17 Common Medicare Myths Debunked

Many Medicare-related myths and misconceptions are floating around—perhaps you’ve come across information on social media or in a conversation and wondered, “Is that true?” You have the right to get accurate information about your health insurance and Medicare coverage options.

According to a Nationwide Retirement Institute survey conducted in 2018, even though 86% of older adults are enrolled in – or plan to sign up – Medicare coverage, a whopping 72% wish they had a deeper understanding of the Medicare program. The study also discovered the following Medicare myths:

  • 53% were unaware that Medicare Part B is not accessible, even if they had worked and paid Social Security income taxes for ten years or more.
  • 23% were unaware that Medicare enrollment has a time limit and a specific period.
  • 29% were unaware that Medicare costs aren’t the same for everyone. 

Other common myths include individuals believing that Medicare covers everything and that Medicaid and Medicare are interchangeable. Let’s discuss some of these Medicare myths and misconceptions in detail. 

Myth# 1: Medicare Part B Coverage is Free

If only that were correct! Part B of Medicare coverage is not free. Premiums, deductibles, copays, and coinsurance may be paid out of pocket, as with any health insurance plan.

In reality, no component of Medicare is entirely free. While you may be eligible for premium-free coverage under Part A, you may still be subject to a copay, deductible, and coinsurance. Medicare Advantage (Part C) plans may have low or no premiums, but they also have other costs. Moreover, you may need to pay insurance premiums if you have Part D coverage. 

Myth# 2: You Can Sign up for Medicare at any Time

False! You can register for Medicare if you meet certain requirements and for a specific period. There are rules and guidelines for each of these enrollment periods, and failing to follow them may result in financial penalties.

Most individuals qualify for Medicare when they reach the age of 65; however, you can also become eligible through qualified disabilities and other medical conditions. You will have a 7-month IEP (Initial Enrollment Period) to enroll in a Medicare plan based on your age and disability.

What is the Medicare Initial Enrollment Period?

Most people become eligible to enlist in Medicare plans for the first time three months before their 65th birthday. This is the start of your IEP (Initial Enrollment Period), which lasts for seven months. If you enroll through disability, you will have an initial enrollment period after receiving disability benefits for 24 months. And if this occurs before the age of 65, you will get another one when you reach that age.

Special Circumstances: Medicare Coverage when Working Past 65

The only exception to the rule mentioned above is for individuals who work past 65 and can delay Enrollment because they have creditable coverage through their employer. They can register in Medicare immediately after losing their company coverage during a Special Enrollment Period if they fall into this category. This period allows them to obtain Part A and Part B coverage within eight months, and they only have the first two months to sign up for Part C or Part D without any penalty.

Myth# 3: Medicare Costs the Same for All

Again, the answer is yes and no. The out-of-pocket costs for Medicare coverage include deductibles, coinsurance, premiums, copayments, and copays. Your premium costs for part B coverage depend on your medical payroll tax status. Also, your Part B premium is determined by your income, and everyone pays a standard Part B premium. The higher your income, the more you will pay in addition to the standard premium. The coinsurance and deductibles for Parts A and B have always been the same. The amount you pay out-of-pocket for Part D, Medigap, and Medicare Advantage depends on the program you select. On the other hand, individuals with higher incomes will pay higher Part D premiums.

Myth #4: Medicare Insurance Covers Everything

When people say “Medicare covers everything,” they refer to Medicare Parts A and B. But the fact is Medicare Part A is “hospital insurance” and only covers hospital stays and related inpatient services. Part B coverage is medical insurance, which typically covers physician and outpatient consultations and associated services. 

Medicare Part A and Part B plan don’t cover the following things:

  • Prescription medications
  • Dental, hearing, and vision care services
  • Fitness
  • Special benefits such as coordinated care or transportation for specialists appointments.

These are just some of the health services that Parts A and B do not cover. The prescription drug plan will require you to purchase a Part D stand-alone coverage in addition to Part A and Part B or enlist in a Medicare Advantage policy that provides prescription drug coverage. Other benefits are only available through Medicare Advantage plans, and each program differs in terms of what and how they cover benefits.

Myth# 5: Medicaid and Medicare are the Same

This is one of the most common Medicare myths, and it’s not true. Both Medicaid and Medicare are government-funded programs. These programs assist people in paying for medical care services. But is that where the connections end?

Medicare is typically reserved for elderly or disabled persons and is designed for people with low incomes and resources. The federal government manages Medicare, and states govern Medicaid insurance programs. The federal government sets eligible income and resource levels, but each region determines what counts when calculating this for an individual. 

Applicants who qualify for both Medicaid and Medicare are referred to as “dual-eligible. If you get approved and sign up for both programs, they might be able to cover most of your medical care costs. Find out more about being dual-eligible.

Myth# 6: Medicare Costs and Coverage will Remain Unchanged

The truth is that Medicare examines medical care costs and makes necessary changes each year. Often, the cost of deductibles and premiums goes up. They do, however, occasionally fall. For example, the company predicts the average Medicare Advantage premium will plunge by 14% in 2020. Health insurance can also vary from year to year, particularly with Medicare Advantage and Part D plans. Each year, Medicare and your current plan will send you notices about your costs and coverage if you have supplementary coverage. Open Enrollment is the time to check this information and make adjustments if required.

