For millions of people in the United States, Medicare is a necessity. And you’re likely to find a lot of resources about it on the web as well. But, again, this is because the subject can be complicated and overwhelming for individuals coming across it for the first time.

The same complexity leads to confusion, later becoming a myth among the population. Since it could be challenging for the new individuals to find the facts about Medicare enrollment, we have compiled a piece.

Here’s the truth about Medicare’s myths so that you can safeguard your retirement savings and budget for future medical expenses accordingly.

Myth 1: Medicare is Free

For many people, Part A (hospital insurance) is free. For example, if you paid Medicare payroll taxes for ten years, you would receive Part A for free. Others will pay the total monthly premium or a subsidized monthly premium depending on their Medicare payroll tax history. 

A monthly premium is required for all other aspects of Medicare Part B (medical insurance), Part D (prescription medication coverage), and Medigap (Medicare supplemental insurance). In addition, Part C (Medicare Advantage) plans also levy a monthly surcharge.

Myth 2: Everyone Pays Same Price for Medicare

The answer is yes and no once more. Premiums, deductibles, coinsurance, and copayments (or copays) are examples of out-of-pocket expenses under Medicare. Generally, your paid Medicare tax status determines your Part A premium, and your income determines your Part B premium. Everyone has to pay an average Part B premium. The more you earn, the more you’ll pay above the usual premium.

Part A and Part B coinsurance and deductibles are the same for everyone. However, part D, Medigap, and Medicare Advantage out-of-pocket payments vary depending on the plan you select. People with more excellent salaries, on the other hand, will pay higher Part D costs.

Myth 3: Medicare Covers Everything, including Long-term Care

Many individuals believe that Medicare coverage is similar to their regular health insurance, covering almost everything. The fact is that Medicare covers the majority of essential healthcare requirements. Essential requirements include hospitalizations, lab tests, doctor visits, same-day surgery, and preventative care are all covered. However, long-term care is not covered. 

People are often startled when they realize that Medicare does not cover dental, vision, hearing, prescription medicines, or outpatient treatment. To cover these expenses, you’ll need supplemental insurance.

Myth 4: Medicare’s Costs and Benefits will Remain Unchanged.

The fact is that Medicare assesses and adjusts the cost of care every year. As a result, premiums and deductibles are frequently raised. They do, however, occasionally go down.

Notably, coverage can also vary from year to year, particularly for Medicare Advantage and Part D plans. Each year, Medicare and your current plan provider will send you notice regarding your costs and coverage, if any. You can examine the provided information and make required adjustments during Open Enrollment if you need.

Myth 5: You Automatically Enrolled in Medicare When Turn 65

Another myth with Medicare is concerning automatic enrollment. The answer is again yes and no. 

You will be directly enrolled in Parts A and B if you currently receive Social Security or Railroad Retirement Board (RRB) benefits. When enrolled automatically, you don’t need to take any action. If enrolled automatically, you’ll get a ‘Welcome to Medicare’ packet three months before your 65th birthday. 

If you aren’t receiving these benefits, you must enroll or consult SSA (Social Security Administration) at least four months before turning 65.

Myth 6: I can Enroll in Medicare Whenever I Want

Many individuals believe that Open Enrollment is the best time to enroll in Medicare. However, it’s not true. You must apply for Medicare during your seven-month IEP. Your IEP covers the month of your birthday, as well as the three months preceding and following it.

Enrolling in Part A is nearly always a good idea. However, you may not need to sign up for Part B straight immediately if you’re still working and have creditable coverage. If you don’t enroll in Part B during your IEP, you’ll have to pay a lifetime penalty when you finally do. And the longer you wait, the more strict the punishment will be. The same applies to Part D.

Myth 7: I Can’t Qualify for Medicare Because I Have Poor Health

Medicare eligibility is determined by your Social Security income, not your health. Due to a pre-existing condition, Medicare cannot reject coverage. It also can’t boost your rates if you’re sick.

The same is valid with Medicare Advantage plans. Medigap insurance, on the other hand, is a little more complicated. You can buy a Medigap plan regardless of your health status, but you must join during Medigap OEP (Open Enrollment Period). If you don’t sign up at this time and then try to buy Medigap later, your application may be denied. If you are accepted, they may increase your fee.

Myth 8: I Can’t Get Medicare Because I Never Worked or Didn’t Work Long Enough

The fact is that if you are 65 years old and a U.S. citizen or lawful permanent resident, you are eligible for Medicare. Your Part A cost is determined by your job history. You must have paid Medicare payroll taxes for ten years or 40 annual quarters to be eligible for Part A premium-free coverage. People who paid this tax for 30-39 consecutive quarters will have to pay a premium of $274 in 2022. People who haven’t paid the tax for more than 30 quarters will have to pay the entire amount, i.e., $499, in 2022. 

And what about if you have a working partner? Can you get the coverage? When you turn 65, you may be eligible for Part A premiums based on your spouse’s employment history if your spouse is at least 62 years old.

You can learn more about eligibility and coverage for a non-working spouse here;

Medicare Eligibility & Coverage for Non-Working Spouse

Myth 9: Medicare Only Covers People 65 Years and Older

The majority of Americans identify Medicare with health insurance for the elderly. On the other hand, certain younger persons are also eligible for Medicare benefits. 

For example, people who have received Social Security disability payments or some RRB disability benefits for the past 24 months are eligible. In addition, ALS (amyotrophic lateral sclerosis) and ESRD (end-stage renal disease) patients may potentially be eligible regardless of their age.

Myth 10: Medicare and Medicaid are the Same

It’s easy to get Medicare and Medicaid mixed up. Both are government-run healthcare schemes. The federal government looks after Medicare. 

However, Medicaid is a bond between the state and federal governments. It supports low-income individuals, families, pregnant women, and persons with disabilities. In addition, you may be qualified for both Medicare and Medicaid, making things even more complex. This is referred to as dual eligibility. It broadens your coverage to include long-term care, for example. It also covers the majority of your medical expenses.

If you are eligible for Medicare coverage and are willing to know what plans will suit your medical needs, you can reach out to our licensed agents specializing in Medicare.