When it comes to Medicare, there is a lot of inaccurate information out there. Not being informed properly can cause costly mistakes for seniors. To help seniors get their essential health benefits, we share the truth behind some of those common myths about Medicare.
Myth #1: Medicare coverage is automatic once you turn 65
Popular Belief: When I turn 65 I will automatically become eligible for Medicare and they will send me my Medicare card.
Truth: This depends. If you are already drawing your social security benefits prior to becoming eligible for Medicare, then you do not need to enroll; they will automatically enroll you and send your card (always make sure they have your current address on file). Otherwise, you DO NOT automatically receive your Medicare card; Original Medicare (Parts A and/or B) once you become eligible. To get Original Medicare, you must enroll through the Social Security office. You can complete your enrollment online through the social security website, or by calling Social Security at 1-800-772-1213, you can also do it by visiting your local Social Security office in person. If you find that you need assistance, we are always available.
Myth #2: Older eligible adults can enroll into Medicare at anytime
Popular belief: It doesn’t matter when older adults sign up for Medicare, they can do it anytime and everything will be the fine… as long as they are eligible.
Truth: If eligible seniors do not enroll during their Initial Enrollment Period (IEP), they may have to pay higher premiums later for not doing so.
A person is eligible for Medicare when they turn 65 and have worked for at least 10 years, they also may be eligible to get Medicare earlier if they have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
For those aging in, the best time to enroll is during one’s Initial Enrollment Period (IEP), which starts 3 months before their 65th birthday month and goes until 3 months after their birthday month.
Each year from October 15th to December 7th, there is the Open Enrollment Period (OEP). During this time, Medicare recipients can renew, change, or enroll into healthcare and prescription drug plans. There are also other enrollment periods and special enrollment periods one could be eligible for.
Myth #3: Medicare is free
Popular belief: Medicare is a government benefit therefore those eligible do not have to pay anything for it. They’ve already paid for it by paying taxes all those years they worked.
Truth: Yes, Medicare is paid for by a tax funded trust fund; people who have Medicare insurance coverage still may have to pay monthly premiums and co-pays for services and prescription drugs.
Many people can qualify for free Part A and/or Part B premiums IF they meet certain criteria.
Others with low income may be eligible for the Qualified Medicare Beneficiary (QMB) program, which can pay for their Part A and Part B premiums.
- The Qualified Medicare Beneficiary (QMB) program provides Medicare coverage of Part A and Part B premiums and cost sharing to low-income Medicare beneficiaries. In 2017, 7.7 million people (more than one out of eight people with Medicare) were in the QMB program.
(source: Medicare.gov)
Most people are required to pay a Part B monthly premium unless they are eligible for the QMB program.
Aside from the monthly premiums, recipients will usually have to also pay co-pays, co-insurance, or deductible.
Myth #4: Medicare pays for everything medical-related
Popular belief: If it’s related to health or medical care, Medicare will pay for it.
Truth: Medicare Parts A & B will cover most hospital and medical expenses but not all.
Medicare Part C and D can cover expenses and services not covered by Parts A and B, like prescription drugs and other medical fees.
Even with all the different parts, Medicare recipients still must pay any doctor or facility fees that are not covered.
Myth #5: Medicare & Medicaid are only available through the federal government
Popular belief: Medicare and Medicaid are the same, and they are government insurance.
Truth: Medicare and Medicaid are two separate programs and are not all offered and provided by the federal government.
Medicare is health insurance that is available to people ages 65 and older, as well as people under 65 with qualifying disabilities. It is a government program that consists of four different parts; A,B,C, and D but only two of those parts are provided by the government as you can see below.
The 4 parts of Medicare:
Provided by the government (Original Medicare):
- Part A (provides coverage for hospital visits)
- Part B (provides coverage for medical services)
Provided by private insurance companies:
- Part C (also known as Medicare Advantage plans)
- Part D (provides prescription drug coverage)
Medicaid provides health coverage eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by each state and the federal government.
Some people are eligible for both Medicare and Medicaid programs. You would need to apply for each program separately.