Myth# 7: Medicare Coverage is Automatic when Turning 65

This is another myth with a yes and no answer. If you already receive Railroad Retirement Board (RRB) and Social Security benefits, you will be automatically enrolled in Part A and Part B coverage. You are not required to do anything. Moreover, you’ll receive a ‘Welcome to Medicare’ packet three months before your 65th birthday. However, if you aren’t receiving these benefits at least four months before you reach the age of 65, you must be actively registered at that time. Enrollments in Medicare Advantage, Medigap, and Part B coverage are voluntary.

Medicare Myths# 8: I can’t Qualify for Medicare Program Because I’m in Poor Health

Health insurance is the function of Social Security services, not your health. Medicare cannot refuse coverage because of pre-existing medical conditions. It also cannot increase your premiums rates due to poor health. The same is true for Medicare Advantage or M.A. plans. Nevertheless, Medigap coverage becomes complicated. You can purchase a Medigap policy regardless of your medical status if you enroll during your Medigap open enrollment window. If you do not sign up during this period and then try to get Medigap later, insurance agencies may reject your application. If you are accepted, they may charge you more.

Myth 9: Medicare only Covers People Age 65 and Older

The majority of people associate Medicare with health insurance for senior citizens. Nonetheless, certain younger people are eligible for Medicare coverage. This includes applicants who have received Social Security disability (SSD) benefits or certain RRB disability benefits for almost 24 months. People with ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis) can also qualify.

Medicare Myths # 10: I can’t Get Medicare Coverage Because I Never Worked or won’t Work Long Enough

The fact is you are eligible for Medicare coverage if you are 65 or older and a U.S. citizen or authorized permanent resident. Your employment history determines your Medicare Part A costs. To get Part A coverage premium-free, you must have paid Medicare income taxes for the previous ten years or 40 yearly quarters. People who paid this tax for 30-39 annual consecutive quarters will pay a lower premium. Furthermore, people who spent the income tax for fewer than 30 quarters will need to pay the entire premium. So, what about a spouse who does not work? If your spouse is at least 62 years old, you may be eligible for Part A premiums under your spouse’s work record when you reach the age of 65.  

Myth# 11: Medicare Advantage and Medicare Supplement Programs are the Same Things

This is one of the most common Medicare myths, and it’s not correct!

Many people discover that relying solely on Original Medicare (Part A & Part B) is insufficient. You can enroll in either a Medicare Advantage (Part C) or a Medicare Supplement plan to ensure adequate coverage. These are two distinct types of programs.

The Medicare Advantage plan, like an HMO plan, provides benefits not offered by the Original Medicare plan. Some Advantage plans include prescription drug coverage (Part D). With the HMO plan, you have an online primary care physician (PCP) who manages your care and refers you to specialists to keep you healthy. One of the benefits of an HMO plan is having a team behind you to ensure you get the proper care.

Medicare Myths #12: Medicare will Tell me when it is Time to Register

This is not correct.

Medicare will not notify you when it is time to register. Unless you are already receiving Social Security benefits at the age of 65, you should remember to sign up independently. When you enroll for insurance coverage depends on whether you are retiring at the age of 65 or working past 65 and receiving medical care services through your company.   

Medicare Myths # 13: If Your Spouse has Medicare, You are Automatically Enrolled

Not true! Unlike employer-provided health insurance, Medicare doesn’t allow you to get coverage through your spouse. To receive Medicare Part A and B insurance, you must apply for it separately.

Medicare Myths # 14: Medicare doesn’t Provide You Lot of Options

Since the government runs Medicare, some people believe it is a one-size-fits-all design. This is among the most common Medicare myths.

Compared to your company’s coverage, Medicare typically provides you with far more health insurance coverage options. However, you have multiple Medicare plan options when you enroll in the company’s plan. Medicare allows you to tailor your coverage to your specific needs.

For example, do you want a plan that will accompany you on your travels? Would you pay more in monthly installments or more when you go to the doctor? Do you need lifestyle benefits covered by your plan, such as the gym membership?

By 2022, you’ll have access to Medicare services like allowances for counter products, grocery gift cards, and even flex-spending cards for hearing aids, glasses, and dentures. Our advisors will assist you in comparing all available plans and enrolling in the best one for your needs.

Myth# 15: Medicare Covers Long-term Care 

“One common source of misunderstanding is long-term care benefits, such as nursing home care,” says Jane Sung, Senior Strategic Policy Advisor in the AARP Public Policy Institute. “Medicare plan does not provide long-term care, custodial care, personal care, or residential care 24 hours a day, seven days a week.”

Medicare Myths # 16: Only the Federal Government Offers Medicare Plans

It’s not the case. Medicare is a primary health insurance program available to people 65 and older and individuals under 65 with qualifying disorders. Medicare is a federal government program that consists of four elements. However, only two parts are provided by the local government.

The four components of Medicare 

Provided by the federal government (Traditional Medicare)

  • Part A (offers coverage for hospital visits)
  • Part B (offers coverage for medical services)

Private insurance companies offer the following services:

  • Part C (also called Medicare Advantage plans)
  • Part D (includes the prescription drug coverage)

What does it mean to you?

When you reach the age of 65, you can sign up for Medicare to get Part A and Part B coverage from the government. Though, in many cases, this will not be sufficient coverage. To complete insurance coverage, you could enroll in a Medicare Advantage plan (Part C) that includes drug coverage (Part D).

Medicare Myths # 17: It is Complicated

It isn’t necessary. You have a team of professional advisors on your side, so you don’t need to navigate the world of Medicare on your own. We can assist you in understanding your Medicare options during Annual Enrollment and beyond. 

Set up a call with us to discuss your situation and receive free, no-obligation information and guidance on your next steps.

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