When making your way through the most commonly believed Medicare myths, it can become frustrating to try and separate fact from fiction. After all, we live in a world where information is easier to access than ever. In the same breath, we’re also aware of the fact that incorrect information is seven times more likely to spread than information that has been properly fact-checked and verified by reputable sources. In an effort to separate fact from fiction, we’ve decided to dispel 7 frequently encountered Medicare myths below.
Medicare Myth 1: Medicare covers and replaces my regular health insurance.
Many people assume Medicare coverage is like their regular health insurance in that it covers just about everything.
The truth is Medicare covers most basic healthcare needs. It covers hospital stays, lab tests, doctor visits, same-day surgery, and preventive services.
It also covers durable medical equipment, some home health services, short-term skilled nursing care, and hospice.
It doesn’t cover long-term care. And people are often surprised to find out it doesn’t cover most dental care, vision care, hearing services, prescription drugs, or care outside of the United States. It would be best to have additional insurance to cover these needs when traveling abroad.
Medicare Myth 2: Medicare automatically kicks in when I turn 65.
Unless you are currently receiving Social Security or Railroad Retirement Board (RRB) benefits. You don’t need to do anything.
You’ll get a ‘Welcome to Medicare’ packet three months before your 65th birthday.
However, if you aren’t getting these benefits at least four months before you turn 65, you have to enroll at that time actively. Enrollment in Part D, Medigap, and Medicare Advantage plans is voluntary.
Medicare Myth 3: I won’t qualify for Medicare due to my poor health.
Medicare coverage is a function of Social Security benefits, not your health.
You cannot be denied coverage due to a pre-existing condition. It can’t raise your rates due to poor health, either. It is the same with Medicare Advantage plans too.
However, Medigap coverage gets tricky. You can buy a Medigap plan regardless of your health status if you sign up during your Medigap open enrollment period. However, if you miss signing up during this time and want to buy Medigap later, insurance companies can reject your application. If they accept you, they may end up charging you more.
Medicare Myth 4: I don’t qualify for Medicare since I was never a working professional.
The truth is you qualify if you are 65 years or older and a U.S. citizen or legal permanent resident.
Your work record determines your cost for Part A.
To get Part A premium-free, you must have paid Medicare payroll taxes for ten years or 40 yearly quarters.
People who pay this tax for 30-39 yearly quarters will pay a discounted premium.
People who pay the tax for less than 30 yearly quarters will pay the entire premium.
But what about a non-working spouse? You can qualify for Part A premiums under your spouse’s work record when you turn 65. After that, however, your spouse needs to be at least 62 years old.
Medicare Myth 5: Medicare and Medicaid are one and the same.
It’s easy to confuse the two, and many people do. They are both government healthcare programs.
Medicare falls under the Federal Government.
Medicaid is a joint program between the Federal Government and the states. It provides free or low-cost healthcare for low-income individuals, families, pregnant women, and people with disabilities.
To complicate matters, it’s possible to qualify for both Medicare and Medicaid. This is dual eligibility. It expands your coverage to include things like long-term care. It also covers most of your healthcare costs.
Medicare Myth 6: Medicare costs are the same for everyone.
Out-of-pocket costs under Medicare include premiums, deductibles, coinsurance, copayments, or copays.
Your premium for Part A (Hospital Insurance) depends on your Medical payroll tax status.
Your premium for Part B (Medical Insurance) depends on your income.
There is a standard Part B premium that everyone has to pay. The higher your income, the more you will pay above the standard premium.
The deductibles and coinsurance for Part A and Part B are the same for everyone.
The out-of-pocket costs for Part D, Medigap, and Medicare Advantage depend on your plan. However, people with higher incomes will pay higher premiums for Part D.
Medicare Myth 7: Medicare is healthcare for free.
MYTH, for the most part. Part A (Hospital Insurance) is free for many people.
You would get Part A for free if you or your spouse paid Medicare payroll taxes for a minimum of 10 years.
Other people will either pay the total monthly premium or a discounted monthly premium, depending on their Medicare payroll tax history.
All other parts of Medicare come with a monthly premium. This includes Part B (Medical Insurance), Part D (Prescription Drug Coverage), and Medigap (Medicare Supplemental Insurance). Part C (Medicare Advantage) plans may also charge an additional monthly premium.
If you want to explore more about Medicare and senior insurance, you can reach out to Innovative Broker Partners, or read the following blog that provides more information here. As part of our trusted coalition here at Senior Resource Connectors, they will be able to guide you on the next best steps for your new journey. Alternatively, get in touch with our clinical concierge at no cost to you for the best referral within our trusted network of companies.
Our mission at Senior Resource Connectors is to provide Arizona seniors and their loved ones easy access to the most trusted and highly professional resources for care as they encounter the many physical and emotional challenges of aging today.
