Top 6 Medicare LIES You Need to Know

Medicare misinformation is everywhere, and it’s costing people thousands of dollars in unexpected expenses and poor coverage decisions. After helping thousands of Medicare beneficiaries navigate their options, I’ve identified six persistent lies that continue to mislead people about Medicare coverage, costs, and enrollment rules.

Lie #1: Medicare Is Completely Free

This is perhaps the most damaging Medicare myth circulating today. While Medicare Part A is premium-free if you’ve worked 10 years and paid into the system through payroll taxes, that’s where the “free” stops.

Medicare Part B costs $202.90 per month in 2026, and this premium increases significantly for high-income earners through IRMAA adjustments. Beyond premiums, Medicare comes with substantial out-of-pocket expenses including deductibles, coinsurance, and no annual maximum out-of-pocket limit.

This is exactly why most people choose either a Medicare Supplement Plan or Medicare Advantage plan to help cover these gaps. If you choose a Supplement Plan with original Medicare, you’ll also need to add a separate Part D drug plan since original Medicare doesn’t cover prescriptions.

Agent Tip

I’ve seen people shocked by their first Medicare Part B bill because they believed Medicare was entirely free. Always budget for at least the Part B premium plus your chosen supplemental coverage when planning for Medicare costs.

Lie #2: Medicare Covers Everything You Need

Medicare’s coverage gaps are substantial and often catch people off guard. Medicare does not cover routine dental, vision, or hearing services.

For dental care, Medicare won’t cover routine cleanings, exams, fillings, or crowns. However, extractions before cancer treatment would be covered if they’re directly related to an underlying medical condition that Medicare does cover.

Vision coverage is similarly limited. Medicare covers treatment for serious conditions like glaucoma, cataracts, or diabetes-related eye issues, but routine eye exams and glasses aren’t covered unless you’re recovering from cataract surgery.

Hearing aids represent another significant gap—Medicare provides no coverage for hearing aids or routine hearing exams. Perhaps most importantly, Medicare doesn’t cover long-term custodial care. It only covers skilled nursing facilities for the first 100 days, and only if you meet strict qualification requirements.

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

This fundamental misunderstanding leads to poor enrollment decisions every year. Original Medicare (Parts A and B) is administered directly by the government. Medicare Advantage plans are administered by private insurance companies and completely replace original Medicare when you enroll.

When you choose Medicare Advantage, you’re no longer using original Medicare—the private plan becomes your primary coverage. These are two entirely different systems with different networks, different rules, and different costs and benefits.

Medicare Advantage plans typically offer additional benefits like dental and vision, but they come with network restrictions and referral requirements that don’t exist with original Medicare plus a supplement plan.

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

Medicare enrollment follows strict timelines, and missing these deadlines can result in lifelong penalties. Your Initial Enrollment Period is a 7-month window that starts three months before you turn 65, includes your birthday month, and extends three months after.

You can sign up outside this window only if you have credible coverage through active employment—either your own job or your spouse’s job with an employer that has more than 20 employees. If you don’t have this qualifying coverage and miss your enrollment window, you’ll face penalties.

Part B penalties are particularly costly: 10% of the premium for each 12-month period you were eligible but didn’t enroll. This penalty continues for as long as you have Medicare. Part D drug plan penalties work similarly and compound over time.

Agent Tip

The biggest enrollment mistake I see is people thinking they have flexibility when they don’t. If you’re not working or your spouse isn’t working with qualifying employer coverage, you must enroll during your Initial Enrollment Period to avoid penalties.

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

Medicare Supplement plans offer powerful protections, but only during specific enrollment windows. Your Medigap Open Enrollment Period is six months starting the first of the month you turn 65 and enroll in Part B.

During this window, insurance companies cannot deny you coverage or charge you more based on your health history. This is your guaranteed access to any Medicare Supplement plan offered in your area.

Outside this window, unless you qualify for guaranteed issue rights or live in New York or Connecticut (which have special consumer protections), insurance companies can ask health questions, deny your application, or charge you significantly more based on your medical history.

Some states offer additional opportunities. For example, California’s Birthday Rule allows annual plan changes, while other states have their own special provisions.

Lie #6: You Must Take Medicare at Age 65

This lie prevents people from making optimal timing decisions about Medicare enrollment. If you’re working past 65 or your spouse is working with active employer coverage through a company with more than 20 employees, you can delay Medicare enrollment without penalties.

This delayed enrollment can save you significant money on Part B premiums during the time you have qualifying employer coverage. When you’re ready to retire or lose that coverage, you’ll get a Special Enrollment Period to sign up for Medicare without penalties.

However, this only works with active employer coverage. COBRA, retiree health plans, or coverage from employers with fewer than 20 employees don’t qualify for penalty-free delayed enrollment.

Why These Medicare Lies Persist

These misconceptions continue spreading because Medicare’s complexity makes it easy for incomplete or outdated information to circulate. Well-meaning friends, family members, and even some professionals may share information that was once true or applies only to specific situations.

Additionally, some marketing materials deliberately oversimplify Medicare to make sales presentations easier, which contributes to these persistent myths. Recognizing deceptive Medicare marketing is crucial for making informed decisions.

How to Get Accurate Medicare Information

Always verify Medicare information through official sources or licensed agents who specialize in Medicare. The rules are complex and change frequently, so getting current, accurate information is essential for making good decisions.

Consider your specific situation carefully. What works for your neighbor or friend might not be the best choice for your health needs, budget, and preferences. Finding the best Medicare plan requires understanding your individual circumstances.

Frequently Asked Questions

Does Medicare Part A really cost nothing?

Medicare Part A is premium-free if you’ve worked and paid Medicare taxes for at least 10 years (40 quarters). However, Part A still has a $1,736 deductible per benefit period and coinsurance costs for extended hospital stays.

Can I switch from Medicare Advantage back to original Medicare with a supplement?

Yes, you can switch during Medicare’s Annual Open Enrollment (October 15 – December 7), but getting a supplement plan may require answering health questions unless you qualify for guaranteed issue rights.

What happens if I miss my Medicare enrollment deadline?

Missing your Initial Enrollment Period typically results in late enrollment penalties for Part B (10% per year) and Part D (1% per month). You’ll also have to wait until the General Enrollment Period (January 1 – March 31) to sign up.

Do I need Medicare if I have VA benefits?

VA benefits and Medicare work together differently depending on your situation. Many veterans benefit from having both, but the decision depends on your specific VA benefits and healthcare needs.

Are Medicare Supplement rate increases inevitable?

Most Medicare Supplement plans do experience annual rate increases, but the amount varies by company and plan type. Some pricing methods may offer more stable rates over time.