22 Most Common Medicare Myths

Let’s clear up several Medicare myths that are going around right now.

Medicare is really confusing for most people!

Lots of acronyms.  And what’s true for one person isn’t always true for every person.  Which creates a lot of rumors and myths.

Here are 21 of the most common Medicare myths people get wrong.

1. Medigap and Medicare Supplement are different

Medigap and Medicare supplement are the exact same thing.  I know this can be confusing since they are two different words. So most people thing they are different products.

But they are identical and can be used interchangeably.

2. Medicare and Medicaid are the same thing

Medicare is primarily for people who are age 65 or older regardless of income.

Medicaid is for people with a lower income regardless of age.

It’s possible for people to have both Medicare AND Medicaid.  This usually happens when someone is 65 or older and has a lower income.

3. Medicare covers everything

There are some pretty large gaps in Medicare coverage.  If you have just basic Medicare, you are responsible for paying 20% of the medical bills.

And there’s no limit to that 20%!

You pay other costs too for things like prescription drugs, hospitalizations, or even dental cleanings.

4. Medicare is Free

You’ve likely paid into the Medicare system all your life.  Some people are surprised they have to pay a premium for Medicare once they get started too.

Most people don’t pay a premium for Medicare Part A which is your hospital benefits.

But most people do pay a premium for Medicare Part B which is your medical benefits.  The standard amount in 2021 is $148.50 per month.

And these are the premiums for basic Medicare.  We already know there are some large gaps.  So most people take out additional coverage like:

• Medigap/Medicare supplement and prescription drug coverage
• Medicare Advantage

5. Medicare costs the same for everyone

Most people think Medicare costs the same for everyone since it’s a government program.  But that’s not true.

If your income is considered high, you could pay an extra charge on top of your Part B Premium called IRMAA.

If your income is considered low, you may not have to pay a premium at all for Medicare Part B.

Premiums for other plans like Medicare Advantage or Medigap vary depending on where you live.

6. Medicare costs and coverage won’t change

Basic Medicare premiums are reviewed each year and can be increased.  In 2020 the standard premium was $144.60 which increased to $148.50 in 2021.  Not a huge change but also not the same.

The coinsurance for Medicare Part A and your deductibles can also change each year.

7. Medicare coverage is automatic when you turn 65

Many people think they will be automatically enrolled in Medicare when they turn 65.  And for some people, this is true.  But for others, it’s not the case.

So how do you know?

If you are receiving your Social Security or Railroad Retirement benefits then you will be automatically enrolled into Medicare A&B.

But if you have not started those benefits yet, then you will NOT be automatically enrolled.  You will have to apply for Medicare if you want to start at age 65.

8. I have to start Medicare at age 65

Most people are under the impression they must start Medicare at age 65 or face a penalty for the rest of their life.  Again this is true for some people but not all.

If you have health insurance from your or your spouse’s current employer, you may be able to delay Medicare.  It needs to be creditable coverage and they must have more than 20 employees.

But if it meets that criteria, you have flexibility to start Medicare right away or delay Medicare for now.

This is probably the 3rd most common of the Medicare myths I hear each month.

9. You shouldn’t start Medicare until you retire

So you realized you can wait to start Medicare until you retire.  But that doesn’t mean it’s the right decision to make.

I talked to someone this week who is paying $600 per month for their health insurance they get through work.  Plus they have a $5,000 deductible to pay before the coverage ever kicks in.

It makes a ton of sense for him to switch to Medicare.

• He continues working
• Drops his employer health insurance
• Starts Medicare

Which means he continues to work like he wants but now pays less money for better coverage.

If you are able to delay Medicare then we just compare premiums and benefits and let the math decide what to do.

10. I can enroll in Medicare whenever I want

If you miss your chance to enroll when you turn 65, you need to have a special enrollment period to start Medicare.  One example would be losing employer health coverage.

If you don’t qualify for that chance to enroll, you may only be able to enroll one time during the year.  And your coverage won’t start right away either.

So it’s important to take the correction action during your window of time around your 65^th birthday.

11. I can’t qualify for Medicare because I have poor health

Medicare does not ask you health questions.  Your health history has no impact on being eligible for Medicare A & B or how the coverage works for you compared to other people.

12. I’m not eligible for Medicare because I didn’t work long enough to qualify

To be eligible for Medicare Part A, you or your spouse must have worked and paid into the Medicare system for at least 40 quarters (10 years).

So if you OR your spouse meet specific criteria, you can qualify for premium free Medicare part A.

Even if you don’t meet that criteria, it’s still possible for people to pay for Medicare part A similar to how people pay for Medicare Part B.

13. Medicare only covers people age 65 or older

It’s true most people aren’t eligible until they are 65.

But some people are eligible before they turn 65.  They must qualify for Medicare but that can happen for several reasons including:

• disability
• Lou Gehrig’s disease
• End Stage Renal Disease

14. Medicare Advantage and Medicare supplements are the same thing

Unfortunately, this is often the most common of the Medicare myths that exist.

