The TOP 5 Medicare Myths Debunked

Medicare can be confusing, and there are plenty of misconceptions that might lead you to make poor decisions about your healthcare coverage. Whether you’re new to Medicare or have been enrolled for a while, it’s essential to separate fact from fiction. Here, we’ll debunk the top five Medicare myths to help you navigate the program with confidence.

1. Myth: Medicare Covers All Healthcare Costs

Many people believe that once they enroll in Medicare, all their healthcare costs will be covered. Unfortunately, that’s not the case.

Reality: Medicare helps cover a wide range of medical services, but it doesn't cover everything. Original Medicare (Part A and Part B) typically covers about 80% of your medical costs after deductibles, leaving you responsible for the remaining 20%. Additionally, services like vision, dental, and hearing aids are not covered under Original Medicare. To bridge these gaps, many opt for Medicare Supplement Plans (Medigap) or Medicare Advantage Plans (Part C).

2. Myth: You Don’t Need to Worry About Medicare Until You Turn 65

Some believe that Medicare only applies once you hit 65 and that you don’t need to think about it before then.

Reality: While Medicare eligibility starts at 65 for most people, you need to start planning earlier to ensure a smooth transition. The Initial Enrollment Period (IEP) begins three months before your 65th birthday and extends for three months after. Missing this window could result in late enrollment penalties. Additionally, if you’re under 65 and have certain disabilities or end-stage renal disease, you may qualify for Medicare earlier.

3. Myth: Medicare Is Free

One of the most common myths is that Medicare doesn’t cost anything once you’re eligible.

Reality: While most people do not pay a premium for Part A (hospital insurance), Part B (medical insurance) comes with a monthly premium. In 2025, the standard Part B premium will increase to around $180 per month, though it can be higher for individuals with higher incomes. Medicare Part D (prescription drug coverage) and Medicare Advantage Plans may also come with additional premiums, deductibles, and copayments.

4. Myth: Medicare Automatically Covers Prescription Drugs

Many assume that Medicare automatically includes prescription drug coverage.

Reality: Original Medicare does not cover most prescription drugs. To get drug coverage, you must enroll in a Medicare Part D plan or select a Medicare Advantage Plan that includes prescription drug coverage. If you don’t sign up for Part D during your initial enrollment period, you may face a late enrollment penalty if you decide to enroll later.

5. Myth: You Can Switch Medicare Plans Anytime You Want

A lot of people think they can switch between Medicare plans at any time.

Reality: There are specific enrollment periods for changing your Medicare coverage. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can switch from Original Medicare to a Medicare Advantage Plan, switch Medicare Advantage Plans, or add/drop a Part D prescription plan. There are also Special Enrollment Periods (SEPs) for qualifying life events like moving or losing employer coverage.

Conclusion

Understanding the facts about Medicare is crucial to making informed decisions about your healthcare. By debunking these common myths, you can take control of your Medicare journey and ensure you get the coverage that meets your needs.

If you need help navigating Medicare options, our team at SC Health Insurance is here to assist you with expert guidance and personalized advice.