Are You Falling for These 5 Medicare Myths?

Along with Social Security, Medicare is one of America's most important safety nets. It provides health insurance to millions of seniors each year who otherwise wouldn't be able to afford high-quality care.

Given all the good things about Medicare, one thing many people agree on is that the program isn't the easiest to understand or navigate. There are tons of moving parts that make keeping up with changes necessary to ensure you understand your coverage.

If you're currently on Medicare or will be soon, here are five myths worth debunking to help you understand the program better.

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Myth 1: There is one type of Medicare plan

Medicare isn't one single health insurance policy; it's made up of four primary plans:

• Part A: Hospital insurance that covers things like inpatient stays, hospice, and other forms of healthcare.
• Part B: Medical insurance that covers doctor visits, preventative services, outpatient care, and various medical supplies.
• Part C: Medicare Advantage, which is a private alternative to Original Medicare (Part A and Part B).
• Part D: Prescription drug coverage that ideally lowers the costs of medications.

Which plan is right for you largely comes down to your medical needs, preferred doctors and hospitals, and the level of flexibility you need.

Myth 2: Medicare is free for people aged 65 and older

Although you pay into the Medicare system throughout your career, that doesn't mean your coverage is free once you turn 65. Most people still pay a premium each month and a deductible. The deductibles for Part A and Part B are $1,736 and $283, respectively. This is a $60 and $26 increase from 2025's deductibles.

It's also worth noting that Part A's deductible is per benefit period, and Part B's is annually. A new benefit period happens once you're out of the hospital or special nursing care for 60 days in a row. So, there's a chance you could have multiple in the same year. Part B is per calendar year.

The premium for Part B is $202.90 monthly, up from $185 in 2025. If your income is over $109,000 ($218,000 if married and filing jointly), you could face the IRMAA surcharge, potentially pushing your premium as high as $689.90 ($487 added).

Myth 3: Medicare is a one-stop shop

Medicare covers a lot, but it doesn't cover everything. That's why it's best to look into supplemental plans to help you avoid unexpected coverage gaps. Notable procedures and items excluded from Medicare are:

• Routine dental, vision, or hearing care (with a few exceptions)
• Long-term custodial care, such as assisted living or a nursing home
• Most outpatient prescription drugs, if you're only enrolled in Part A or Part B
• Most services that are completed abroad
• Routine physical exams (except for a one-time "Welcome to Medicare" visit within the first 12 months of having Part B)

Beginning this year, Medicare is also becoming more restrictive on what it covers. Prior authorizations will be required for procedures such as knee surgery for arthritis and skin grafts. The six states testing out this new process are New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.

Image source: Getty Images.

Myth 4: You can enroll in Medicare at any time, as long as you're 65 years old

The earliest you can sign up for Medicare is age 65, but you can't enroll at any point after that. Medicare has a strict enrollment window that you must follow. In the time leading up to your turning 65, there's a seven-month window: three months before your birthday, your birthday month, and three months after your birthday.

For Part B coverage, your monthly premium could increase by 10% for every 12 months you could've had the coverage but didn't sign up. For example, if your original premium was $202.90 and you waited 24 months, your premium would jump to $243.48.

The late penalty for Part D coverage is calculated using the national base beneficiary premium ($38.99 this year) and the number of months you went without it. Going 24 months without it would add $9.40 to your monthly bill.

Myth 5: Medicare Advantage and Medigap work the same way

Both Medicare Advantage (Part C) and Medigap are offered by private insurers, but they don't work the same way. Medicare Advantage replaces your Original Medicare and generally requires that you visit doctors within a certain network. You might also need prior authorization for certain treatments.

Medigap only works with Original Medicare to help cover gaps in coverage and costs. For example, it would cover out-of-pocket expenses such as co-payments and co-insurance. The ideal time to enroll in Medigap is the six-month enrollment period that begins after you're 65 and already enrolled in Part B.

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