Medicare is a government-funded health insurance program that provides coverage for people aged 65 and above, as well as younger people with certain disabilities or medical conditions. While Medicare has been around for decades, there are still many misconceptions about the program that persist. In this blog, we will debunk the top Medicare myths and separate fact from fiction.

Myth #1: Medicare Covers Everything

One of the most common myths about Medicare is that it covers everything. While Medicare provides coverage for a wide range of medical services, it does not cover everything. There are certain medical services that Medicare does not cover, such as cosmetic surgery, hearing aids, and routine dental care.

Additionally, Medicare does not cover 100% of the cost of covered services. Beneficiaries are responsible for paying a portion of the cost through deductibles, coinsurance, and copayments. However, there are supplemental insurance plans available, known as Medigap policies, that can help cover some of these costs.

Myth #2: Medicare is Only for Low-Income Individuals

Another common misconception is that Medicare is only for low-income individuals. While Medicare does provide coverage for people with low incomes, it is not exclusively for them. Medicare is available to anyone who meets the eligibility requirements, regardless of income level. Here are some examples of collaboration with  Medicare programs for low-income individuals:

  • Medicare Savings Programs: These programs are designed to help people with limited income and resources pay for their Medicare premiums, deductibles, coinsurance, and copayments. There are four types of Medicare Savings Programs, each with its eligibility requirements and level of assistance.
  • Extra Help: This program, also known as the Low-Income Subsidy (LIS), helps people with limited income and resources pay for their Medicare Part D prescription drug costs. The program assists with monthly premiums, annual deductibles, and prescription copayments.
  • Medicaid: Medicaid is a joint federal-state program that provides health coverage for people with low income and limited resources. It covers a wide range of health services, including hospitalizations, doctor visits, prescription drugs, and long-term care. People who are eligible for both Medicare and Medicaid (known as dual eligibles) can receive benefits from both programs.
  • Medicare Advantage Special Needs Plans: These plans are designed for people who have specific health conditions or who are eligible for both Medicare and Medicaid. They provide additional benefits and care coordination services to help meet the unique needs of these individuals.

Overall, Medicare provides several options for low-income individuals to access healthcare services and manage their healthcare costs.

Myth #3:  Original Medicare is Free

Another common myth about Original Medicare is that it is free. While Medicare Part A premiums, which cover hospital stays, are free for most beneficiaries, you still need to pay a hospital deductible every benefit period if you don’t have a Medicare Supplement plan which covers it. The hospital deductible is 1600$. Medicare Part B, which covers doctor visits and other outpatient services, requires a monthly premium. The monthly premium is based on the beneficiary’s income level, but the average premium is 164.90$ in 2023. Also, you are responsible for paying the Part B annual deductible which is 226$.

Myth #4: Medicare Covers Long-Term Care

Many people believe that Medicare covers long-term care, such as nursing home care. However, this is not entirely true. Medicare only provides coverage for a limited amount of skilled nursing care following a hospital stay, and only if certain conditions are met. Medicare does not provide coverage for custodial care, which is the type of care that is often provided in a nursing home.

Myth #5: Medicare is Going Bankrupt

There is a common belief that Medicare is going bankrupt and will not be available for future generations. While it is true that Medicare faces financial challenges, the program is not going bankrupt. The Medicare program is funded through payroll taxes, premiums, and general revenue, and as long as those funding sources continue, the program will continue to exist.

However, the Medicare program indeed faces financial challenges due to rising healthcare costs and an aging population. To address these challenges, policymakers will need to make changes to the program, such as reducing the growth of healthcare costs, increasing revenue, or reducing benefits.

Myth #6: Medicare Advantage Plans are Better than Original Medicare

Medicare Advantage plans are a type of Medicare plan that is offered by private insurance companies. These plans typically provide additional benefits, such as prescription drug coverage and vision and dental care, that are not available under Original Medicare. While Medicare Advantage plans can be a good option for some beneficiaries, they are not necessarily better than Original Medicare.

