An Overview of the Different Parts of Medicare
Original Medicare (Parts A and B) is free for most people who qualify, depending on their or their spouse’s work history and/or income levels. Individuals with higher incomes may have to pay a premium for Part A coverage.

Part B provides coverage for doctor visits and outpatient services as well as durable medical equipment and some home health services. An insurance deductible must be met and there is a monthly premium attached.

Medicare Part A

Medicare Part A covers hospital stays, home health care and end-of-life hospice services as well as a portion of doctor services, outpatient care and medical equipment costs. Part B (which covers doctor visits, X-rays and lab tests) is optional but most people choose to enroll; monthly premiums depend on how much Medicare taxes were paid during employment while also including deductibles and co-insurances.

To be eligible for premium-free Part A, you must obtain at least 60 quarters of coverage (QCs), earned through payroll taxes paid by both employees and employers. 40 QCs is needed for premium-free Part B coverage, but even if this threshold isn’t reached you may still enroll in premium Part A with monthly premium payments.

Situations beyond their control may prevent people from meeting their initial enrollment period due to Medicare Part B and premium Part A enrollment deadline. A Special Enrollment Period (SEP) offers those who missed initial enrollment due to circumstances beyond their control a chance to enroll without incurring late enrollment penalties. It begins either when they are informed of their Medicare entitlement or when group health plan coverage ends – whichever comes first. In order to qualify for this SEP, fill out Form CMS-L564 from CMS’s Medicare Downloads Section; for applications related specifically to Working Aged/Working Disabled individuals complete form CMS-40B from Working Aged/Working Disabled users respectively – see Downloads section under Medicare Downloads Section for details.
An Overview of the Different Parts of Medicare

Medicare Part B

Medicare Part B, commonly referred to as outpatient coverage, works in tandem with Medicare Part A to cover many things outside the hospital environment such as doctor visits, lab work, physical therapy sessions and supplies as well as preventative services like annual flu shots or cancer screenings. Medicare also reimburses some costs related to outpatient prescription drug plans.

Medicare Part B typically requires a monthly premium, in addition to any deductibles or coinsurances applicable, which most people must pay. Some individuals must also pay an extra amount known as Income Related Monthly Adjustment Amount (IRMAA).

Individuals can sign up for Medicare Part B during a Special Enrollment Period when changing jobs, ending an employer group plan or losing COBRA/TFL coverage; or during general enrollment periods throughout the year.

If someone fails to sign up for Medicare Part B when first eligible and then decides they want it later on, they could face a late enrollment penalty that increases their monthly premium by 10% per year they delay enrolling – this penalty continues for as long as they have Part B coverage. Thus it would usually be best for them to enroll as quickly as possible in order to avoid these penalties.

Medicare Part C

Medicare Part C (Medicare Advantage) is a private-sector alternative to original Medicare, offering various benefits and deductibles depending on your chosen plan. Part C plans may also cover prescription drug coverage.

Your Medicare Advantage plan costs an extra monthly premium on top of your Medicare Part B premium payment, managed by a private-sector company that must provide all of the same core services as original Medicare, such as hospitalizations, doctor visits and preventive care. In addition, Medicare Advantage plans may offer extra perks like dental and vision coverage as well as gym memberships or health-related wellness programs.

Medicare Advantage plans must first receive approval by the Centers for Medicare and Medicaid Services before enrolling beneficiaries. If an initial Medicare Advantage plan doesn’t pass muster, you may switch to another or even return to traditional Medicare altogether.

Medicare Advantage plans may offer a special enrollment period (SEP) for individuals who missed regular open enrollment periods due to imprisonment or relocation due to disaster or emergency. This SEP begins the day that you notify Social Security Administration and ends six months later; you will be responsible for paying premiums from this date forward; benefits should start taking effect shortly thereafter.

Medicare Part D

Medicare Part D prescription drug coverage is offered either as a stand-alone policy or through select Medicare Advantage plans. Benefits under Part D are determined using a national fee schedule and typically consist of deductible, initial coverage period and coverage gap benefits; there may also be coverages for some biological drugs and smoking cessation medications. Most plan sponsors offer multiple Part D plans with various formularies grouped under “good, better and best” categories to reflect differences in cost and coverages between plans; more comprehensive formularies may come at a higher cost.

At Open Enrollment Period (OEP), individuals will be informed if any changes to their Medicare plans for next year need to be made during an Open Enrollment Period from October 15 through December 31. At this time, individuals receive their Annual Notice of Change (ANOC).

Individuals released from imprisonment can use a special enrollment period (SEP) to sign up for Medicare within 12 months of release from incarceration, selecting a retroactive coverage date beginning the month they enroll and ending six months later.

Individuals disenrolling from Medicare Part D plans during an SEP to switch over to employer or union-sponsored coverage such as COBRA may alter their enrollment for two months after their SEP ends by filling out form CMS-L564 to make necessary changes.


