Top 6 Medicare LIES You Need to Know

Lie #1: Medicare is Free

One of the most common Medicare myths is that it’s completely free. While Medicare does provide essential healthcare coverage, it’s not without costs. Here’s the truth:

• Medicare Part A (hospital insurance) is free only if you have worked and paid Medicare taxes for at least 10 years.
• Medicare Part B (medical insurance) comes with a monthly premium. In 2025, the standard premium is $185 per month, but if you’re a high-income earner, you could pay even more due to Income-Related Monthly Adjustment Amounts (IRMAA).
• Medicare does not cover everything, and there are out-of-pocket expenses, including deductibles, copayments, and coinsurance. This is why most people either opt for a Medicare Supplement (Medigap) plan or a Medicare Advantage plan to help cover additional costs.

Lie #2: Medicare Covers Everything

While Medicare offers extensive coverage, it does not cover all types of care. Some key services Medicare does not cover include:

• Routine dental, vision, and hearing care – Medicare won’t pay for dental checkups, eyeglasses, or hearing aids.
• Long-term care – Medicare only covers up to 100 days in a skilled nursing facility. If you need long-term care beyond that, you’ll need separate insurance or personal funds.
• Certain prescription drugs – Original Medicare (Parts A & B) does not cover most prescription medications. You’ll need to enroll in a Medicare Part D plan or choose a Medicare Advantage plan with drug coverage.

Lie #3: Medicare Advantage is the Same as Original Medicare

Many people assume that Medicare Advantage (Part C) is just an enhanced version of Original Medicare. However, there are major differences:

• Original Medicare is administered by the federal government and allows you to see any doctor nationwide who accepts Medicare.
• Medicare Advantage plans are run by private insurance companies and often come with provider networks, meaning you may be restricted to certain doctors and hospitals.
• Many Medicare Advantage plans require referrals for specialist visits and prior authorizations for certain procedures, making access to care more complicated.
• While Medicare Advantage plans may include extra benefits like dental and vision, they often have high out-of-pocket costs and annual coverage changes, meaning your benefits could shift from year to year.

Lie #4: You Can Sign Up for Medicare Anytime Without Penalties

Medicare has strict enrollment periods, and missing your initial enrollment window can result in lifelong penalties. Here’s how it works:

• You have a 7-month Initial Enrollment Period (IEP), which includes the 3 months before, the month of, and 3 months after your 65th birthday.
• If you delay enrolling in Medicare Part B without having creditable coverage (such as employer-based insurance), you could face a permanent penalty, which adds 10% to your Part B premium for every 12 months you were eligible but didn’t enroll.
• The same applies to Medicare Part D (prescription drug coverage) – if you don’t sign up when first eligible, you could pay a penalty that lasts as long as you have Medicare coverage.

Lie #5: You Can Get a Medicare Supplement Plan Anytime Without Health Questions

Medicare Supplement (Medigap) plans can provide excellent coverage, but you are not guaranteed acceptance at any time. Here’s what you need to know:

• You have a 6-month Medigap Open Enrollment Period starting from the first month you are both 65 or older and enrolled in Medicare Part B.
• During this period, you can enroll in a Medigap plan without medical underwriting, meaning you cannot be denied coverage or charged higher rates due to pre-existing conditions.
• If you apply for Medigap coverage outside of this period, insurers can deny you coverage or charge you higher premiums based on your health history unless you qualify for a guaranteed issue right (such as losing employer coverage).

Lie #6: You Have to Take Medicare at Age 65

Many people believe they are required to enroll in Medicare at age 65, but that’s not always the case.

• If you are still working at 65 and have health coverage through your employer or your spouse’s employer, you can delay Medicare Part B and Part D without penalties as long as your employer has 20 or more employees.
• Once you retire or lose employer coverage, you will qualify for a Special Enrollment Period (SEP) to sign up for Medicare without facing late penalties.
• If your employer has fewer than 20 employees, you may still need to sign up for Medicare at 65, as Medicare could become your primary insurance.

Final Thoughts

There are a lot of misconceptions surrounding Medicare, and believing these Medicare lies can end up costing you time, money, and access to healthcare. Understanding how Medicare actually works will help you make the best decision for your needs.

If you have any questions about Medicare, whether it’s Medicare Advantage, Medigap, or Part D plans, give us a call at 800-208-4974. We’d be happy to help you navigate your options and find the best plan for your situation.