There is a lot to understand and many options to consider when it comes to Medicare. Even with over 60 million Americans enrolled, there’s still a lot of confusion about how the program works. Common misconceptions surrounding Medicare can end up being costly, so we’ve put together some truth behind some of the most common myths.
Myth: Medicare and Medicaid are the same thing
While the names sound similar, Medicare and Medicaid are two different programs. Medicare—a federal health insurance program—pays for a variety of health care expenses and services. Depending on your coverage, this could include hospitalizations, physician visits, prescription drugs, preventive services, skilled nursing facility, home health care, hospice care and more. Originally created for people 65 and older, Medicare also covers those under the age of 65 who have a long-term disability.
Medicaid is a state and federal program that provides health coverage for eligible low-income adults, children, pregnant women, elderly adults and people with disabilities, regardless of age.1 In some cases, individuals can be eligible for both Medicaid and Medicare, known as dual eligibility, with both programs working together to provide health coverage at a lower cost.
Myth: Medicare covers all of my expenses
Original Medicare has two parts—Part A (hospital insurance) and Part B (medical insurance). Unfortunately, Parts A and B don’t cover everything. In fact, Medicare only pays about 80% of your Medicare-approved services once you hit your Part B deductible. The other 20% is up to you. Most dental care, hearing services and prescription drugs aren’t covered by Medicare, and additional insurance may be needed. Luckily, there are several options to fill the gaps in your Medicare coverage.
Myth: My prescriptions are covered by Medicare
Original Medicare doesn’t cover all of your prescription drug costs, but Medicare Prescription Drug Plans—also known as Medicare Part D—can help cover the cost of both brand-name and generic prescription medications. A Medicare Part D plan can be purchased as a standalone plan, to supplement Original Medicare or to accompany a Medicare Supplement Insurance Plan.
Another way to get prescription drug coverage is with a Medicare Advantage Plan—also known as Medicare Part C. Medicare Advantage Prescription Drug Plans give you the option to get your Medicare health and prescription drug benefits covered under a single plan.
Myth: When it comes to Original Medicare, everyone is paying the same amount
Premiums, deductibles, coinsurance and copayments are what make up your out-of-pocket costs under Medicare. The deductibles and coinsurance under Part A and Part B are typically similar for everyone, while premiums for both Part A and Part B vary from person-to-person
Myth: Medicare and Medicare Advantage plans are the same
Medicare Advantage plans—also known as Medicare Part C—provide an alternative to Original Medicare. These plans are offered by private health insurance companies and are approved by Medicare. Medicare Advantage plans are legally required to offer at least the same benefits as Original Medicare but often also include additional coverage, such as routine vision or dental benefits, prescription drugs or health wellness programs.
Myth: Since I have Medicare, I have long-term care insurance
It’s easy to assume that Medicare is just like any regular health insurance and covers just about everything. While Medicare covers most basic healthcare needs, it doesn’t always cover long-term care. If you live in a nursing home, you’re likely there for an indefinite stay, requiring daily non-medical assistance, which unfortunately isn’t covered by basic Medicare. We can help you better understand Medicare and its coverage for long-term and hospice care, making sure you have the benefits you need and deserve. There’s no obligation to enroll.
Myth: My Medicare coverage is automatic
The only exception to this myth is that if you are already receiving Social Security benefits, then you’ll automatically be enrolled in Medicare Part A and Part B when you turn 65. If you aren’t receiving benefits, though, then you will have to sign up for Part A and Part B, in addition to any other coverage you might want or need. Enrollment in Part D, Medigap and Medicare Advantage plans is voluntary.
Myth: I can enroll in Medicare whenever I want
Your Initial Enrollment Period is when you should enroll in Medicare. The Initial Enrollment Period is a seven-month window that begins 3 months before the month you turn 65 and ends three months after and it’s important to enroll in Part A during this period. If you are still working, you may not need to sign up for Part B right away. It is worth noting that failing to enroll in Part B during your IEP might cause you to have to pay a penalty when you do sign up. The same goes for Medicare Part D.
Myth: Medicare is going to disappear
Like virtually all federal programs, Medicare is subject to change. The fact of the matter is that no one knows for certain if, when, or how Medicare will continue to evolve. Medicare evaluates the costs of care and makes adjustments every year, so it’s important to understand your specific coverage, premiums and deductibles and that you evaluate your coverage each year to make sure it’s still working for you.
Understand your Medicare Options with SelectQuote
At SelectQuote, we can help you better understand the ins and outs of Medicare and ensure you’re getting all of the available Medicare benefits you deserve. In just minutes, we can compare all the Medicare options available to you. There’s no obligation to enroll.
1 https://www.medicaid.gov/medicaid/index.html
