What You Need to Know About Medicare

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Medicare is complex.

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From late enrollment penalties to coverage ambiguities, deciding the when, what and how about your Medicare coverage can be painstakingly confusing. Fortunately, our employees at Sylvia Group have the expertise to help you understand your options and choose the plan that's right for you.

Who is eligible for Medicare?

Medicare is the health insurance program that provides coverage for most Americans after age 65. Medicare provides medical coverage for people under age 65 who are disabled and entitled to Social Security benefits, people who have End Stage Renal Disease (ESRD), or who are diagnosed with Lou Gehrig’s Disease (ALS). For more information on disability-based Medicare eligibility visit ssa.gov.

What does Medicare cover?

Original Medicare refers to Medicare Part A and Part B Insurance. Original Medicare covers many of your health care costs, including hospitalization, skilled nursing care, outpatient medical care and testing, etc. While Medicare covers a portion of your medical costs, it does not cover everything. Certain services are not covered by Original Medicare, although you may purchase private insurance policies to cover some of these services.

The program offers four parts:

Medicare Part A is a baseline health plan that covers hospital inpatient services, care in skilled nursing facilities, home health visits and hospice care.

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Medicare Part B is a supplemental health plan to cover physician services. Coverage includes physician care, durable medical equipment, physician-ordered supplies, ambulatory surgical services, outpatient hospital care, outpatient mental health services and laboratory services.

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Medicare Part C is also referred to as Medicare Advantage. It is required to cover all services in Parts A and B.

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Medicare Part D provides affordable prescription drug plans.

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What doesn't Medicare cover?

Helps provide for the cost of long-term care beyond a predetermined period that is not covered by health insurance, Medicare or Medicaid. Can include nursing home, assisted living facility, adult day care, or in-home assistance, depending on the policy.

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Medicare does not offer coverage for dental care, including preventative and diagnostic care.
Medicare does not offer coverage for ongoing vision care expenses such as routine eye exams, prescription glasses and contact lenses.
Medical expenses incurred while abroad are not covered under Medicare.
Medicare does not cover cosmetic surgery, but it does cover plastic surgery in some scenarios.

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Medicare Part A and Part B does not cover acupuncture. However, some Medicare Advantage plans may provide additional benefits, including acupuncture.
Medicare covers diagnostic hearing exams ordered by your doctor or other health care provider, but it does not cover costs associated with hearing aids.
While Medicare Part B covers medically necessary treatment of foot injuries or diseases, it doesn't cover routine foot care like pedicures.

Medicare Supplement Insurance

Since Medicare requires you to pay deductibles, coinsurance and co-payments for most services, many people purchase private Medicare Supplement insurance to cover their out-of-pocket expenses. In most states, you can only purchase a Medicare Supplement plan within eight months of your Medicare enrollment date. After that, you may be subject to health underwriting to purchase Medicare Supplement insurance. Medicare Supplement plans are standardized across most states. In Massachusetts, however, there are only two Medicare Supplement plans – Core Coverage and Supplemental 1 Coverage. Massachusetts residents do not need to furnish evidence of good health to purchase Medicare Supplemental insurance after their initial enrollment period, and may change their plan at the annual open enrollment period: October 15 to December 7 each year.

Outpatient Prescription Drugs

Outpatient prescription drugs are not covered by Original Medicare. Under the Medicare Modernization Act of 2006, Medicare beneficiaries must purchase prescription drug coverage referred to as Part D insurance. If you postpone the purchase Part D prescription insurance until after your initial enrollment ends, a late enrollment penalty will apply to your insurance premium. 


Q&A

Q: Is it necessary to shop for a new prescription plan every year? 

A: Given that premiums for most prescription plans are staying about the same or dropping slightly for 2018, you may not need to change plans this year.  However, if your health has changed in the past year – that is, if you are taking more medications, you’ve recently been prescribed medications which are not covered by your plan, or you were notified that your medications are not included in the plan formulary for 2018, for example – then you should review your options during open enrollment.  

Q: What specifically do I need to do if I'm turning 65?

A: Depending on whether you're still working, the answer is, “It depends.” There's no doubt it can be a complicated and confusing process to transition to Medicare — which is why Sylvia Group hosts our annual Medicare webinar every October. You can listen to the webinar and view the accompanying PowerPoint presentation in this video. For an overview of 2018 information regarding deductibles and premiums, including the Income-Related Monthly Adjustment Amounts (IRMAA) for Medicare Part B and Part D premiums, click here.

If you have more questions, contact our Vice President of Employee Benefits and health insurance expert Julie Jennings.

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DISCLAIMER: This information is provided as an overview of Medicare for adults age 65 and older.  Medicare is also the health insurance program for younger disabled adults and those with specific medical conditions. Eligibility requirements, other rules regarding Medicare and details regarding coverage are available through the Medicare website, www.medicare.gov.  

Customized coverage to meet your family's needs

We've been serving needs of families on the SouthCoast and beyond with health insurance for more than 65 years. Because we're an independent agency, we can work with multiple companies to find the policy that best suits your circumstances.

To speak or meet with a Sylvia Group agent, contact Julia Jennings at (508) 742-9234 or jjennings@sylviagroup.com.

Testimonials

  • “By giving, advocating and volunteering, Sylvia Group has proven they are dedicated to our community. Whether they are volunteering at one of our Day of Caring events or working with us to provide affordable health insurance and benefits to our employees, Sylvia Group does whatever they can do to make a difference for United Way of Greater New Bedford. The team at Sylvia Group is a trusted group of dedicated professionals, and we thoroughly enjoy working with them.”

