Medicare Myths and Misconceptions

The misconception: Many people think it doesn’t matter whether they choose Original Medicare with a Supplement or a Medicare Advantage plan because the costs will “even out.”

The truth: Costs can vary widely. Regardless of enrolling in a supplement plan or a Medicare advantage plan, you must pay your Part A and Part B premiums. 

Medicare Part A is typically $0/monthly premium for those who have qualified (worked 40 quarters, roughly ten years, and paid into their FICA taxes). Part B has a monthly premium that varies pending income.  

Higher income earners receive an additional charge called Income Related Monthly Adjusted Amount, IRMAA. And if you receive an IRMAA for part B you also receive an IRMAA for Part D. 

Medicare Part A and B must be in good standing (and paid) for the Supplement Plan or Medicare Advantage plans to be effective. It is not advised to only have Medicare A and B (otherwise called Original Medicare) alone, as the financial exposure is too great.

There is a Part A deductible and 20% of Part B you are responsible for, with no out of pocket cap or maximum. The guidance is to  pair Original Medicare with a supplement plan to cover those gaps or enroll in a managed care Medicare Advantage plan. 

• Medicare Supplement plans (also called Medigap) charge a flat monthly rate, and pending your plan of choice, cover all or most of the gaps of Original Medicare. These plans provide you with access to doctors and facilities all across the United States. In other words, they travel with you. No network provisions and no referrals or prior authorizations needed. Government pays first (Original Medicare- that red, white, and blue card) and the supplement plan pays second, covering the out of pocket cost gaps.

• Medicare Advantage (Part C) plans are managed and offered by private carriers. Some have low or even $0 monthly premiums and pay as you go. You  must pay copays and coinsurance until you hit your deductible before the plan pays in full. Costs are negotiated (and renegotiated) yearly and depend on the plan’s network rules and specific providers. Prior authorizations and referrals are required for many on these plans. Advantage plans coordinate all your benefits, meaning they pay those claims, not the government.

The right choice depends on your health needs, budget, travel, and how much flexibility you want in choosing your health care providers. They’re not automatically “the same” as there are major differences when it comes to costs or access.

The misconception: Many people believe they’re locked into the first Medicare plan they pick—forever.

The truth: You can switch plans, but timing matters, as does your health.

• You can change your Medicare Advantage or Part D prescription drug plan every year during the Annual Enrollment Period (October 15–December 7), with no medical underwriting.
  
  
• There’s also the Medicare Advantage Open Enrollment Period (January 1–March 31), where you can switch Advantage plans (no medical underwriting) or go back to Original Medicare (you will have to go through medical underwriting).
  
  
• Certain life events, like moving to a new area, may qualify you for a Special Enrollment Period (no medical underwriting)
  
  
• You can change your supplement carrier or plan type (F, G, N, etc.) any day throughout the year. There are no ‘lock in’ periods with the supplement plans, however there is medical underwriting.

The catch? Your health matters. If you want to switch back to Original Medicare with a Medicare Supplement plan after having a Medicare Advantage plan, medical underwriting rules may apply after your initial enrollment window.

If you are sick and/or have certain chronic conditions, you may not be able to make a change. That’s why it’s important to choose carefully at the onset of your enrollment and review your options every year.

The misconception: Once you’re on Medicare, you’ll never have to worry about medical bills again.

The truth: Medicare is comprehensive, but not all-inclusive.
Original Medicare and supplement plans have gaps. They don’t cover:

• Routine dental, vision, or hearing care
  
  
• Prescription drugs from the Pharmacy (that’s what Part D is for)
  
  
• Long-term custodial care

Medicare Advantage plans may bundle extras outside of medical, like dental, vision, hearing, and gym memberships, but coverage levels differ. Medicare Advantage plans may have some extras that seem attractive, but keep in mind these are not all-inclusive; they have gaps. Medicare Advantage plans do not cover:

• Long Term Custodial Care
  
  
• Full costs of medications received in a facility, like chemotherapy, dialysis, infusions (which is why you should pair cancer, stroke, heart attack, policies with MAPD plans).
  
  
• Full costs for hospitalization and ambulance (which is why you should pair hospital indemnity policies with MAPD plans).

Knowing these gaps helps you plan for supplemental coverage or out-of-pocket costs.

The misconception: “I hardly ever see the doctor, so any plan will do.”

The truth: Choosing the wrong plan now can limit your future options medically and financially.

• Medigap plans have guaranteed issue rights only during certain enrollment windows. If you pass on one when you’re first eligible and want it later, you may face health underwriting or higher costs.
  
  
• Medicare Advantage plans often have network restrictions, which may not matter much if you’re healthy now but this could change your situation if you need specialized care later.

Your health can change quickly. Discuss your anticipated healthcare needs and plan ahead to save money and headaches down the road. 

Think of your healthcare as you would home and auto insurance. Make the purchase hoping you will never need it, yet if you do need it, you want to have comprehensive coverage.

The misconception: Ads for $0 premium Medicare Advantage plans can lead people to think the plan won’t cost them anything.

The truth: $0 premium does not mean $0 cost.

• You still pay your Part B premium and any IRMAA charges you acquire, which remember is also added to Part D.
  
  
• You’ll likely face copays and coinsurance for doctor visits, hospital stays, and medications, until you reach your deductible. Someone undergoing Chemotherapy, for example, may hit their $12 K deductible in November, only for it to start at zero again in January and must pay another $12K before the plan kicks in to pay in full. That’s $24K out of pocket in the matter of a few months. 
  
  
• Out-of-pocket costs can add up, especially if you need frequent care or specialists outside your plan’s network.

If something sounds too good to be true, it probably is. ALWAYS compare the full picture of your Medicare plan, not just the premium.

The misconception: “I don’t take medications, so I don’t have to enroll in a drug plan.”

The truth: Medicare penalizes you with a Late Enrollment Penalty (LEP) for enrolling in Part D with a gap in “creditable” drug coverage. LEP is added to your monthly premiums for the life of your time on Medicare. 

Medicare is too important to base on rumors or half-truths. The best approach is to review your options every year, compare plans carefully, and ask a trusted professional for guidance.

At Jbird Insurance Group, Medicare Dana is here to break down the confusion, cut through the myths, and help you find coverage that fits your life and your budget.

If you’re looking at your options for this year’s open enrollment, let’s schedule a time to chat. Send me an email at [email protected].