Debunking Common Medicare Myths: What You Really Need to Know

Medicare is one of the most important health insurance programs in the U.S., providing coverage for millions of older adults and people with disabilities. Yet, despite its widespread use, there are many misconceptions about how it works. These myths can cause confusion and lead people to make decisions that don't fully benefit them. In this blog post, we’ll debunk some of the most common Medicare myths and provide the facts so you can navigate your options with confidence.

1. Myth: Medicare Covers All Healthcare Costs

One of the biggest myths surrounding Medicare is that it covers all healthcare expenses. While Medicare provides substantial coverage, it doesn’t cover everything. There are still out-of-pocket costs like premiums, deductibles, co-payments, and co-insurance.

• Part A covers hospital services, but you’ll need to pay a deductible.

• Part B covers outpatient services, but it doesn’t pay for everything, such as most prescription drugs.

• Part D helps with prescription drug costs, but there are still gaps like the “donut hole,” where coverage is temporarily reduced.

If you want more comprehensive coverage, you may need to consider a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan (Part C), which offer additional coverage options.

2. Myth: Medicare Only Covers Seniors Over 65

While Medicare is primarily known as a program for people age 65 and older, it also covers certain younger individuals with disabilities or chronic conditions. People under 65 can qualify for Medicare if they have a qualifying disability, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

It's essential for those under 65 who are eligible to sign up as soon as they qualify to avoid gaps in coverage.

3. Myth: If I Have Employer Health Insurance, I Don’t Need Medicare

Many people mistakenly think that if they have employer-sponsored health insurance, they don’t need Medicare. However, if you're approaching 65, you need to understand how your employer insurance works with Medicare.

• If your employer has fewer than 20 employees, you are required to enroll in Medicare when you first become eligible to avoid late penalties.

• If your employer has more than 20 employees, you can choose to delay enrollment in Medicare Part B (which covers outpatient services) without penalty.

Even if you stay on your employer’s plan, it’s often a good idea to enroll in Medicare Part A to avoid potential penalties and delays when you eventually need it.

4. Myth: Medicare Doesn't Cover Prescription Drugs

Medicare does not automatically include prescription drug coverage in its original form (Parts A and B). However, you can get prescription drug coverage through Medicare Part D, a plan that works alongside Original Medicare.

Additionally, if you enroll in a Medicare Advantage Plan (Part C), many of these plans include prescription drug coverage, so you may not need a separate Part D plan. Be sure to review all your options and choose what best meets your needs.

5. Myth: Medicare Is Free

Another common misconception is that Medicare is free. While Part A is often free for most people who have worked and paid Medicare taxes for at least 10 years, you still have to pay premiums for Part B (outpatient care), Part D (prescription drugs), and possibly a Medicare Advantage or Medigap plan. The premium for Part B can be as low as $164.90 per month in 2025, but it can be higher depending on your income.

In addition to premiums, there are deductibles, coinsurance, and copayments that vary by plan. It's important to budget for these costs when considering your Medicare coverage.

6. Myth: Once I Sign Up for Medicare, I Can’t Change My Plan

Another misconception is that once you enroll in a Medicare plan, you’re stuck with it. While you can’t change plans outside of the Medicare Annual Enrollment Period (AEP) or specific special enrollment periods, you do have the option to switch your plans during open enrollment.

The AEP typically runs from October 15 to December 7 every year. During this period, you can switch from Original Medicare to Medicare Advantage, change Medicare Advantage plans, or switch Part D prescription drug plans.

Be sure to review your coverage annually to ensure it still meets your needs, as premiums, coverage options, and benefits can change each year.

7. Myth: Medicare Doesn't Cover Dental, Vision, or Hearing

Original Medicare does not cover routine dental, vision, or hearing services. However, these services may be covered under Medicare Advantage plans. Many Medicare Advantage plans offer additional benefits such as dental cleanings, vision exams, and hearing aids.

If you are enrolled in Original Medicare, you’ll need to purchase separate coverage for these services, often through a stand-alone dental or vision plan.

Conclusion

Medicare can be a complex system to navigate, but debunking these myths can help clear up some of the confusion. Understanding what Medicare does and does not cover, when to enroll, and how to best complement it with additional plans can help you make informed decisions about your healthcare. Remember, it’s always a good idea to speak with a healthcare professional or insurance advisor to tailor a plan that fits your needs.

If you’re looking for personalized Medicare advice or help finding the right plan, contact us at Lindbergh and Associates today! We’re here to ensure that you get the most out of your coverage.

Have questions about your Medicare options? Feel free to reach out, and we’ll guide you through every step of the process!