KevinKevin
14:47 24 Jan 24
John is a very knowledgeable subject matter expert and is thorough in his approach. He takes time breaking down and explaining what can be a somewhat complex subject and helps makes it easier to understand! John always has the best interests of his clients guiding his recommendations. We have found John's advice to be extremely helpful and would recommend him to anyone seeking health insurance.
Laura BogenschutzLaura Bogenschutz
18:06 21 Jan 24
John Claeys is the best! He has helped my husband and I tremendously with our Medicare and supplement coverage! He breaks it down to where you can understand it! We would be so confused without John!! Thank you John for being there for us!!
Thompson FamilyThompson Family
15:46 18 Jan 24
John Claeys is one of the most knowledgeable individuals on Medicare and supplemental insurance plans you can ever find. Not only is he very personable he also stays involved from year to year to ensure you have the best policies for your current needs.
Ingrid FauskeeIngrid Fauskee
23:21 17 Jan 24
I just got a Medicare plan through John Claeys. I was getting a lot of mail about Medicare and was so confused. Some friends told me about John so I emailed him and he contacted me right away.. He was amazing! He went through everything with me, he explained every detail and was so patient with all my questions . So grateful to him for all he did. Thank you John.😁
John Claeys helped me understand the in's and out's of Medicare. He found the best insurance and prescription plan to best suit my needs at an affordable price.Thank you John!Laurie Boriskie
Marsha AllenMarsha Allen
16:55 24 Oct 23
My experience with John was definitely 5 Star! He explained everything thoroughly, and simply. He answered all my questions regarding Medicare completely. I would absolutely recommend John, without reservation.
Linda WilliamsLinda Williams
10:08 12 Jul 23
I had a 5 star experience and would recommend him. Always returning my calls promptly, very helpful and informative, listened to what my needs was regarding my Medicare. I truly felt comfortable with John's help to navigate through the maze of Medicare
Cindy KulakCindy Kulak
14:51 18 Jun 23
John is very knowledgable, honest and ethical in helping clients evaluate Medicare options and get enrolled. He made the process extremely easy for myself and my husband.
Dale SimsDale Sims
16:28 11 May 23
John did a great job of explaining Medicare and supplemental insurance. He was thorough and patient. He answered all of my questions. I greatly appreciated his help.
Leeann MoosLeeann Moos
17:26 06 Apr 23
When I became eligible for Medicare, my phone was constantly under attack from Medicare options sales folk. Since I needed help understanding my options and life is too short to do business with annoying people a little research was in order. Thats how I found John. His other customers seem very pleased with his service and I decided to give him a try. I was NOT disappointed! He did an excellent job for me, is extremely personable and I could not be happier. Thank you John
Rose WrightRose Wright
16:07 05 Apr 23
I am so thankful for the help that Mr. John was able to assist me with medicare information. After being bombarded with letters and phone calls you just need someone who can walk you through the confusion. And after getting all the info and the best plan and benefits for what i needed. I am glad that He was there for me.Thank you so very much,Rose Wright
Steve HenselSteve Hensel
21:08 04 Apr 23
Claeys Group is great to work with. John is truly professional, knowledgeable and makes the entire process flow so much more smoothly than I expected. I would highly recommend him.
Deborah RounsavallDeborah Rounsavall
14:25 07 Mar 23
I changed from my person finance planning group to John for help. Others led me astray. John is very responsive and follows up promptly. Even helped me on the weekend at the end of year to get all my documents in on time so I didn't lose insurance coverage. Explains all the options in a manner that us rookies can understand it. I highly recommend John.
Setella ParksSetella Parks
13:12 07 Mar 23
John's knowledge is invaluable when it comes to navigating the murky water of Medicare plans. He answered all our questions in a manner we could understand and helped us compare benefits between plans, services, and providers readily available in our area. I am so happy we called on him to assist us! He handled EVERYTHING professionally and patiently and has followed up to make sure we are good. Highly recommend his 5 star service!
Sherry JonesSherry Jones
21:01 23 Feb 23
John was recommended by my sister-in-law, who spoke very highly of him. He wrote out the differences between policies and explained it step by step to me so I could understand which policy would be best for my needs. He was professional but also down to earth so I could be at ease. He did this at my bed side which was such a blessing for me. I highly recommend John for your Insurance needs.
T/D HT/D H
19:40 20 Feb 23
We were recommended by friends to call John Claeys for our insurance. He came twice to gather information on what we were looking for and returned with information and details. We are delighted to have John Claeys as our agent and would recommend to our friends and anyone else to call John Claeys today.Tom and Debbie
Joyce SandvikJoyce Sandvik
20:32 30 Aug 22
John Claeys came to our house to talk about all aspects of Medicare. He wrote out some information on a notepad as he talked and answered our questions. He gave us the handwritten notes along with printouts of more information specific to my needs. My husband and I took o a few days to discuss the options. John took a list of my medications and researched all the available prescription insurance policies for me. He narrowed it down to the best policy (best prescription prices) for me. It was so easy and I felt confident I was getting exactly what I need when I turn 65. Every September, he will research prescription policies from my updated list of medications to find the best policy for my needs. Thanks to John Claeys for making this transition extremely easy and effortless.
Marilyn ScottMarilyn Scott
09:35 23 Jul 22
John enrolled my husband into Medicare 4 years ago. I knew then I wanted him to help me with my Medicare when it was my time to enroll. John helped me recently. He is very knowledgeable, humble and so patient. He made sure I had the best plan for me. He genuinely cares about his clients. He is the best insurance consultant! I highly recommend John for your Medicare needs!!
James MartinJames Martin
20:31 20 Jun 22
John did a great job of providing many options for my insurance. He is very thorough.
Judy MarkmanJudy Markman
17:02 20 Jun 22
John goes above and beyond to find the best insurance to fit your needs at an affordable price. I definitely recommend!
Dave LemingDave Leming
16:56 20 Jun 22
John was referred to my wife and I as we began to transition to use Medicare as our insurance options. He was very knowlegeable about all things related to government programs and supplemental options as well. I would strongly recommend his services to anyone requiring such support.
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