There is no such thing as a zero dollar Medicare supplement!

There are some major differences between Medicare Advantage and Medicare supplements.  Both are good options to consider.

But depending on your priorities, one may be a much better option for you than the other.

15. Medigap/Medicare supplement coverage varies by company

Medicare standardizes Medicare supplements for most states.  They do this using plans with specific letters.

Right now, Plan G is the most comprehensive plan people starting Medicare can buy.  And a Plan G works the exact same way regardless of the company you buy it from.  They cover the same doctors and hospitals because they must be accepted if Medicare is accepted.  They cover the same bills in the same way because Medicare decides what’s covered and how it’s covered.

But the price you pay for the Medicare supplement can vary drastically from company to company.

16. All Medicare Advantage Plans are the same

Since Medigap plans are standardized, Medicare Advantage plans must be standardized too right?

WRONG

Medicare Advantage plans vary greatly from company to company and plan to plan.

Many companies have multiple Medicare Advantage plans you can choose from. Even though they are with the same company, they may cover different doctors.  The premiums you pay and the benefits you receive also vary from plan to plan.

17. I can change plans every year no questions asked

Many people have had health insurance from an employer or through healthcare.gov.  These types of coverage often let you change plans every year.  You don’t have to answer health questions or anything.

This is true for some parts of Medicare.

But not all.

Medicare Advantage and Prescription Drug plans allow you to change without waiting periods or health questions.

But Medigap/Medicare supplements do NOT.

If you want to get a new Medigap plan, then you must pass a health review.  If you don’t have health insurance right now, you must pass a health review plus you may have a waiting period before the plan covers you fully.

18. Medicare Advantage members don’t pay Part B premiums

When you choose a Medicare Advantage plan, you get your Medicare benefits from an insurance company instead of the federal government.

For this reason, many people think they don’t need to pay a Part B premium to the federal government.

This is not true.

The requirements to get a Medicare Advantage plan are:

• Must have Medicare A+B
• Must live in the service area (the county the plan is offered)

So if you don’t pay your Medicare Part B premium, you will lose your advantage plan very soon.

19. You can’t start Medicare unless you receive Social Security Benefits

If you are receiving Social Security benefits, your Medicare premiums will come right out of your benefit automatically.

But what happens if you want to start Medicare now and wait to start Social Security? Can you do that?

YES!

Many people start Medicare every year while waiting to start collecting their Social Security benefits.  The coverage works the exact same way.

The only difference is how you pay your Medicare premiums.

Medicare bills people quarterly if you are not receiving your Social Security benefits.  You have the option of setting up automatic monthly payments if you prefer.

20. Medicare Advantage is less expensive than a Medigap/Medicare supplement

Usually a Medicare Advantage plan’s monthly premium is less than a Medigap.

But that’s not the whole story.  We need to look at total costs instead of just monthly premium.

In 2021, a Medicare Advantage can have a maximum out of pocket limit of $7,550.  That means you could be responsible for paying up to $7,550 in medical bills that year.

A Medigap Plan G leaves you responsible for paying the Medicare Part B deductible.  That’s only $203 in 2021.

$7,550 vs $203 is a HUGE difference in exposure.

So premium isn’t the only thing to compare when looking at costs.

21. I’ll start with an Advantage plan now while I’m healthy, and switch to a Medicare supplement if I need it later

When you first start Medicare, you are guaranteed to be approved for any Medicare insurance plan you want.

But you only have a short window of time where that is true.

After that time period is over, you must pass a health review to get a Medicare supplement.

Unfortunately, when the time comes that you want to switch to a more comprehensive plan is often the exact time when you are unable to pass a health review.  Which means you’re stuck with your current coverage.

22. It costs too much money for professional help

Finally, this is probably the 2nd most common of all the Medicare myths.

I’m an independent insurance agent.  I’ve been licensed since 2009 and every year I have to pass a series of certifications to prove I am staying up to date with current regulations.

My clients do not pay me one penny!

They also don’t pay any extra for my help.

This is because the insurance company you choose to enroll with pays me a compensation for helping you through the process.  But they are not able to charge you a higher premium for working with me.  So if you call that insurance company to enroll, sign up through their website, or work through me you pay the same price.

But I’ll:

• Help you make sense of this Medicare Maze
• Help complete the enrollment process for you
• Provide customer service for claims, concerns, or general questions
• Provide annual reviews to confirm your coverage fits your lifestyle as time progresses

All at no cost to you!

Need help sorting Medicare maze and the Medicare myths that come along with it?

I’m sure this helped clear up some Medicare myths for you.  If you want to finding the right Medicare plan for your unique needs, please:

• call me at 855-712-7316
• email me at Mike@askMedicareMike.com
• click this link to schedule time with me.

Talk to you soon!

Medicare Mike