Medicare myths you need to debunk before you start your journey

When you begin to research Medicare, you’ll notice there’s no shortage of educational resources available — and for good reason. Medicare can be complicated, especially if you’re navigating it for the first time. What’s more, not all information is accurate, which can make things even more confusing. 

 “There's a lot of material out there,” says Jennifer Kehm, a member experience strategist at Aetna®. “You need to filter through the noise to really know what's credible.” Here she identifies six of the most common Medicare myths and explains what you need to know about each of them. 

Myth 1: Medicare is free.

“This misunderstanding does have kernels of truth,” says Kehm. Most people won’t have to pay a premium for Medicare Part A. However, if you sign up for Medicare Part B, you will need to pay a monthly premium.  

If you decide to enroll in a Medicare Advantage plan, you must first sign up for Medicare Part A and Part B. Together, Parts A and B are known as Original Medicare. This means you will pay your Part B premium plus a monthly plan premium for your Medicare Advantage plan. Some Medicare Advantage plans have premiums as low as $0.  

Whether you have Original Medicare or a Medicare Advantage plan, you’ll also be responsible for additional costs. These may include deductibles, copays, coinsurance, prescription drugs or other types of health insurance. 

Myth 2: I can enroll in Medicare whenever I want.

You will be automatically enrolled in Medicare if you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65. Otherwise, you’ll need to sign up for Medicare. You can choose to enroll during your Initial Enrollment Period (IEP). This is the seven-month window of time including your birthday month and the three months before and after it. If you don’t enroll during your IEP, you may face a penalty in the form of higher premiums. The longer you wait, the higher the potential penalties.

To learn more about the Medicare enrollment periods, visit Medicare.gov.

Myth 3: Medicare covers all medical expenses.

Medicare is made up of different parts. Each part is associated with different coverage and costs. And you can combine parts to get the coverage that fits your health needs. 

Part A covers expenses associated with hospital care. Part B includes coverage for doctor visits and other procedures that don’t require an overnight hospital stay. Together, Parts A and B make up Original Medicare.   

Part C, also called Medicare Advantage, offers the same coverage as Original Medicare, and plans may include additional benefits.  These plans are offered  together with your former employer, union or trust. Part D provides prescription drug benefits. You can get Part D coverage in one of two ways. One way is as part of a Medicare Advantage plan. The other is as a stand-alone Prescription Drug Plan (PDP) added to Original Medicare.  

Medicare Supplement plans complement Original Medicare. They help fill basic "gaps" in Original Medicare such as copayments, coinsurance and deductibles.

Myth 4: Medicare Advantage plans always cost more than Original Medicare. 

If you have a Medicare Advantage plan, your costs may be the same as or lower than an Original Medicare plan, according to the Kaiser Family Foundation. These plans are made up of a network of health care providers, which can reduce overall health care costs. In addition, many Medicare Advantage plans have $0 premiums. And there’s a limit on how much you pay for out-of-pocket costs for covered medical services each year. Plans may also include extra benefits Original Medicare does not.

Myth 5: With Medicare Part D, I always pay the same amount for my prescriptions.

A stand-alone Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage will help you pay for your prescription medications. But “the pricing really fluctuates depending on the coverage stage you’re in,” says Kehm. Meaning, you may not always pay the same amount for your drugs. The amount you pay can also vary depending on the pharmacy you use. And it can vary between different Medicare plans.

Myth 6: Medicare is part of Social Security. 

Medicare and Social Security are two separate government-run programs. The Social Security Act was signed by President Franklin Roosevelt in 1935. Medicare came 30 years later, when it was signed into law in 1965 under President Lyndon Johnson. Your eligibility for both programs is usually associated with your age and how long you or your spouse has worked. You may also be eligible for Medicare if you have a certain disability or medical condition. But the similarities generally end there.  

As you embark on your Medicare journey, you’ll want to be sure you understand the facts of the program. That way, you can better assess all of your options and more confidently choose the plan that’s right for you. 

About the author

Noah Hughes is a writer, researcher, and multimedia storyteller. He loves exceptional storytelling and finds his greatest joy in bringing ideas to life for people all around the world. When not writing he spends his time traveling, working on his photography, and eating good food.