10 Medicare Myths, Debunked
Ready to navigate the world of Medicare? Don't let common misconceptions hold you back.
In this blog post, we'll debunk 10 myths about Medicare, like "Doctors won't take Medicare," "Medicare will pay for everything a patient needs," and "Medicare is free since I paid Medicare taxes."
Let's separate fact from fiction and empower you with the knowledge you need for a smooth Medicare journey.
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1. Doctors won't take Medicare
In reality, most doctors (estimated between 92-98%) participate in the Medicare program and accept Medicare patients.
Specialists, particularly psychiatrists, can be a bit trickier, as some of them choose not to be a Medicare participating provider.
So, while most doctors accept Medicare, we recommend that you always check with your specific healthcare provider to ensure they are Medicare-approved and that they accept Medicare assignment. This helps prevent any unexpected out-of-pocket expenses.
Our team of licensed agents can also ensure you have a plan that is compatible with your specific doctors, physicians, hospitals, and pharmacies.
2. Medicare will pay for everything a patient needs
While Medicare covers most medically necessary services, it doesn't cover everything. There are limitations and exclusions to what Medicare will cover, such as:
- Long-term care
- Cosmetic procedures
- Experimental medications
- Most dental care, routine vision, and hearing exams
Additionally, Medicare may require co-payments, deductibles, and coinsurance for covered services. We recommend exploring supplemental insurance options like Medigap, Short-Term Care Insurance, or Cancer Insurance, which can provide additional coverage.
If you meet with a licensed agent here on our team, you'll complete a Client Needs Assessment together, which shows us any gaps in your coverage. You can then decide if you want to fill those gaps or take on the risk.
3. Half of government expenditures go to Medicare
Half of government expenditures do not go to Medicare – it's 16.9% as of June 30, 2023 (USASpending.gov).
According to KFF, Medicare spending (net of income from premiums and other offsetting receipts) is projected to rise to 18% in 2032.
Here's a quick breakdown of government spending by category:
- Medicare: 16.9%
- Social Security: 15.6%
- National Defense: 14.4%
- Health: 10.6%
- Net Interest: 9.8%
- Income Security: 8.5%
- General Government: 6.2%
- Unreported Data: 3.8%
- Veterans Benefits and Services: 3.4%
- Education, Training, Employment, and Social Services: 2.1%
- Commerce and Housing Credit: 1.9%
- Transportation: 1.4%
- Community and Regional Development: 1.2%
- National Resources and Environment: 1%
- Administration of Justice: 1%
4. Medicare is free since I paid Medicare taxes
While it's true that most people pay Medicare taxes during their working years, Medicare is not free.
Medicare Part A, which covers hospital insurance, is often premium-free for those who have worked and paid Medicare taxes for a certain period. However, you still have deductibles, co-payments, and coinsurance if you need care.
However, Medicare Part B, which covers medical services, does come with a monthly premium as well as a deductible and 20% coinsurance.
Medicare Part D, which covers prescription drugs, also has premiums, deductibles, and co-payments.
It's important to budget for these costs and explore options such as Medicare Supplement plans that help fill in the gaps of Medicare for a monthly premium.
5. Everyone pays the same amount for Medicare
Medicare costs vary depending on factors such as income, the specific Medicare parts you enroll in, and whether you qualify for any financial assistance programs.
As an example, Medicare Part B, which covers medical services, has a standard monthly premium that varies based on income.
Additionally, Medicare Part D, which covers prescription drugs, has varying premiums and costs depending on the specific plan you choose.
Contact our office and we can help you determine exactly how much Medicare will cost you.
6. Medicare Advantage plans are only for people with excellent health
Medicare Advantage plans are available to all Medicare beneficiaries, regardless of their health status. These plans are offered by private insurance companies and provide an alternative to Original Medicare (Parts A and B).
Medicare Advantage plans are not exclusive to people with excellent health. In fact, these plans can be a great fit for those with chronic conditions or complex healthcare needs as they may offer additional coordinated care and specialized services.
Additionally, Medicare Advantage plans have no underwriting questions, so the insurance company is required to accept you regardless of your health.
7. I have to figure out Medicare on my own
Our team of licensed sales agents is here to help you make sense of Medicare. As an education-first agency, our primary goal is to provide you with the information and guidance you need to make informed decisions about your healthcare coverage.
We are well-versed in Medicare rules, regulations, and options, and can answer any questions you may have.
Our agents can:
- Walk you through the various parts of Medicare
- Explain the differences between Original Medicare and Medicare Advantage plans
- Help you understand coverage options
- Assist you in finding a plan that best fits your needs and budget
Navigating Medicare can be complex, but our experienced team is here to support you every step of the way!
8. I have to enroll in Medicare when I turn 65
It's not mandatory to enroll in Medicare when you turn 65.
As an example, if you already have health insurance through an employer or other source, you may prefer to delay enrolling in Medicare. We can help you compare your employer plan to Medicare, as sometimes, Medicare can save you a substantial amount of money.
Keep in mind that if you delay enrollment and don't have creditable coverage, you may face penalties or gaps in coverage. We are here to provide personalized guidance based on your circumstances, so don't hesitate to schedule an appointment!
9. Medicare pays for dental, vision, and hearing coverage
Original Medicare (Parts A and B) does not typically cover routine dental, vision, or hearing care.
Medicare may cover certain medically necessary procedures related to dental, vision, or hearing issues, such as procedures done in a hospital setting.
But your routine care like dental cleanings, eyeglasses, and hearing aids are generally not covered.
If this coverage is important to you, some Medicare Advantage plans may offer additional benefits that include dental, vision, and hearing coverage. We also offer separate dental, vision, and hearing insurance plans that help cover those routine and preventative services.
10. Medicare will pay for home health care or assisted living care if I need it
Medicare does provide coverage for certain types of home health care, but there are specific eligibility criteria that must be met.
For home health care, Medicare will only cover services that are deemed medically necessary and are ordered by a doctor. These services are provided on a part-time or intermittent basis and are typically temporary and short-term in nature.
Medicare does not cover long-term care in assisted living facilities or nursing homes.
We strongly recommend exploring additional options, such as long-term care insurance or short-term care insurance.
From the misconception that doctors won't take Medicare to the belief that Medicare pays for everything, we have clarified the realities.
Don't feel overwhelmed by the complexities of Medicare, as our team of licensed agents is here to help.
Schedule an appointment with us today to receive personalized guidance and support in navigating the world of Medicare.