Busting the Top Five Medicare Myths

by Lance D. Reedy

I have been a member of the Society of Certified Senior Advisors for several years and receive their publications both in print and online. Their recent article, Busting the Top Five Medicare Myths, caught my attention. I have paraphrased these myths below and added pertinent comments as necessary to fit our five states of ID, MT, OR, WA, and WY. Please click here to review the article in its entirety.

Myth 1: I can enroll any time I want to.

One of the biggest misunderstandings about Medicare supplement (Medsupps) concerns the Annual Election Period (AEP-also known as Medicare open enrollment) that runs from October 15th through December 7th. For additional information, please refer to our companion article in this issue titled Have Your Medicare Supplements Rates Gone Up?

I have heard this statement over and over: “Oh, I thought you can change your Medsupp during open enrollment (meaning the AEP).”  The AEP is all about changing your Part D prescription plan (PDP) or your Medicare advantage (MA) plan. It has very little to do with Medsupps.

In general, once you are past 65 and a half, changing your Medsupp from one plan to another requires medical qualification. There are some exceptions. Washington allows you to change your plan virtually any time without medical qualification.  Oregon allows you to do the same during the month of your birthday. The other eleven months you can change your Medsupp subject to qualifying medically

In Idaho, Montana, and Wyoming, you can change your Medsupp any month of the year subject to medical qualification.

There is another twist to this. If you have been on a plan that disenrolls you, such as an MA plan, then you can use the guarantee issue rules to sign up for Medsupp plans A,B,C,F,K, and L with NO medical qualification. Guarantee issue, means just that, your acceptance is guaranteed, even if you have a substantial health issue such as a recent heart attack.


Myth 2: Medicare pays for long-term care.

Medicare covers 20 days at 100% for skilled nursing facility care after a medical event such as a stroke or hip replacement. Medicare will cover another 80 days, subject to fairly strict qualifications. There is also a $164.50 per day coinsurance (in 2017) which most Medsupp and MA plans cover.


Myth 3: Medicare covers all my health expenses.

Congress passed the Medicare legislation into law in 1965 to keep seniors from being financially wiped out due to high medical costs. That was the purpose for the original legislation.  Over time, more things have been added such as preventative procedures and home health care.

Medicare was never intended to cover dental, routine vision care, cosmetic surgery, and custodial care in a nursing home.


Myth 4: Medicare is free.

Most native-born people receive Medicare Part A hospitalization at no cost. Part B, medical, has a premium in 2017 for new enrollees of $134 per month. People in higher income brackets have higher Part B premiums.


Myth 5: I don’t need to enroll in Medicare.

There is no one pointing a gun at your head saying that you MUST enroll in Medicare Part B or else. However, it’s a smart idea to do so. The CSA website article gives some tips for those that are on an employer plan.

However, the CSA article has a glaring error that none of their proofreaders caught regarding the late enrollment penalty (LEP) for not signing up for Medicare Part B. Here is the erroneous text:

That penalty means premiums can go up almost 10 percent for every month you are eligible for Medicare but not enrolled.

The 10 percent late enrollment penalty should read “can go up almost 10 percent for every year (not month) you are eligible….”

Conclusion: The error in Myth #5 is a good example of how a single word mistake can cause misinformation.  Sadly, this is all too prevalent in much of what you hear on the street, from the senior center, the news media, and even from supposedly knowledgeable people such as the Council on Aging.

Where do you go to obtain accurate information? Medicare.gov is an excellent source. Additionally, AARP also has lots of good info about Medicare.

Finally, your pro agents, meaning us, endeavor to be a trustworthy source of information, and admittedly, we’re still in the learning process.  If you have a question where we don’t have the answer, we’ll research it and get back to you with the most accurate and reliable information we can find. End