One disadvantage of Medicare Advantage plans is that they often restrict the providers that beneficiaries can see. Beneficiaries who choose a Medicare Advantage plan may need to switch doctors or hospitals if their provider is not in the plan’s network. Additionally, Medicare Advantage plans may have higher out-of-pocket costs for certain services. Also, it is misleading that many people think Medicare Advantage plans are free due to zero dollars monthly premiums. But, that is far from the truth. Private insurance companies can have their terms of payment and even though you can have 0 dollars premium, you will still be responsible for paying Part B premium and even a deductible if your plan requires it. Also, you will typically have to pay copays for doctor visits and may have very high out-of-pocket costs if you visit a doctor or hospital that isn’t in your plan’s network.

Myth #7: Medicare Part B Covers Prescription Drugs

Yes, some medications are covered through Medicare Part B. Part B provides coverage for medically necessary services, including certain outpatient prescription drugs that are administered by a healthcare provider. Here are a few examples of the types of medications that may be covered under Part B:

  • Injectable and infused drugs: Part B covers many injectable and infused drugs that are administered in a doctor’s office, outpatient clinic, or another healthcare facility. These may include chemotherapy drugs, immunosuppressants, and other specialty medications.
  • Certain oral cancer drugs: Some oral cancer drugs that are approved by the FDA for the treatment of certain types of cancer may be covered under Part B.
  • Vaccines: Part B covers a variety of vaccines, including the flu vaccine, pneumonia vaccine, and hepatitis B vaccine, among others.
  • Durable medical equipment (DME) with integrated drug delivery: Part B may cover certain DME that includes a drug delivery component, such as insulin pumps or nebulizers.

While Medicare Part B does provide coverage for prescription drugs, it does not cover all prescription drugs. Medicare provides prescription drug coverage through Part D, which is offered by private insurance companies. Part D plans have formularies, which are lists of covered drugs, and beneficiaries may need to pay out-of-pocket costs for prescription drugs that are not on their plan’s formulary. most prescription drugs, including those that are taken at home, such as pills, capsules, and liquids are covered under Part D.

The closure of the donut hole for all medications has created some confusion among individuals who assume they will no longer have to pay for medications once they reach this stage of drug payment. However, this is not the case. From now on, members of drug plans will be responsible for covering 25% of the cost of any prescribed medication after meeting the deductible until they reach the out-of-pocket spending limit of $7,400 in 2023, which will then qualify them for catastrophic coverage.

Myth #8: Medicare Covers Foreign Travel

Many people believe that Medicare provides coverage for medical care when they travel outside of the United States. However, this is not entirely true. Medicare only provides limited coverage for medical care received outside of the United States, and only in certain circumstances.

For example, Medicare may provide coverage for emergency care that is needed while a beneficiary is traveling outside of the United States, but only if the care is received in a foreign hospital that is closer to the nearest U.S. hospital. Additionally, Medicare may provide coverage for some medically necessary services that are received on a cruise ship that is within six hours of a U.S. port.

Myth #9: Medicare Is Complicated and Confusing

While it is true that Medicare can be complex and confusing, there are resources available to help beneficiaries navigate the program. The Medicare website has a wealth of information, including a Medicare plan finder tool that can help beneficiaries compare different Medicare plans and estimate costs.

Additionally, there are trained counselors and advocates available to help beneficiaries understand their Medicare options and make informed decisions about their healthcare coverage.

Myth #10: Medicare and Medicaid Are the Same Things

While Medicare and Medicaid are both government-sponsored healthcare programs, they are not the same thing. Medicare is a federal program that provides health insurance for people who are 65 or older, as well as people with certain disabilities. Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families.

Medicare Health Advisor at Medigap Medicare Insurance | Website | + posts

Dr. Susan Johnson is a Medicare Health Advisor with extensive knowledge and experience in health insurance, particularly Medicare. She has spent over 15 years working in various healthcare settings, including hospitals, clinics, and private practices.

As a Medicare Health Advisor, Dr. Johnson specializes in helping people navigate the complex world of health insurance, including original Medicare, Medicare Advantage, Medicare supplements, and Medicare Part D. She is committed to providing personalized guidance to her clients, helping them make informed decisions about their coverage and reduce their healthcare costs.