10 Common Medicare Myths Debunked

Health Line

3 days ago

There is a lot of information about Medicare, which can lead to various misconceptions or 'myths' about the program. Debunking these myths can help you better understand your options and coverage.
Medicare is a federal health insurance program for people over 65 or who have certain illnesses or disabilities. There are many options when it comes to Medicare plans and coverage.
People may find the various options and enrollment confusing. Explaining some common misconceptions may help you make the best Medicare choices for your circumstances.
Glossary of common Medicare terms
Out-of-pocket cost: This is the amount you pay for care when Medicare doesn't pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments.
Premium: This is the monthly amount you pay for Medicare coverage.
Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments.
Coinsurance: This is the percentage of treatment costs you're responsible for paying out of pocket. With Medicare Part B, you typically pay 20%.
Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications.
Myth 1: Medicare Part B is free
Medicare Part B helps cover outpatient services and treatments. However, there are out-of-pocket costs involved.
Everyone with Medicare is responsible for paying the Part B monthly premium, which starts at $185 and may be higher depending on your income.
You are also responsible for paying the $257 Part B deductible. Once you meet this deductible, Medicare will cover 80% of the approved costs for your care, leaving you responsible for the other 20% of the costs.
A note on Medicare Advantage
If you have a Medicare Advantage (Part C) plan, you are still required to pay the Part B premium, as well as your plan premium. However, your Medicare Advantage plan will set its own deductible.
Myth 2: I can enroll in Medicare whenever I want
You are eligible to enroll in Medicare when you turn 65 years old. You have an initial enrollment period that runs for 7 months, beginning 3 months before your birthday and ending 3 months after. During this time, you can enroll in any plan.
Medicare also has an open enrollment period from October 15 to December 7 each year. During this time, you can join, drop, or switch to a new plan.
If you do not sign up for Medicare parts A and B when you become eligible, you may be subject to late enrollment penalties.
Myth 3: Medicare plans are only available through the federal government
There are four parts to Medicare, and only two of them are available through the federal government.
The four parts are:
Part A
Part B
Part C (Medicare Advantage)
Part D
Part A and Part B make up Original Medicare, which is provided by the federal government. The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program, while the Social Security Administration (SSA) processes your enrollment.
Medicare Advantage (Part C) and prescription drug coverage (Part D) are provided by Medicare-approved private insurance companies. The insurance providers and plans vary by area. You can find plans in your area using the Medicare online search tool.
Myth 4: Medicare covers all of my medical expenses
Medicare does have comprehensive coverage for healthcare. However, there are still out-of-pocket expenses involved.
Original Medicare (parts A and B) also does not include prescription drug coverage. You will need to purchase a Part D plan from a Medicare-approved private insurance company.
Each part of Medicare has its own costs that you are responsible for paying. These include:
premiums
deductibles
copayments
coinsurance
Medicare cost examples
Most people with Medicare Part A do not pay a premium. However, you are responsible for paying the inpatient deductible and the coinsurance for each day you are in the hospital.
$1,676 deductible per benefit period
Days 1 to 60: $0 after the deductible is met
Days 61 to 90: $419 per day
Days 91 to 150: $838 per day while using lifetime reserve days
After day 150: all costs
Everyone with Medicare must pay the Part B premium. The Part B costs include:
Premium: $185 or more, depending on income
Deductible: $257 annually
Coinsurance: 20% of Medicare-approved costs
Myth 5: I will be automatically enrolled in Medicare
The only time you will be automatically enrolled in Medicare is if you are already receiving Social Security benefits when you become eligible.
Otherwise, you will have to go to the SSA website and enroll in Medicare when you become eligible.
Medicare and SSDI
Anyone who is receiving Social Security Disability Insurance (SSDI) is eligible to receive Medicare after 24 months of receiving SSDI.
»Learn more: How to apply for Medicare
Myth 6: Medicare will notify me when it's time to enroll
Medicare won't notify you when you become eligible to enroll. It is up to you to sign up when you become eligible.
Generally, you become eligible to enroll 3 months before your 65th birthday. However, you have until 3 months after your birthday to sign up without late enrollment penalties.
Myth 7: Medicare Advantage and Medicare Supplement plans are the same
While both Medicare Advantage (Part C) and Medicare Supplement Insurance (Medigap) are provided by Medicare-approved private insurance companies, they are separate coverage plans.
Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B), and the plans within the former offer the same coverage as the latter. However, they often come with prescription drug coverage (Part D) and additional benefits not covered by Original Medicare, like vision, dental, and hearing.
Medigap is extra insurance you can purchase from private insurance companies to help cover costs associated with Original Medicare, such as copayments, coinsurance, and deductibles.
You cannot have Medigap with a Medicare Advantage plan. You are only eligible to purchase a Medigap plan if you have Original Medicare.
Myth 8: Medicare and Medicaid are the same thing
Medicare is a federal health insurance program that is generally for people over 65 years old. If you have certain illnesses or disabilities, you may also qualify for Medicare coverage. Since this is a federal program, the coverage and costs are standard no matter where you live, except for Medicare Advantage plans.
Medicare is funded through your out-of-pocket costs and taxes as well as two government trust funds.
Medicaid is a joint federal and state program that helps pay for medical costs for people with limited incomes. The federal government has certain rules all Medicaid programs must follow. However, each state runs its own program, meaning benefits and eligibility requirements can vary from state to state.
People with Medicaid don't typically pay anything for covered medical expenses. However, they may owe a copayment for certain items or services.
Myth 9: Medicare costs the same for everyone
Many Medicare costs can vary. For example, most people do not pay a premium for Part A. However, if you have not earned enough work credits by working and paying Medicare taxes, you can purchase Part A. Depending on how long you have worked, you will pay either $285 or $518 per month.
You may also pay a higher premium for Part B if your income is above $106,000 as an individual or $212,000 as a married couple.
The costs of Medicare Advantage (Part C), Part D, and Medigap all vary based on the plan you choose and the area you live in.
Myth 10: I can't sign up for Medicare because of my health
Medicare will cover you even if you have preexisting conditions. You are eligible for Medicare when you turn 65 years old, even if you have current health issues.
You are also eligible for Medicare if you have certain illnesses or disabilities, like end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Takeaway
There are various misconceptions or 'myths' about Medicare, so it's easy to become overwhelmed and confused.
Understanding the difference between myth and fact can help you navigate Medicare easily and make informative decisions on your coverage.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.