In general, Medicare is a federal health insurance program in the United States. It provides health coverage to eligible individuals, primarily those over 65 years of age, but also to those under 65 with certain disabilities, and those with End-Stage Renal Disease.
Medicare is funded by taxes and premiums and is designed to help cover some of the costs of necessary medical services, such as hospital stays, doctor visits, and preventive care. Medicare has four main parts: Part A, which covers hospital stays; Part B, which covers doctor visits and outpatient care; Part C, also known as Medicare Advantage, which is an alternative to Original Medicare; and Part D, which covers prescription drug coverage.
From time to time, Medicare Insurance is subject to some misconceptions which result in confusion rising among many potential or active beneficiaries. We will now list the 6 biggest myths related to Medicare Insurance and provide you with truthful, reliable information concerning all of them.
Myth 1: Medicare covers all healthcare costs
Medicare does not cover all healthcare costs. While it covers many necessary medical services, there are still some expenses that Medicare beneficiaries are responsible for paying out of pocket, such as deductibles, copays, and coinsurance.
What Medicare covers is:
- Hospital stays: Medicare Part A covers inpatient hospital stays, as well as care in a skilled nursing facility, hospice care, and some home health care services.
- Doctor visits: Medicare Part B covers visits to doctors, specialists, and other healthcare providers, as well as certain preventive services, diagnostic tests, and durable medical equipment.
- Outpatient services: Medicare Part B covers a range of outpatient services, including physical and occupational therapy, laboratory services, and some types of durable medical equipment.
- Prescription drugs: Medicare Part D covers prescription drugs for those enrolled in the program, with some limits and restrictions.
- Preventive services: Medicare covers a variety of preventive services, such as flu shots, cancer screenings, and annual wellness visits, to help beneficiaries stay healthy and catch potential health problems early.
Additionally, there are some services that Medicare does not cover at all, such as long-term care, dental care, and cosmetic surgery. It is important for Medicare beneficiaries to understand their coverage and the costs they are responsible for, so they can budget and plan accordingly.
Myth 2: Medicare is only for the elderly
While Medicare is primarily for people over 65 years of age, it is also available to people under 65 with certain disabilities, and those with End-Stage Renal Disease.
Individuals under 65 with disabilities who have received Social Security Disability Insurance (SSDI) for at least 24 months are eligible for Medicare, as are those with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease). People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) are also eligible, regardless of their age.
Medicare is not only for the elderly and eligibility requirements for Medicare can vary based on individual circumstances. Those who think they may be eligible should contact the Medicare program for more information.
Myth 3: Medicare and Medicaid are the same things
Medicare and Medicaid are both government-run healthcare programs, but they serve different populations and have different benefits and costs.
Medicare is a federal health insurance program that provides health coverage to eligible individuals, primarily those over 65 years of age, but also to those under 65 with certain disabilities and those with End-Stage Renal Disease.
Medigap, also known as Medicare Supplement Insurance, is a type of private health insurance that helps fill in some of the gaps in original Medicare coverage. Medigap policies are sold by private insurance companies and are designed to supplement Original Medicare, helping to cover out-of-pocket costs such as deductibles, copays, and coinsurance.
In other words, Medicare is the primary health insurance coverage, and Medigap is a secondary insurance that works alongside Medicare to help cover additional costs.
To conclude: no, Medicare and Medigap are not the same things and Medicare beneficiaries can only enroll in a Medigap policy if they are also enrolled in Original Medicare. Medigap does not cover the same benefits as Medicare Advantage, which is another alternative to Original Medicare.
Myth 4: You don’t have to pay anything for Medicare
Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), is not free. While most people do not pay a premium for Part A, they generally pay a monthly premium for Part B, which in 2023 is $148.50. There are also deductibles and coinsurance amounts that beneficiaries may have to pay when they receive medical services or supplies.
In addition to Original Medicare, there are Medicare Advantage plans (Part C) and Medicare Supplement Insurance (Medigap) plans that can help cover some of the costs not covered by Original Medicare. These plans come with additional out-of-pocket costs, including monthly premiums, deductibles, and co-payments. These additional out-of-pocket costs can vary depending on the specific plan and location. Carefully review the costs and benefits of each Medicare option and consider your healthcare needs before enrolling in a plan. Also, you may want to consult with a Medicare counselor or financial advisor to help you make an informed decision.
So, Medicare is not free, but it can help cover many of the medical expenses for eligible individuals.
Myth 5: You can’t change your Medicare coverage
Yes, it is possible to change Medicare coverage. Beneficiaries can make changes to their coverage during specific times of the year, such as the Annual Enrollment Period (AEP) from October 15 to December 7 each year, or during the Medicare Advantage Open Enrollment Period (OEP) from January 1 to March 31 each year.
During the AEP, beneficiaries can enroll in a Medicare Advantage plan, switch from one Medicare Advantage plan to another, or switch from a Medicare Advantage plan back to Original Medicare. They can also enroll in or change a Medicare Prescription Drug Plan (Part D).
During the Medicare Advantage Open Enrollment Period, beneficiaries who are enrolled in a Medicare Advantage plan can switch to another Medicare Advantage plan or switch back to Original Medicare.
It’s important to thoroughly review your options and consider your healthcare needs before making any changes to your Medicare coverage. Again, you can always consult with a Medicare counselor or financial advisor to help you make an informed decision.
Myth 6: All healthcare providers accept Medicare
The truth is, not all healthcare providers accept Medicare insurance. Original Medicare (Parts A and B) has a nationwide network of providers who accept Medicare, but there may still be some providers who do not accept it. Beneficiaries can check with individual providers to see if they accept Medicare.
For Medicare Advantage plans (Part C), the network of providers that accept the insurance will depend on the specific plan. These plans have a network of providers that beneficiaries must use to receive coverage. Beneficiaries should check with their plan to see which providers are in their network.
While many healthcare providers accept Medicare, it’s important to check with your doctor or hospital to confirm that they accept Medicare before getting treatment.