8 Medicare Myths: Separating Fact from Fiction

Medicare is a vital health insurance program for millions of Americans, but there are many misconceptions that can confuse beneficiaries and potential enrollees. As a Medicare broker, I’ve encountered a lot of misinformation, and it’s time to clear up some common myths! In this blog, I’ll debunk eight widespread Medicare myths so you can make more informed decisions about your healthcare coverage.

1. Medicare Covers All Healthcare Costs

One of the most persistent myths about Medicare is that it covers all your healthcare expenses. While Medicare covers many essential services, it doesn’t cover everything. For example:

• Dental, vision, and hearing care are generally not covered by Original Medicare (Parts A and B). If you need coverage for these services, you may need to enroll in a Medicare Advantage plan or purchase standalone dental, vision and hearing coverage.

• Long-term care (also known as custodial care) is not covered under Medicare unless it’s part of a short-term skilled nursing care stay following a hospital stay.

It’s essential to understand Medicare’s limitations and consider additional coverage to avoid large out-of-pocket expenses.

2. I Have to Enroll in Medicare as Soon as I Turn 65

While many people do need to enroll in Medicare when they turn 65, this isn’t always the case. If you (or a spouse) are still working and have employer health insurance through a large employer (20+), you can delay enrollment without facing penalties. You will have a Special Enrollment Period (SEP) to enroll in Medicare when you retire or lose health coverage. To learn more, visit Working Past 65 and Working Past 65: Five Costly Mistakes Beneficiaries Make.

If you’re not sure whether you need to enroll at 65, contact me to today for a free consultation!

3. Medicare Part A Is Free for Everyone

Many people believe that Medicare Part A, which is hospital coverage, is always free. While most people don’t pay a premium for Part A if they (or a spouse) have worked and paid Medicare taxes for at least 40 quarters (10 years), those who haven’t worked long enough may have to pay a premium for Part A (up to $518 in 2025) depending on work history.

4. Medicare Advantage Plans and Medicare Supplements Are the Same

This is a big misconception! Medicare Advantage (AKA Part C) and Medicare Supplement (Medigap) plans are two different Medicare options that function very differently:

• Medicare Advantage plans are offered by private insurance companies and essentially replace Original Medicare. These plans often include additional benefits like vision, dental, and hearing coverage, and often times, prescription drug coverage. However, they may have network restrictions requiring you to use certain doctors or hospitals.

• Medicare Supplement plans help cover the gaps in Original Medicare (Part A + Part B = “Original Medicare”), such as copayments, coinsurance, and deductibles. These plans work alongside your Medicare benefits and allow you to keep Original Medicare while helping to pay for out-of-pocket costs.

Choosing between the two depends on your healthcare needs and preferences. An independent Medicare broker can help you determine whether a Medicare Advantage or Medicare Supplement plan best suits your needs.

5. Medicare Is Free for Everyone

While many people think of Medicare as a “free” healthcare option, there are still costs involved, such as premiums, deductibles, and copayments for certain services. Here’s a quick breakdown

• Part A: Most people qualify for premium-free Part A (hospital coverage), but if not, you’ll pay a premium.

• Part B: You’ll pay a monthly premium for Part B, which covers doctor visits and outpatient services. In 2025, the standard premium for Part B is $185 per month, although it can be higher if you are a high income earner.

• Part D: If you enroll in a prescription drug plan, you may pay a premium for that coverage.

• Medicare Advantage or Medicare Supplement: If you choose either of these plans, you may pay additional premiums on top of your Part B premium.

6. Medicare Covers Prescription Drugs Automatically

Original Medicare (Parts A and B) does not cover most prescription drugs. To get prescription drug coverage, you need to enroll in a Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage. If you don’t enroll in a Part D plan when you’re first eligible and don’t have other creditable drug coverage, you may face a late enrollment penalty when you sign up later.

7. If My Doctor Accepts Medicare, My Treatment Will Be Covered

Just because a doctor accepts Medicare doesn’t mean all your treatments or services will be covered. Medicare only pays for services that it deems medically necessary. Some procedures, treatments, or tests might be denied if they don’t meet Medicare’s coverage guidelines. Before receiving any service, it’s always a good idea to check with your provider and Medicare to ensure the treatment is covered and to understand any potential out-of-pocket costs.

Truman’s Tip

Download the Medicare “What’s Covered” app to your phone’s homescreen so you have quick access to what is and is not covered under Medicare!

8. I Can Enroll in Medicare Anytime

Medicare has specific enrollment periods, and missing them can result in penalties. Here are key periods to know:

• Initial Enrollment Period (IEP): A seven month window that includes the three months before you turn 65, the month of your 65th birthday, and the three months after your birthday month. For more info on IEP, visit What is the Medicare Initial Enrollment Period?

• General Enrollment Period (GEP): If you miss your IEP, you can enroll between January 1 - March 31 each year, but you may face late penalties.

• Special Enrollment Period (SEP): If you have qualifying circumstances, such as employer coverage, you may be eligible to enroll without penalties outside of IEP and GEP.

Summary

Medicare is a great program, but it’s essential to understand what it does and doesn’t cover. By debunking these eight common myths, I hope you feel more confident about your healthcare choices. If you’re still unsure about your options or need help navigating Medicare’s complexities, I’m here to help. Don’t hesitate to reach out for personalized guidance on your Medicare journey!

Care Compass is an independent insurance agency that helps seniors navigate the complexities of Medicare and other Senior Products. Our services are offered at NO COST! Care Compass is proudly owned and operated in Blair County, Pennsylvania. We provide Medicare insurance assistance to the residents of Altoona, Hollidaysburg, Duncansville and the surrounding region. If you need assistance with Medicare, contact Care Compass today!