By Bob Moos, Southwest public affairs officer for the U.S. Centers for Medicare and Medicaid Services
Navigating Medicare can be challenging under the best of circumstances. It becomes even more difficult when someone new to Medicare falls victim to the myths, or misconceptions, about the health care program.
Let’s take a look at the most common myths in hopes that you’ll avoid the confusion that could cost you time or money.
Myth No. 1: Medicare is free.
Medicare’s hospital insurance, known as Part A, has no premium if you’ve worked throughout your life. But the outpatient services coverage, or Part B, does have a monthly premium, as does the prescription drug insurance, or Part D.
In addition, there are deductibles and co-payments for certain services. Overall, the traditional Medicare program covers about 80 percent of your costs, which means you’re responsible for the other 20 percent.
Many people buy a “Medigap” supplemental health insurance plan from a private company to help cover those out-of-pocket costs. Or they opt out of the traditional Medicare program and purchase a Medicare Advantage plan from a private insurer to receive their Medicare benefits.
Myth No. 2: Medicare covers everything.
Though traditional Medicare pays for many health care services, it doesn’t cover all of them. For example, it doesn’t pay for standard dental, vision or hearing care. If you’re interested in any of those services, you may want to consider a Medicare Advantage plan that offers extra benefits.
Myth No. 3: You’ll be automatically enrolled when it’s time.
That’s only partially true. If you’re already receiving Social Security, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. (You’ll still need to sign up for Part D.) If you’re not on Social Security yet, you must enroll in Medicare yourself.
For most people, the best time to apply for Medicare is during the three months before your 65thbirthday, the month you become 65 and the three months after you turn 65. So, let’s say your birthday is Aug. 15. That means you can sign up from May 1 through Nov. 30.
Myth No. 4: Everyone pays the same for Medicare.
If your annual income is below $85,000, or $170,000 for a married couple, you pay the standard Part B and D premiums. But if it’s more, you pay a surcharge. In 2018, the surcharge for Part B ranges from $53.50 to $294.60 per month, depending on your income. That’s in addition to the standard $134 premium.
Myth No. 5: Having poor health will disqualify you from coverage.
Medicare can’t reject you, or charge you higher premiums, because of a health problem. It can’t discriminate based on a pre-existing condition. In fact, about two-thirds of Medicare beneficiaries live with at least two chronic conditions.
Myth No. 6: Medicare covers long-term care.
Many people don’t realize until it’s too late that Medicare typically doesn’t pay for long-term “custodial” care – the kind of personal care that helps you with such day-to-day tasks as getting in and out of bed, bathing, dressing and eating.
Medicare does cover some skilled nursing or rehabilitative care if a physician orders it after a hospital stay of at least three days. You pay nothing during the first 20 days of your care and then part of the cost for the next 80 days.
Myth No. 7: Medicare and Medicaid are the same thing.
The two programs are often confused. Medicare covers health care for people 65 and older and for people with certain disabilities. Medicaid helps cover health care for people with low incomes and few resources. Some people qualify for both.
Myth No. 8: A lot of doctors don’t take Medicare.
The vast majority of doctors accept Medicare. The traditional Medicare fee-for-service program offers the broadest possible access to health care professionals. You can go to any provider who’s taking new Medicare patients.
Medicare Advantage plans, on the other hand, often require you to go to doctors within their network of providers or pay more for getting care elsewhere. So, before signing up for a particular Advantage plan, make sure you’re satisfied with its network of providers.
Even after 53 years, Medicare is still misunderstood. If you’re in doubt about some aspect of the Medicare program, please visit www.medicare.gov or talk with a customer service representative toll-free at 1-800-633-4227.