Debunking Medicare’s Biggest Myths

For the approximately 61 million people enrolled in Medicare (1), it can be difficult to determine fact from fiction. We’re here to help you sort through the misinformation and uncover the truths behind the biggest Medicare myths.

Myth #1: Medicare is free.

Let’s start with the biggest Medicare myth of them all. Despite what many people believe, Medicare is not free.

Many people think Medicare is free because of the deductions they’ve seen on their paychecks over the years. It’s true that if you paid payroll taxes for 10 years (or 40 quarters), Medicare Part A (hospital insurance) typically does not have a monthly premium. However, Part B (medical insurance) typically still does, and its premium is subject to change each year. 

Click here for a resourceful article on how much Medicare will cost in 2023.

Myth #2: Medicare covers 100% of your health care costs.

While that would be nice, Medicare does not cover all your health care costs.

Like individual or group health insurance plans, Medicare has deductibles, copays, and coinsurance. Deductibles are subject to change each year. The Part A deductible is per benefit period, so you could incur it more than once in a calendar year. The Part B deductible is an annual limit.

Myth #3: Medicare Advantage members are exempt from paying the monthly Part B premium.

Many Medicare Advantage Plans have a low to $0 premium. You must first enroll in Medicare Part A and Part B before you can enroll in Medicare Advantage and would still need to pay the costs associated with those two parts of Medicare. In other words, in most cases you must still pay for Part B each month. However, some Medicare Advantage plans help pay all or part of your Medicare Part B premium.

Interested in learning more about Medicare Advantage? Call Advise at (833) 923-1869 (TTY: 711) to speak with a Medicare expert today.

Myth #4: You can enroll in a Medigap plan any time.

Delaying enrollment in a Medigap plan when you first become eligible can cost you.

When you enroll in Medicare Part B, you have six months from the effective date to enroll in a Medigap plan without undergoing health screening questions. This window ensures you can get adequate coverage even if you have pre-existing conditions.

After this six-month period, you can still apply for a Medigap plan, but in most states, you will need to meet medical underwriting requirements. Certain health conditions and medications may cause the Medigap provider to charge you more or decline you for coverage.

Myth #5: You can delay enrolling in Medicare if you have coverage through an employer.

You can delay enrolling in Medicare if you have creditable coverage through your employer. Creditable coverage is coverage that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Most plans that offer prescription drug coverage, like plans from employers or unions, must send their Part D eligible members a yearly notice explaining whether your drug coverage is creditable coverage. If your employer has 20 or more employees, you can delay enrolling in Medicare without penalty. If you do not delay enrolling, your employer group health plan (GHP) coverage is your primary insurance and Medicare is secondary. If you do not know if the drug coverage you have is credible, you should contact your plan.

However, if you work for an employer with fewer than 20 employees, Medicare becomes your primary insurance at age 65. This means you should still enroll in both Medicare Part A and Part B during your initial enrollment period, which is October 15 through December 7, 2022.

If you plan on working past age 65, it’s a good idea to check with your employer’s benefits administrator to see how Medicare works with your current plan. If you do not keep creditable employer coverage, you will pay a Part B late-enrollment penalty (LEP) for every 12-month period that you wait to enroll in Medicare. If you do not enroll in Part D or keep creditable employer coverage, you will pay a Part D late-enrollment penalty for any continuous period of 63 days or more after the end of your initial enrollment period for Part D coverage. Generally, the Part D late-enrollment penalty is added to your monthly premium for as long as you have Medicare drug coverage and the amount changes each year.