    – MICHELLE N. HANTMAN, President and CEO, United Way of Greater New Bedford

  • “When I needed assistance with my business insurance program, Jill White immediately responded – and, even more important, she listened. She understood the challenges I had with my former agent, and she and the Sylvia Group team designed a program specific to my restaurant’s needs. I’m confident that with Jill’s expertise and personal attention, Fay’s is in good hands. That gives me the peace of mind to focus on what my family and I do best: serve delicious food and provide great customer service while running a successful business.”

    – EVELYN BETTENCOURT, Owner, Fay's Restaurant and Knotty Pine Fine New England Catering

  • “Sylvia Group is very resonsive to our ever-changing needs. Jill White provided us with wonderful support when we moved our child-care program location. She ensured that our coverage was seamless and that it met all of our program, licensing and funding needs. Sylvia Group always assists us immediately when we have questions and/or requests. We knw we are in good hands and that they have the best interest of our YWCA participants in mind. It's a pleasure to work with the staff of Sylvia Group; they are truly customer-focused.”

    – GAIL FORTES, Executive Director, YWCA Southeastern Massachusetts

  • “Thanks to John Beauregard and the professionals at Sylvia Group, our MassMEDIC membership has paid immediate dividends. Through the BIO Business Solutions® program, Primo Medical received a significant premium reduction on our Professional Liability policy. In addition, utilizing Chubb as our insurance provider and Sylvia Group as our broker, we’re confident that we have business partners who truly understand our insurance needs, provide outstanding loss control services and continue to work with us to lower our total cost of risk.”

    – CHRISTOPHER LAPLANTE, Chief Financial Officer, Primo Medical Group

  • "Getting the right insurance to guard against risks is absolutely critical for nonprofits, as well as other businesses; dealing with a costly claim could force a nonprofit to shut down permanently. Going with the Sylvia Group, we made the right decision and have never looked back. They have a thorough knowledge of nonprofits, where risks can oftentimes be more complex. They have gotten to know our mix of services, evaluated our insurance needs and designed an insurance program around our specific insurance coverage needs — allowing us, on a tight budget, to purchase the right amount and type of insurance at the best value. Sylvia Group staff have built strong, personalized helping relationships with our staff. I can sleep at night knowing they make sure that our insurance policies are adequate to cover our risk exposures. I have recommended, without hesitation, the Sylvia Group to my colleagues working in both the nonprofit and for-profit arenas."

    - MARIA A. ROSARIO, Executive Director, NorthStar Learning Centers, Inc.

  • “Sylvia Group is an attentive, professional and knowledgeable insurance agency. They are familiar with the ever-changing rules and regulations when it comes to independent, nonprofit schools., and John Beauregard always goes above and beyond for Friends Academy. Whether it is something small, like registering a new school vehicle, or something bigger, like filing a claim after our greenhouse was destroyed by a hurricane, he treats every question and every claim with utmost importance. Sylvia Group is invested in our program as well; John sponsors and participates in our yearly golf tournament. Sylvia Group is an exceptional insurance company that I would recommend to all my cohorts.”

    – KATHERINE FURTADO, Chief Financial Officer, Friends Academy

  • “The Sylvia Group team provides a multitude of services in all aspects of employee benefits. The team's dedication to their clientele is apparent through their willingness to provide trainings in your office, at their business and through valuable webinar resources. They are readily available to answer questions and help with any issues that may arise. CMHS, Inc. appreciates the relationship that we have enjoyed with the Sylvia Group throughout the years.”

    – JOHN WINTERHALTER, President, Comprehensive Mental Health Systems, Inc.

  • “I want to thank you for this incredible resource, ThinkHR. We will be accessing it frequently and appreciate Sylvia Group making this available to Advanced Eye Centers.”

    - PAUL C. ABRANTES, Executive Director, Advanced Eye Centers

  • “I love your staff. In the first three or four weeks after we moved over to Sylvia Group for our insurance, I have had more communication and attention from them than I had in the seven or eight years we were with our former agency! You have a great team.”

    – PAT CASSAN, Ocean Explorium

  • “I just wanted to take the time to recognize what a remarkable job Danielle Andre is doing. I cannot thank her enough for her time, her kindness and her willingness to make sure I’m comfortable with all the necessary changes that occurred from an insurance standpoint. As a whole, every Sylvia Group staff member has been friendly and knowledgeable, but Danielle has certainly gone above and beyond for me.”

    – SHANNON S., Personal Insurance client

  • “I so appreciate Julie Jennings' help with Medicare planning. It is a relief to be able to consult with a knowledgeable professional on insurance issues. I have no idea how people do this without such help.”

    – CHRIS BLACK, Personal Insurance client

  • “Working with Sylvia Group over recent years has taken our insurance issues from 'groans and moans' to 'no problem.' Rose Lopes, our Account Manager, is one of the most responsive people I have ever worked with. She responds immediately to questions or special requests. It is such a pleasure to work with Rose, who does whatever it takes to find a solution to our needs. We are very pleased… She always has our interests in mind.”

    – LYNNE FOLEY, Director of Human Resources, Five Star Companies, Inc.

  • "Sylvia Group is by far the best insurance agency I have ever dealt with, both personally and in my business. They provide customer support that is not found in other agencies. For example, they take a personal interest in their clients, calls are always taken or returned immediately, and during reviews suggestions are made to offer the most cost effective and comprehensive coverage. When claims occur, they have always been there to facilitate the process. It has truly been a pleasure to have them represent me in my insurance needs."

    - WILLIAM N. WHELAN, Chairman, Whelan Associates LLC

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