Medicare Myths Debunked

medicare myths debunked text overlaying image of wooden blocks spelling out the words myths and factsYour Initial Enrollment Period (IEP) is an important time if you’re considering your Medicare options. It’s natural that everyone has their own opinions regarding Medicare and the best coverage. While advice from family and friends can be helpful, when it comes to Medicare, there are a lot of myths passed around. Maybe you’ve come across information on social media or in conversation and wondered “Is that really true?”. You deserve accurate information about your coverage options so we’ve compiled a list of 10 common myths that we’d like to debunk for you.

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Medicare Myths

1.Medicare is free.

There’s a misconception that since Medicare is a government benefit, seniors don’t have to pay for it because it has already come out of their taxes. While that would be great, it’s unfortunately not entirely true. Medicare Part A, or hospital coverage, doesn’t have any premiums. That is as long as you have paid your Medicare taxes for at least 40 calendar quarters. Even so, you still have a deductible and copays. So that part of the myth is kind of true. 

 

However, Part A is the only Medicare product with no premium. Part B, medical coverage, has a monthly premium of $164.90 as of 2023. It’s important to note that the premiums are adjusted annually, meaning some years they increase and some years they’ll decrease. These premiums might also be higher for enrollees with higher income. The good news is that if you’re on Social Security, your Part B premium can be paid directly from those benefits, so while you may not be paying directly out of pocket, you are still paying for it. Additionally, if you choose the Medicare Advantage route you may also have to pay a monthly premium.

2. Medicare covers all healthcare costs.

Medicare does cover a large portion of your healthcare but not everything. Between Part A and Part B most of your hospital and basic medical expenses are covered. 

This includes:

 

  • Hospital care
  • Skilled nursing facilities 
  • Hospice
  • Lab tests
  • Surgeries
  • Home health care
  • Doctor visits
  • Outpatient care
  • Durable medical equipment
  • Some preventative services

 Even with the services it does cover you are still responsible for deductibles, coinsurance, and copays. As you can see there are still several services that you may need that aren’t covered. Such as hearing, vision, and dental care. There is also no prescription drug coverage in Original Medicare (Part A and B). Typically to get those things covered most people will enroll in Medicare Advantage, Medicare Part D (prescription drug coverage), or a Medicare Supplement Plan. Any of those options do provide coverage for the gaps in your Medicare coverage.

3. You are automatically enrolled in Medicare.

This is another myth that is only partially true. If you have been receiving Social Security benefits or Railroad Retirement Board Benefits (RRB) for at least 24 months after you turn 65, then you will automatically be enrolled in Medicare Part A and B. Be aware that even after automatic enrollment, you are responsible for enrolling yourself in either Medicare Advantage, Medicare Part D or any Medicare Supplement Plans. 

 

Now, if you’re not receiving Social Security or RRB, then enrolling is entirely up to you. The best thing to do is to enroll during your IEP, which will begin 3 months before you turn 65 and will end 6 months after your 65th birthday. 

4. I can enroll in Medicare at any time.

This is completely false and can be one of the most detrimental myths to believe. If you don’t enroll during your IEP, you can face enrollment restrictions as well as a penalty. You will then have to wait for the next eligible enrollment period, which is known as the General Enrollment Period (GEP). The GEP lasts from October 15th to December 7th every year. The penalty for waiting is a premium increase of 10% for twice as many years that you were eligible and did not enroll. To make that simpler, If you did not enroll in Part A for 2 years after your IEP then the penalty would apply to your premium for the next 4 years. For Part B, the increase only lasts for the amount of time you did not enroll, so it would only apply for those first 2 years.

 

Now having said that, another way that you can avoid these penalties, aside from applying on time, is if you qualify for a Special Enrollment Period (SEP). To trigger an SEP you would have had to still be working and have credible health coverage through your employer or through your spouse’s employer during your IEP. Once you leave your job or lose the group plan coverage, you then have 8 months to enroll without penalty. Another way you can get an SEP is if you are under 65 and eligible for Medicare due to illness or disability, but have health insurance through a caregiver or spouse’s employer-sponsored health insurance. However, this only applies if their company has at least 100 employees.

 

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5. Medicare costs the same for everyone.

While Medicare offers the same benefits to everyone, the cost is not universal. How long you worked and paid Medicare taxes, as well as your gross income determine your premiums and deductibles. The more you make, the more you will end up paying just like with regular health insurance. Additionally enrolling in Medicare Advantage, or Part D, or any Medicare Supplement Plans will change how much you pay for Medicare. So it varies greatly from person to person depending on their specific circumstances.

6. I can only enroll if I’m healthy.

This is a huge myth, Original Medicare cannot deny your coverage due to illness or a pre-existing condition due to implementation of the Affordable Care Act. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. Once you turn 65 or retire you are eligible for Medicare Parts A and B, period. Also,there are no penalties or premium increases for pre-existing conditions. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. 

7. Medicare Advantage and Medicare Supplement Plans are the same thing.

This is not true at all. They are similar in that private companies offer them but they are entirely different. Medicare Advantage is an alternative to Original Medicare. It may include prescription drug coverage. Medicare Supplement Plans are additional coverage you can buy to fill in the gaps left by your Original Medicare. Additionally, you can buy one or the other but not both. 

8. Medicare doesn’t have as many options.

You may believe that Medicare is a one-size-fits-all program because it’s a government program. However, this is another one of those pesky Medicare myths. Medicare typically provides significantly more health insurance options than your employer’s group coverage. Whereas you may have had only a few plan options to choose from when enrolling in employer coverage, Medicare provides you with dozens of options. Medicare allows you to tailor your coverage to your specific needs.

9. Medicare will notify me when it’s time to enroll.

Obviously you don’t want to be late enrolling in Medicare. Nobody wants to have a penalty added to their premium. Unfortunately, Medicare does not give you an enrollment reminder when it’s time for you to enroll. The good news is that if you have Social Security Benefits or RRB before you’re 65, you will automatically enroll in Medicare Parts A and B. On the other hand, if you don’t have those benefits you have to remember to enroll on your own. So, it’s important that you note the specific times when you can enroll. 

10. I am on COBRA so I don’t need to sign up for Medicare Part B.

COBRA does not count as active employment. To delay Part B enrollment without incurring a penalty, you or your spouse must be actively employed and covered by a group health plan. Additionally, if you are already on COBRA and your Medicare begins, your COBRA status will change when you turn 65. Meaning your COBRA coverage will end. You won’t be eligible to delay Part B without incurring a penalty. You may even experience a delay in the start of your Part B coverage, which could result in a serious coverage gap.

EZ Can Help

Now that you have all the facts it’s time to enroll with the help of EZ. EZ is able to help you enroll in Medicare, purchase a Medicare Supplement Plan, or just help you weigh your options. Our insurance agents collaborate with some of the most reputable insurance providers in the country. They are able to provide you with a free analysis that compares all of the plans that are available in your region. We will discuss your medical and financial needs and then assist you in locating a plan that is tailored to meet those requirements. To start, enter your zip code into the box below. Or give one of our licensed agents a call at 877-670-3602 and we’ll get the ball rolling for you.

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