you trust to guide you through that process.

because, again, not knowing what you don't know is a big detriment as well. So, Jack, this has been just a masterclass in Medicare, and I've really appreciated the sequence of steps that you've taken us through to understand it. If someone would like to reach out and connect with you to chat through some of their options, what's the best way they can learn more and reach out and connect with you? Well, they can always reach me through my email, and that is Jack, J-A-C-K, at fourth quarter advisors.com, and that's spelled out, F-O-U-R-H-Q-U-A-R-T-E-R-A-B-I-S-O-R-A-B-I-S-O-R-A-B-I-S-O-R-R-A-B-R-E.

There's a lot of good information and some videos on our website, which is fourth-quarter-advisors.com, and we're constantly adding content to that. And I will even give people our phone number because this is so important, I don't want anyone to make mistakes. My cell phone is 203-507. 3826. Perfect.

Well, Jack, we'll also have a link to your website under the show notes here, and I really appreciate you coming on and enlightening us on this very important topic. Thank you. You're welcome. You've been listening to Influential Entrepreneurs with Mike Saunders. To learn more about the resources mentioned on today's show or listen to past episodes, visit www.com. Thank you.