After a lifetime of working, raising a family, and paying your taxes like the good citizen you are, it’s time to reap the benefits—Medicare benefits to be exact.
Whether you’re a current beneficiary or planning for your future, don’t let the myths of Medicare coverage lead you to miss out on benefits. We’re setting the record straight on 10 common misconceptions about Medicare, so you can make informed decisions about your healthcare coverage. Ready to demystify Medicare? Contact Wanda and her team today for personalized guidance!
Myth #1: You’re automatically enrolled in Medicare when you turn 65.
Getting Medicare coverage is not a “turn 65 and BOOM–you’re enrolled in Medicare” scenario. Only if you are already receiving disability benefits, Social Security or Railroad Retirement Board benefits when you turn 65 will you automatically be enrolled in Original Medicare (Parts A and B). Otherwise, you’ll need to verify your eligibility, completing your initial enrollment for Medicare through the Social Security Administration. Your Medicare Initial Enrollment Period begins three months before your 65th birthday, includes your birthday month, and continues for three months after your birthday month.
Rethink this myth as “turn 65 and you’re now eligible for Medicare.”
Myth #2: You can enroll in Medicare at any time.
Many people believe that if they’ve turned 65, they can enroll in Medicare at any time, whenever they want. Not true.
There are specific enrollment periods for Medicare, starting with your Initial Enrollment Period that has a window of seven months (as explained in Myth #1). You then have annual enrollment periods when you can change your plan if you are unhappy with your present plan. If you have other insurance coverage when you turn 65 (e.g. through an employer plan or a spouse’s plan) you may defer your Medicare coverage and be eligible for a Special Enrollment Period (SEP) later when that existing coverage ends. Missing your Medicare enrollment timelines and deadlines can result in premium penalties, some of which you’ll pay for the life of your Medicare coverage.
Myth #3: Medicare comes from the government.
Yes, Medicare is a federal health insurance program, administered by the Centers for Medicare and Medicaid Services (CMS), providing coverage to individuals aged 65 and older, as well as to those with certain disabilities.
This government-funded and managed Medicare (Original Medicare) has two parts: Part A covering hospital insurance and Part B covering medical insurance. If you elect Original Medicare, your Part A and Part B coverage is administered by the federal government.
Medicare Advantage Plans, also known as Medicare Part C, are offered and managed by private insurance companies. Medicare pays the insurance company to provide Medicare’s benefits, and healthcare services are coordinated through the private insurer’s plan. Medicare Advantage Plans provide Part A and B coverage, while also including Part D prescription drug coverage and often additional benefits like dental and vision coverage, wellness and fitness programs.
Myth #4: Medicare does not cover prescription drugs.
This myth is partly true. Medicare Part D prescription drug coverage is not included in the federal Original Medicare program. All Part D prescription drug plans are offered by private insurance companies and supplemented by federal Medicare.
If you elect the federal Original Medicare, you’ll need to get a standalone Part D plan through a private insurer. If you go with a Medicare Advantage Plan, your Part D prescription drug coverage will most likely be bundled into that plan, along with your Part A and Part B coverage, plus additional benefit offerings (e.g. vision, dental, wellness, fitness).
Medicare does offer supplemented prescription drug coverage, but your coverage will come from a private insurer and you’ll most likely be paying something for your prescription drugs.
Myth #5: Medicare is free.
Because Medicare is a federal program designed to provide medical coverage to seniors and individuals with certain disabilities, many people believe it is a free social service. That is not quite true.
Medicare Part A (hospitalization coverage) is free for most people, as anyone who worked and paid Medicare payroll taxes for ten or more years qualifies for premium-free Part A coverage. However, Part B medical coverage has premium, deductible, and coinsurance rates that are set annually, based on income according to the Social Security Act. For 2024, the standard monthly premium for Medicare Part B is $174.70 with an annual deductible of $240. Medicare Part B then pays 80% of healthcare costs with you responsible for the remaining 20%.
Medicare Part D and Medicare Advantage Plans from private insurers have various premiums and different cost-sharing requirements, based on the coverage and features of the plans.
While certain parts of Medicare are free and supplemented for lower costs, there will still be monthly premium and out-of-pocket costs based on the parts and plans you choose.
Myth #6: Medicare covers all healthcare services and costs.
Like the “Medicare is free” myth, many people mistakenly believe that Medicare will meet (and pay for) all their healthcare needs.
Medicare doesn’t cover everything, and which healthcare services are covered depends on the type of plan and the “parts” of Medicare you elect. For example, Medicare Advantage Plans offer more benefits and coverage, like dental, vision, and hearing services. Federal Medicare does not offer or cover these.
Many people mistakenly believe that Medicare Part A hospitalization covers assisted living. It does not cover this “custodial care” – the long-term care provided by assisted living homes for individuals who can no longer live on their own.
Thinking Medicare will cover “all” healthcare needs or not having the right “part” to cover your needs can leave you uncovered, facing additional premiums and out-of-pocket costs.
Myth #7: Medicare Advantage plans are expensive.
Many people see Medicare coverage as either for “the haves” or “the have nots”. They believe Original Medicare is “basic” coverage from the federal government, providing only hospitalization and essential medical insurance, and that Medicare Advantage Plans from private insurers offer more options and better coverage for those who can afford to pay more.
The reality is there are scores of Medicare Advantage Plans from various providers offering a variety of coverage choices at different price points. And while Medicare Part A is free for most people, Medicare Part B has a premium and deductible.
Comparing Original Medicare to Medicare Advantage (and then comparing those advantage plans to each other) can help you get the best coverage at the best price. You may find that you can “afford” even more benefits than you think.
Myth #8: Medicare and Medicaid are the same.
The idea that federal Medicare is for the “have nots” may stem from the myth that Medicare is the same thing as Medicaid. It is not.
Medicare and Medicaid are distinct programs. Medicare is the federal health insurance program primarily for individuals aged 65 and older, regardless of income. Medicaid is a joint federal and state program providing health coverage to low-income individuals, regardless of age.
Low-income seniors may in fact be eligible for both Medicare and Medicaid, but they must apply for each program separately. Be sure you’re applying to the right program with the help of a Medicare Advisor from Wandacare.
Myth #9: Medicare is the same across the country.
Medicare is a federal health insurance program, so the benefit coverage is the same in every state, right? Not exactly. While the basic structure of Medicare is consistent nationwide, there are variations in plans, coverage, and costs from state to state—even from zip code to zip code!
While Original Medicare allows you to see any provider in the U.S. who accepts Medicare, most Medicare Advantage Plans have a set network of providers you choose from. If you’re relocating, you’ll want to check your plan, as a move can change your coverage and put your provider out of network.
Myth #10: Medicare covers healthcare abroad.
Planning on traveling the world in your retirement years? Your Medicare coverage does not travel with you.
There is no international medical coverage through Original Medicare. It only provides for limited coverage for emergencies abroad and will not cover treatments or routine care from doctors outside of the U.S. If you decide to become a global traveler or retire abroad, you may want to look at additional insurance coverage or opt for a Medicare Advantage Plan, as some of these private insurer plans include international coverage.
Expert Guidance from The Wandacare Team in Florida
Have the Medicare coverage you need with the right plan for you, at the best price. The Wandacare Team is here to demystify Medicare with our expertise and personalized guidance.
