6 Medicare Myths Debunked: What You Really Need to Know

Posted by Doreen Dann, RN, BSN, MHA
Estimated Reading Time 2 minutes 51 seconds

Navigating Medicare can be tricky, especially with so much misinformation floating around. Whether you’re approaching the age of eligibility or already enrolled, it’s important to separate fact from fiction to make the best decisions for your health and finances. Let’s debunk some of the most common Medicare myths to give you a clearer understanding of what to expect.

Myth 1: Medicare is Free

One of the most widespread misconceptions is that Medicare is entirely free. While Medicare Part A (hospital coverage) is typically premium-free for most people who have paid Medicare taxes during their working years, there are still costs involved with other parts of Medicare.

• Part B (medical insurance) comes with a monthly premium, which varies based on your income.
• Part D (prescription drug coverage) also requires a monthly cost.
• Medicare Advantage (Part C) plans and Medigap (supplemental insurance) may have additional costs depending on the plan you choose.

It’s important to budget for these expenses when planning for retirement.

Myth 2: Medicare Covers Everything

Another common myth is that Medicare covers all healthcare expenses. While Medicare provides broad coverage, it doesn’t cover everything. Original Medicare (Parts A and B) doesn’t include routine vision, dental, or hearing care, and prescription drug coverage.

In addition to these gaps in coverage, Medicare doesn’t pay for long-term care, such as nursing home stays, which many people don’t realize until they need it. To fill some of these gaps, many beneficiaries opt for a Medigap policy.

Myth 3: You’re Automatically Enrolled at 65

Many people believe that they’ll automatically be enrolled in Medicare when they turn 65, but that’s not always the case. You are only automatically enrolled if you’re already receiving Social Security benefits. If you’re not, you’ll need to sign up during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after.

Missing this enrollment window could lead to late penalties, so it’s essential to mark your calendar and ensure you sign up on time.

Myth 4: Medicare Covers Long-Term Care

Medicare will cover a short-term stay in a skilled nursing facility for rehabilitation after an illness or injury, but it doesn’t cover the cost of long-term care, such as a nursing home or in-home care for chronic conditions. If long-term care is a concern, it’s important to look into additional insurance options, such as long-term care insurance, to protect yourself financially.

Myth 5: You Can Enroll in Medicare Anytime After 65

Another misconception is that you can enroll in Medicare at any time after age 65 without penalty. While you can technically enroll during the General Enrollment Period (January 1 to March 31 each year), if you miss your Initial Enrollment Period, you could face a late enrollment penalty. For example, if you delay signing up for Medicare Part B without having other creditable coverage, you could be hit with a penalty that lasts for the entire time you’re enrolled in Medicare.

Myth 6: Medicare Advantage and Medigap are the Same

Medicare Advantage and Medigap are often confused, but they’re two very different types of coverage. Medicare Advantage (Part C) is an alternative to Original Medicare that provides your Part A and Part B benefits through private insurance companies and often includes Part D prescription coverage.

Medigap, on the other hand, is supplemental insurance that helps cover out-of-pocket costs such as copays, deductibles, and coinsurance for those enrolled in Original Medicare. You can’t have both a Medicare Advantage plan and Medigap, so it’s important to know the differences when selecting the right coverage for you.

Don’t Let Myths Affect Your Healthcare Decisions

Understanding the facts about Medicare can save you from costly mistakes and ensure you get the coverage you need. If you have questions or need more information about Medicare eligibility, coverage options, or costs, reach out to us and speak with a licensed insurance agent. We can help clarify your options and guide you through the enrollment process, ensuring you have the best plan for your needs.