7 Medicare Myths and How Not to Fall for Them

There are many assumptions about what is and isn’t covered with Medicare.

This can lead to a lot of contradictory second-hand information, leaving people to miss out on essential details about the program.

Knowledge is power, so we’re busting 7 common myths about Medicare so you can be absolutely prepared when it’s time to participate in the insurance enrollment process.

Myth 1: Medicare Covers Everything

While Medicare’s Part A (hospital insurance) and Part B (medical insurance) cover many of the core components people look for in a health insurance plan, it does not cover everything.

Some noticeable health care components missing in Original Medicare include coverage for prescription drugs, fitness memberships, hearing, vision and dental.

Medicare Part A does cover some dental procedures but under special circumstances. For example, a mouth injury requiring emergency care. However, your standard cavity filling or cleaning would not be covered.

Stand-alone supplemental insurance plans are available to cover your prescriptions, vision and dental needs. Plus, there are Medicare Advantage Plans, which bundle Part A and B and usually include prescription drug coverage and additional benefits.

Myth 2: Medicare Part A is Always Free

Most people won’t have to pay a monthly premium for their Medicare Part A coverage because they’ve already paid for it in a roundabout way.

You qualify for a premium-free Medicare Part A Plan if you meet the following criteria:

• Paid Medicare taxes for at least 10 years
• Your spouse paid your Medicare taxes for at least 10 years
• You qualify to get or are already getting retirement or disability benefits from Social Security
• You are eligible to get or are already getting benefits from the Railroad Retirement Board

If you don’t meet any of the criteria above, you may be able to purchase a Part A plan and pay a monthly premium of $278 or $505 per month starting in 2024, depending on how long you or your spouse worked and paid Medicare taxes.

You will also be responsible for any copays, deductibles, out-of-pocket expenses and monthly premiums with your Part A coverage.

Myth 3: You Can Enroll in Medicare at Any Time After 65

Many people associate Medicare with the age 65, but that doesn’t mean people are automatically enrolled.

Most people will have their first opportunity to enroll in a Medicare plan during their Initial Enrollment Period (IEP). This seven-month period begins three months before the month of your 65th birthday and concludes on the last day of the third month following your 65th birthday month.

So, if your birthday is April 12, then your IEP begins Jan. 1 and ends July 31.

If you did not enroll in Medicare during your IEP, you would have to wait until the next Medicare Annual Enrollment Period (AEP). This enrollment window starts Oct. 15 and ends Dec. 7.

You may be able to enroll in a Medicare plan before your IEP or outside of AEP if you qualify for a Special Enrollment Period (SEP) or have a debilitating disease.

Myth 4: Medicare Will Tell Me When It’s Time to Enroll

Don’t expect a Medicare enrollment reminder or a 65th birthday card from the Centers for Medicare and Medicaid Services. It’ll be on you to remember to enroll in Medicare when the time comes.

Myth 5: If Your Spouse has Medicare, then So Do You

Contrary to many private insurance plans offering the ability to add a spouse or dependent, Medicare enrollment is tied to each person. So, your spouse can enroll in Medicare on their own during their IEP while you’re on your own insurance plan.

On a related note, if you plan on working past age 65 and wish to delay your Medicare enrollment, you need to check out this blog to find out if it’s right for you.

Myth 6: Medicare and Medicaid are the Same Thing

While their names sound similar, these are two different programs.

Medicare coverage provides health insurance for those who meet specific criteria, including people:

• Age 65 or older
• Younger than 65 with qualifying disabilities
• With End Stage Rental Disease (ESRD) or permanent kidney failure that requires transplant or dialysis.

Medicaid programs offer health care coverage assistance for low-income beneficiaries of every age, including families, children, the elderly, pregnant women and people with disabilities. Medicaid is a federal-state program in which benefits vary from state to state.

Medicaid eligibility depends on factors including:

• Household income
• Family size
• Age
• Disability

If you qualify for both Medicare and Medicaid, then you may want to see if a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) is right for you.

Myth 7: Medicare Plans are Only Available Through the Government

This is false. Medicare Parts A and B, known as Original Medicare, are offered by the U.S. Government. However, government-approved private Medicare insurance plans, are available.

Medicare Advantage Plans (Medicare Part C) combine Medicare Parts A and B and often come with additional benefits that you would normally have to purchase separately in addition to Original Medicare.

Medicare Supplement is another government-approved private health insurance plan available to complement your Original Medicare.

If you’re interested in learning about your options, then we’re here to help.

Get the Rest of Your Questions Answered with Ensurem

Ensurem is here to help in various ways with your Medicare journey.

Our Learning Center is updated regularly with new educational resources so you can better understand the different Medicare insurance plans available and blogs designed to help you live a healthier lifestyle.

In addition, Ensurem has a team of professionals who can help you compare insurance plans available in your area to determine which plans and insurance providers meet your health needs. Call the number on this page to speak to a licensed insurance agent.

Are you more of an online shopper? Check out Ensurem’s online comparison tool to see plans in your area. Click here.