As a Medicare insurance expert for the past 14 years, I often find myself surprised at how little most people know about the program until they are right on its doorstep. Although it’s a national health insurance program that covers more than 50 million people, it’s often misunderstood, and this can cause worry and financial stress just as you head into retirement.
It’s a good idea to take a brief look at Medicare several years before it’s time for you to enroll at age 65 so that you aren’t caught off-guard by any misconceptions you may have had. To get you started, here are five of the biggest myths that I find people believe about Medicare.
Myth #1: Medicare is free
Polls show that more than half of Americans believe that Medicare is free. This couldn’t be further from the truth, and this myth often has to do with those payroll deductions you make throughout your working life.
When you get your paystub and see you that you’ve paid FICA taxes toward your future Medicare benefits, it can lead you to think that by the time you turn 65 you’ll be paid-up. However, those taxes only go to pay for your Part A hospital benefits.
Part B outpatient benefits and Part D drug benefits have monthly premiums that you need to be prepared to pay. In 2019, the standard base premium for Part B is $135.50 a month; about 95% of Medicare beneficiaries pay this amount.
However, a small percentage of beneficiaries are considered high-income, and these people pay what’s called an income-related monthly adjustment amount (IRMAA). Those in the highest income bracket pay well over $400 a month for Part B. See the chart on this page for a breakdown of premiums by income in 2019.
Part D monthly premiums are set by the insurance company and can range from as low as $10 to $15 a month to well over $150 a month depending on the plan and the medications it covers. High-income people pay an IRMAA in addition to the base premium too.
Myth #2: Medicare covers 100% of your healthcare costs
Many people mistakenly believe that once they enroll in Medicare, the federal government will pay for 100% of their healthcare. This is not true.
Just like on your health insurance prior to age 65, you will have cost-sharing in the form of deductibles, copays, and coinsurance. Part A has a $1,364 deductible in 2019, and this deductible is per benefit period, so you could incur it more than once in a calendar year if you had more than one hospital stay.
Part B has an annual deductible of $185 and then covers about 80% of your outpatient costs. You will be responsible for the other 20%, and there is no out-of-pocket maximum to protect you.
Myth #3: With a Medicare Advantage plan, you can skip paying for Part B
Medicare Advantage plans are private insurance plans that are alternatives to traditional Medicare. The plans have local networks of providers. The premiums are lower upfront than Medigap plans, and instead you pay copays for healthcare services as you go along. Some HMO plans may even have a $0 premium, which means you don’t pay anything for the plan itself.
However, you must be enrolled in both Medicare Parts A and B to be eligible to enroll in either a Medicare Supplement or a Medicare Advantage plan. So even if your plan has a low or even zero premiums, you will still be paying for Part B each month.
Myth #4: It’s fine to wait to enroll in a Medigap plan
When you enroll in Medicare Part B, you have six months from the Part B effective date to enroll in a Medicare Supplement plan with no health questions asked. This Medigap six-month open enrollment window is to ensure that when you’re transitioning over to Medicare you can get adequate coverage even if you have health problems.
Once that window has passed, you can still apply for a Medigap plan, but in most states you will need to answer health questions. Certain health conditions and medications can cause the insurance company to decline you. In other words, they do not have to cover you if they believe you pose a medical risk.
People often mistakenly believe that they can just wait until the next fall open enrollment period (OEP) and sign up for Medigap without health questions. However, the reality is that the fall OEP has nothing to do with Medigap plans. Instead, the OEP allows you to make changes to either your Part D drug plan or your Medicare Advantage plan.
You can apply for a Medigap plan any time of year, but if you are past your six-month Medigap open enrollment period, expect to answer health questions and know that getting coverage is not guaranteed.
Myth #5: You can delay enrolling in Medicare if you have employer health insurance
This one is another common mistake that costs unsuspecting beneficiaries a lot of money in late penalties because it is only partially true.
If you work for a large employer with 20-plus employees, then yes, you can delay enrollment into Medicare without penalty. Your employer group health coverage is primary, and Medicare is secondary.
However, if you work for a small employer with fewer than 20 employees, Medicare is primary, so you need to enroll in both Medicare Parts A and B during your initial enrollment period as you turn 65.
If you get this wrong, you will later have to pay a 10% penalty for every year that you waited to enroll. This penalty is added to your Part B premiums, so you’ll pay it for as long as you are enrolled in Part B.
I often say that Social Security should have a class for people at age 50 to learn all of this when they still have 15 more years to save and plan for retirement. Such a class does not exist though, so hopefully, this will help you to avoid some of the most common mistakes.
Have a question about your Medicare coverage? Considerable’s resident expert Phil Moeller, author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, answers reader questions weekly. Send your question to firstname.lastname@example.org.