As you approach Medicare eligibility or navigate the system, it’s easy to feel overwhelmed by the abundance of information—and misinformation—out there. Many common myths can lead to confusion, costing you time and potentially money. Here, we’ll separate fact from fiction and help you better understand Medicare so you can make informed decisions about your healthcare.
Myth 1: Medicare Covers Everything
Fact: While Medicare provides comprehensive healthcare coverage, it does not cover everything. Original Medicare (Parts A and B) covers hospital and medical services but does not include routine dental care, vision, hearing aids, or long-term care. You may need to consider Medicare Advantage plans (Part C) or separate insurance policies for these services.
Myth 2: Medicare Is Free
Fact: Medicare is not free. Most people do not pay a premium for Part A if they or their spouse have paid Medicare taxes for at least 10 years. However, Part B has a monthly premium (the standard is $174.70 in 2024), and there are additional costs like deductibles, co-payments, and co-insurance. Understanding these expenses is crucial for budgeting your healthcare costs during retirement.
Myth 3: You Can Enroll in Medicare at Any Time
Fact: Enrollment periods are specific. The Initial Enrollment Period (IEP) starts three months before you turn 65 and ends three months after your birthday month. Missing this window could result in penalties and delays in coverage unless you qualify for a Special Enrollment Period due to ongoing employer-sponsored health coverage.
Myth 4: Medicare Part D (Prescription Drug Coverage) Is Not Necessary If You’re Healthy
Fact: It’s wise to enroll in a Medicare Part D plan when first eligible, even if you don’t take any prescription medications. Delaying enrollment can result in a late enrollment penalty that increases your premium permanently. Health needs can change, so having prescription drug coverage ensures you’re protected against high medication costs.
Myth 5: Medicare Advantage Plans Are the Same as Original Medicare
Fact: Medicare Advantage (Part C) plans are offered by private insurers and can include additional benefits like dental, vision, and prescription drug coverage, which Original Medicare does not cover. However, these plans may have restricted networks of doctors and hospitals. It’s important to compare the details of each plan to determine which best meets your needs. Compare Medicare Advantage vs. Original Medicare.
Myth 6: All Doctors Accept Medicare
Fact: While many healthcare providers accept Medicare, not all do. Some doctors have opted out of the Medicare program entirely. Always check with your healthcare providers to ensure they accept Medicare before receiving services.
Myth 7: Medicare Advantage Plans Are Always More Expensive
Fact: Medicare Advantage plans (Part C) can sometimes offer lower out-of-pocket costs compared to Original Medicare. Many plans have $0 premiums and include prescription drug coverage. Costs vary widely between plans, so it’s essential to compare options carefully.
Myth 8: Medicare Covers Prescription Drugs Automatically
Fact: Original Medicare (Parts A and B) doesn’t include prescription drug coverage. For that, you need to enroll in a separate Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage.
Myth 9: Once You Choose a Medicare Plan, You’re Stuck with It
Fact: You can change your Medicare coverage. The Annual Enrollment Period (October 15 - December 7) allows you to switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join/switch Part D plans.
Myth 10: Medicare Automatically Enrolls You at 65
Fact: Automatic enrollment in Medicare only occurs if you’re already receiving Social Security benefits when you turn 65. If you’re not drawing Social Security, you must sign up for Medicare yourself. Missing your enrollment period can result in costly penalties and delays in coverage.
Understanding the facts about Medicare can help you make informed decisions and avoid costly mistakes. Don’t let myths and misconceptions steer you off course. Take the time to review your options, ask questions, and seek out reliable information.
If you’re interested in learning more about Medicare and how to navigate your options, consider taking one of our Medicare classes at GetSetUp. We offer a variety of sessions designed to empower you with the knowledge you need to make the best choices for your health and financial well-being.
Reviewed By: Keith Gilbert