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Medicare Myths: Fact vs. Fiction

Medicare Myths: Fact vs. Fiction

Medicare has many unique and intricate rules and regulations. On top of that, it is constantly changing and evolving. When changes come to Medicare, it is often a breeding ground for false ideas about Medicare. Instead of being left in the shadows of the Medicare world, here are the truths behind a few common Medicare myths.

I can enroll into Medicare at any time…

This is one of the most popular myths for anyone that is reaching 65. Many people believe that they can sign up for Medicare any time after they’ve reached the age of 65; however, that’s not the case. There are only a few specific time periods that you can enroll Medicare without facing any penalties.

The truth is that you have a 7-month period, starting three months before the month you turn 65 and lasting until three months after you’ve turned 65. This is your initial enrollment period. Aside from this 7-month timeframe around your 65th birthday, you also have the general enrollment period every year to sign up for Medicare itself. This runs from January 1 through March 31, with Medicare taking effect on July 1.

There are other special enrollment periods that coincide with being enrolled in, or losing, group/employer coverage. Note that the enrollment periods discussed above pertain to Medicare itself – not Medigap, Medicare Advantage or Part D programs, which each have unique enrollment requirements and timeframes.

Medicare covers all medical expenses…

This is another common misconception regarding Medicare. Many people believe that Medicare will cover any and all of their medical expenses, but this is far from the truth. “Original” Medicare (Parts A & B) does cover many services and procedures, but there are also things that it doesn’t cover or where it only covers a portion of the cost.

Some of the misconceptions of things that Medicare will cover include dentures, glasses, or other “nonessential” surgeries. For a full list of what your Medicare plan covers or doesn’t cover, the Medicare.gov web site has coverage specifications.

My preexisting conditions will keep me from being approved for Medicare…

Many people think that you will be denied Medicare coverage based on your current health condition or a preexisting health complication. This is not true. Regardless of your current health or any health complications you’ve had in the past, you can receive Medicare coverage once you qualify for it either through turning 65 or Medicare disability.

Note, of course, that Medicare supplement plans are a little different with their acceptance. If you are in your Medigap Open Enrollment Period (6-month period coinciding with your 65th birthday or Medicare Part B start date), supplemental insurers cannot deny your application for Medigap insurance. However, once you are outside of the open enrollment period, Medigap insurers can deny coverage depending on your health in some cases.

Medicare is bankrupt…

This myth has become one of the fastest growing myths regarding Medicare. Medicare Part A is funded through payroll/income tax on workers, which all funnels into the Hospital Insurance Trust Fund. This large fund is what pays for Medicare expenses that are covered under Medicare Part A. Right now, the number of Americans retiring is greater than the number of Americans joining the workforce. So, many people conclude that Medicare will soon run out of money to pay for healthcare costs.

Although this is not entirely accurate, this myth does have a grain of truth. It’s estimated that the fund will peak in 2019 and begin to drop after that. While the decline is concerning, there is no any real risk for Medicare to go bankrupt anytime soon. That said, it is something that will continue to be at the forefront of discussions, especially in a presidential election year.

Everyone pays the same monthly premiums for Medicare…

White it’s true that the majority of enrollees all pay the same amount for Medicare, there is a portion of enrollees that pay higher monthly premiums than others.

Monthly premiums for Part B are based on income tiers. Any individual that earns more than $85,000 or $175,000 will pay more for their Part B premiums than everyone else. Monthly premiums continue to increase as annual salaries reach higher tiers. So, the more you make, the more you pay, when it comes to Medicare premiums.

Myths debunked

These are not all of the false ideas involving Medicare, but they are some of the most common. As a Medicare beneficiary, you deserve to understand the program and everything it involves. If you have questions regarding Medicare or your coverage, visit the official Medicare website, or contact your local Medigap insurance agent.


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