· Alex Cox-Cuzzi · Medicare Basics · 3 min read
Medicare Myths and Facts: What to Know Before You Choose Coverage
From $0 premiums to preexisting conditions, we're clearing up the most common Medicare myths so you can choose coverage with confidence.
Medicare advice can be well meant and still leave out the detail that matters most to you. Here are common myths we hear, along with the facts worth checking before you make a decision.
Myth 1: Everyone must enroll in every part of Medicare at 65.
Fact: Most people first become eligible around 65, but some people with qualifying group coverage based on their or their spouse’s current employment can delay Part B without a late penalty. Whether you should delay depends on how that coverage works with Medicare. Part D has its own rules for creditable drug coverage.
Myth 2: If I have any health insurance, I can skip Part B without a penalty.
Fact: Coverage is not all treated alike. COBRA, retiree coverage, and Marketplace insurance generally do not give you the same Part B enrollment protection as qualifying coverage from current employment. Check before you postpone Medicare.
Myth 3: A $0-premium Medicare Advantage plan costs nothing.
Fact: You generally still pay your Part B premium, and a plan may have copays, coinsurance, and other costs. Compare what you would spend over a year, especially if you visit specialists or need ongoing treatment.
Myth 4: Medicare Advantage and Medigap are the same thing.
Fact: Medicare Advantage is a way to receive your Medicare Part A and Part B benefits through a private plan. Medigap is supplemental insurance that works with Original Medicare to help pay certain costs. You cannot use Medigap to cover Medicare Advantage copays.
Myth 5: My friend’s plan is automatically the best one for me.
Fact: Plans can differ by location, provider network, medication coverage, pharmacy, and cost. Your doctor and prescription lists are a better starting point than someone else’s recommendation.
Myth 6: I take no prescriptions, so I never have to think about Part D.
Fact: Part D is optional, but going 63 consecutive days or more without Part D or other creditable drug coverage after your enrollment period can lead to a late penalty if you enroll later. Your needs may also change.
Myth 7: Medicare pays for any care I need at home or in assisted living.
Fact: Medicare may cover qualifying home health or short-term skilled care. It generally does not cover ongoing custodial help with daily activities or assisted living room and board. Plan for those costs separately.
Myth 8: Once I choose a plan, I never need to review it again.
Fact: Plan premiums, drug lists, provider networks, and other details can change. Review your Annual Notice of Change and compare your options each fall. Medicare’s Open Enrollment Period for health and drug plans runs October 15 through December 7.
Myth 9: If I have a preexisting condition, Medicare will refuse to cover me.
Fact: Original Medicare does not exclude covered care because of a preexisting condition, and Medicare Advantage plans must cover the medically necessary services Original Medicare covers. Medigap enrollment has different rules, so understand its enrollment window before you apply.
The takeaway: A useful Medicare answer usually starts with a few questions about your coverage, health needs, and location. Mickley Insurance Group can help you sort through those details and compare options in plain language.
