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.


Bill BrannonBill Brannon
16:42 30 May 24
Don McCartyDon McCarty
00:36 07 May 24
Very helpful, friendly, and knowledgeable. Plan pricing was accurate, and I was kept informed throughout the process.
Susan BleuerSusan Bleuer
11:28 02 May 24
John Claeys is a great insurance agent. He is very pleasant and professional to work with and will get you the best insurance at the lowest price. He is quick to return phone calls and resolve issues. We highly recommend him for your insurance needs.
Rick RogersRick Rogers
16:14 01 May 24
If if spent a week studying the options for Medicare and all of the choices that go along with it, I’m sure that I would still be uncertain about what to do. John does a great job of explaining all of the options, including the advantages and disadvantages of each. I recommend him highly without any reservations.
Shari BrockShari Brock
22:12 18 Apr 24
John sat down with both of us and explained everything and answered any questions we had. He researched for the best plans for us. Highly recommend!!
Eric GuvernatorEric Guvernator
03:16 16 Apr 24
With all the endless solicitations I had received as I approached my 65th birthday, I had never expected to feel so comfortable and relieved to have John guide me seamlessly through the process. I couldn’t have asked for a finer experience. Not really having a clue going into our meeting, I left having confidence that I was gifted with the perfect plan as well as an advocate in my corner.I continue to get timely explanations and guidance anytime I send a question on Medicare material.If like me you are approaching this monumental deadline, contact John and let him handle this important process. You will not be disappointed.
Judi CarrollJudi Carroll
23:28 15 Apr 24
John answered all my questions and found me a great plan at an affordable premium.
Lynn SmithLynn Smith
20:41 15 Apr 24
The change to Medicare and supplemental health insurance can be terrifying. John Claeys and The Claeys Group Insurance Services made the process unbelievably simple. John is incredibly knowledgeable and up to date on all of the latest requirements. He explained the process and my options in a very simple and concise way and easily helped guide me in making the best decision for my situation. I cannot imagine navigating this medicare system without him. I also feel confident that he will safeguard and watch my situation in the event of future changes. Knowing that he is watching out for me going forward is the best part of all!
Tena BoneTena Bone
18:06 15 Apr 24
John Claeys has been very thorough with every detail of this important decision for me and my future Healthcare. He has such a sweet and caring spirit. I can't imagine using anyone else for my insurance needs.
Dollene BrownleeDollene Brownlee
15:26 10 Apr 24
John was very helpful explaining different Medicare options
January ShubertJanuary Shubert
13:50 08 Apr 24
Excellent customer service. Professional and knowledgeable. Received what I needed and wanted at a reasonable price.
Melton TimmonsMelton Timmons
23:05 05 Apr 24
John is a great person first. As an agent he is very knowledgeable of the products and services he offers. For every question I had, he provided answers and solutions. I am very comfortable with him and if you need a capable agent, please contact John Claeys.
Rosa MartinRosa Martin
21:53 05 Apr 24
John is a very knowledgeable person in his profession. He has helped my husband, my sister, and myself to find the best affordable insurance for each of us…He made navigating through Medicare a breeze for me. He is willing to help in any way and any time of the day.Thank you John for all your help.
Johnny CoffmanJohnny Coffman
16:33 05 Apr 24
He explained the ins and outs of how Medicare works and clarified the confusion. Highly recommend John Claeys!
Mark BleuerMark Bleuer
22:48 03 Apr 24
John is very professional and courteous. His knowledge and attention to detail is exemplary. I can highly recommend Claeys Group Insurance. He does a great job.
sheila Rhynesheila Rhyne
14:58 03 Apr 24
I have had excellent customer service.Claeys insurance company has helped me for several years now and he does a wonderful job setting me up with the right insurance that fits my needs .I really appreciate the job he does and Thank you again.
Scott GillScott Gill
00:34 03 Apr 24
Highly professional with attention to detail. Felt like John was genuinely interested in matching my needs to the various options.
Karen DeemKaren Deem
21:02 02 Apr 24
John was very pleasant and professional. Medicare can be very confusing. He had all the answers for me.
Beth HamillBeth Hamill
17:52 02 Apr 24
I am so thankful for John's help and kindness...he explains everything so clearly and I feel confident that he is truthful and finding the best plan for me.
Margie FisherMargie Fisher
22:38 13 Feb 24
My husband and I have used John's services for several years, as do many of our friends. At no time has his recommendations let us down. He is kind, patient in making sure we understand our choices and was there for any and all questions afterwards. He would be our ONLY choice when it's your turn to use his insurance services. He will not let you down. What a professional! 🙂
Jerry JonesJerry Jones
02:27 08 Feb 24
John was very helpful in guiding me through the medicare choices. He explained everything thoroughly and answered all my questions.
js_loader
by: