Uncover the truth about Medicare by debunking common myths and clarifying its various parts—A, B, C, and D—to help seniors navigate their healthcare options with confidence.

Medicare is a federally funded program for individuals 65 or older and younger people with disabilities designed to help cover healthcare costs. The program is vital in providing access to medical services and prescription drugs. While Medicare offers essential coverage, navigating its parts—A, B, C, and D—can be confusing. Without understanding how the parts function, misinformation can be created. This article will debunk common myths surrounding Medicare and provide clarity to seniors.

Myth #1: Medicare Covers All Healthcare Costs

A common misconception is that many people believe Medicare covers everything, but coverage gaps exist. The reality is that Medicare only covers certain aspects of healthcare, such as hospitalization, outpatient services, and prescriptions. Even with this, additional coverage, including Medigap and Medicare Advantage plans, may be necessary.

Medicare does not typically cover routine dental, vision, hearing, and long-term care services. For many people, this comes as a surprise. Preparing to plan for these services not covered when you transition to Medicare is a good way to avoid gaps in coverage.

Myth #2: Medicare Advantage is the Same as Original Medicare

Original Medicare and Medicare Advantage are two different ways to receive Medicare benefits. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Private insurance companies provide Medicare Advantage (Part C), which includes all parts of original Medicare (Part A and B) and may offer prescription drug coverage. Some key differences include network restrictions and additional benefits. Many people think that you can see any provider with your Medicare plan.

For Medicare Advantage, this is not true. Instead of Medicare’s network of providers, Advantage plans typically come in the form of HMO or PPO, where you have specific doctors, hospitals, and providers you can use. Advantage plans also usually include dental, vision, and hearing benefits. Knowing the differences between the two can help determine the best option for an individual and their needs.  

Myth #3: You Can Only Enroll in Medicare Once

Many people believe that turning 65 is your only opportunity to enroll in Medicare. While this is true for most, there are several enrollment periods to get Medicare Part A and B:

• Initial Enrollment Period: 3 months before your 65th birthday, the month of, and 3 months after your 65th birthday.
• General Enrollment Period: January 1st – March 31st each year.
• Special Enrollment Period: If you didn’t sign up when you were first eligible because you were covered under a large group health plan and based on current employment, you can get Part A and/or B during the eight months that begins the month after employment or coverage ends, whichever happens first.

Beneficiaries who do not utilize one of these enrollment periods risk facing late penalty fees. It is important to stay informed about the enrollment windows to ensure coverage and avoid incurring more costs.

Myth #4: You Don’t Need to Review Your Medicare Plan Annually

Medicare plans, benefits, premiums, and formularies change yearly. Reviewing your Medicare plan each year can help to ensure that your coverage is the best, most cost-effective option. Not all beneficiaries choose to make a change, but failing to at least review coverage can result in missing out on additional coverage, benefits, or savings.

A good time for beneficiaries to review and make a change to Medicare Advantage or Part D plans is during the annual open enrollment period every October 15th – December 7th. Benefits typically do not change for Medigap plans since they are standardized, but rate increases may occur, so most people will rate shop to see if they can save money on their premiums.

Conclusion

Highlighting common myths about Medicare is critical for ensuring individuals make informed decisions about their healthcare. These myths about coverage, networks, enrollment, and changes to Medicare lead to confusion and lack of planning. Individuals on Medicare or preparing for Medicare should research the necessary information and seek guidance from advisors or other resources to maximize their coverage.