You may find yourself asking—what do I need to know about Medicare? Medicare is a complicated and important program currently serving over 50 million Americans 65 years of age or older. Unfortunately, misconceptions about Medicare are common and can lead to confusion, disappointment and poor decisions. Below we bust 5 of the most common Medicare myths to make sure you get the best possible care to live your healthiest life.
Myth #1 Medicare is free
Many people are under the mistaken impression that once they reach 65 years of age their health care expenses will be fully covered by Medicare. Unfortunately this isn’t the case and there are many potential costs for people who only have Original Medicare coverage.
It is true that the majority of people will qualify for Medicare Part A—inpatient hospital care—without paying a monthly premium. Most people will need to pay a monthly premium in order to qualify for Medicare Part B, which covers doctor’s visits and other outpatient care. As of 2020 this amount was $144.60 or higher based on previous income, usually taken directly from your social security benefit each month.
Even if you have Original Medicare—which includes Parts A & B—you will likely have additional out-of-pocket expenses, because Medicare typically only covers up to 80% of the total costs of these services. There are also additional copays and deductibles to consider. Many people sign up for a Medicare Supplemental Insurance policy in order to defray these expenses and keep their health care costs more stable.
Myth #2 You will be automatically signed up for Medicare
Many people assume that they will automatically be enrolled in the Medicare program when they turn 65 years old. This is not always the case. It is true that if you choose to file for Social Security or Railroad retirement benefits before the age of 65 you will typically be automatically enrolled in Medicare parts A and B. If you choose to delay receiving your Social Security benefits or don’t receive them for some other reason you may need to sign-up for Medicare. If you are over 65 years old or within three months of turning 65 you can visit the Social Security Administration website to enroll in Medicare coverage.
Myth #3 Pre-existing conditions will disqualify me from coverage
By law, those who qualify for Medicare based on age will be accepted, regardless of pre-existing conditions – that is, a health problem you had before the date that new health coverage starts. Medicare Advantage plans are also not allowed to refuse coverage or charge you more based on your current health status (with the exception of end stage renal disease, which will change in 2021). Medicare Supplement Insurance plans must accept all applicants and offer them the best rates during the 6-month open enrollment period, but are allowed to charge higher rates or deny coverage based on medical status after that. Your initial open enrollment window is a 6-month period that begins 3 months before your 65th birthday and ends 3 months after your turn 65.
Myth #4 Medicare covers everything my doctor prescribes
Many Medicare beneficiaries who may be used to having more comprehensive health coverage are surprised by the services and equipment that Medicare doesn’t cover. This includes routine dental care and dentures, hearing exams or hearing aids, routine vision care and glasses, routine foot care, long-term care and most prescription drugs. There are several alternative health services that Medicare won’t cover as well including acupuncture, acupressure, massage therapy or other homeopathic treatments. Medicare also will not cover emergency health care outside of the United States and territories. When in any doubt it is best to query the Medicare website to find out if a service or item is covered.
Myth #5 I can enroll in Original Medicare at any time
You are given 7 months—known as the Initial Enrollment Period or IEP—when you first turn 65 and become eligible for Parts A and B to enroll in the Medicare program. If you don’t enroll for Medicare Part B during this period you may incur future penalties if you enroll later, unless you have comparable coverage through an employer or other source.
Individuals who choose to delay enrollment in Part B and don’t have other qualifying coverage may be subject to a late enrollment penalty of 10% for each 12-month period they could’ve had coverage, but didn’t sign up. These penalties will be in effect for the entire enrollment period. There are also penalties associated with delaying enrollment in Part D prescription drug coverage. When calculating whether or not to postpone applying for Medicare coverage is it wise to consider these potential penalty fees.