SEPARATING MEDICARE MYTHS FROM MEDICARE FACTS

Michael T. Braden February 3, 2026 MEDICARE 101

There are many well-intentioned individuals who seem to think they know everything about Medicare. You might even know someone who fits that description! However, when it comes to Medicare, the choices you make are crucial for your future healthcare. It would be a shame to rely on hearsay or myths that aren't true.

Photo of a Medicare Couple with a notepad and Pen, with the words Medicare Myths written on a clipboard that has a stethoscope wrapped around it.

In today's article, I want to tackle the most common Medicare myths head-on. It’s important to know the truth before making decisions that can’t be undone.

THE BIGGEST MEDICARE MYTHS

MEDICARE IS FREE TO EVERYONE

I wish this were true, but it is another Medicare Myth! The reality is that Medicare is not free. Not everyone automatically qualifies for it either.

MEDICARE HAS FIVE PARTS

Many people believe there are five parts to Medicare, including Medicare Part A, Part B, Part C, Part D, and Part M (Medigap). This is false! There are actually four parts to Medicare:

• Medicare Part A: Covers hospitalization costs and expenses.

• Medicare Part B: Covers outpatient expenses, such as doctor visits, lab work, imaging, outpatient surgery, and durable medical equipment.

• Medicare Part C: This refers to Medicare Advantage Plans.

• Medicare Part D: Covers prescription medications.

  
  
  
  

MEDICARE PART A COVER LONG-TERM CARE

This is incorrect. Medicare Part A covers inpatient hospitalization, skilled nursing care, hospice care, and some in-home health visits. However, it does not cover long-term care, custodial care, or nursing home care.

YOU MUST HAVE PAID MEDICARE TAXES FOR 10 YEARS OR MORE TO RECEIVE MEDICARE BENEFITS

This is a common misconception. Individuals can qualify for premium inpatient hospitalization and skilled nursing care, as well as free Medicare Part A, if their spouse has at least 40 quarters of Medicare taxes paid. You might even qualify if you or your spouse worked fewer than 40 quarters, but you’ll need to pay a monthly premium for Medicare Part A.

MEDICARE ADVANTAGE PLANS MUST COVER EVERYTHING JUST LIKE ORIGINAL MEDICARE DOES

This is a myth! Medicare Advantage plans are offered by private, for-profit insurance companies. While most Medicare Advantage plans include prescription drug coverage, they are not required to cover everything exactly as Original Medicare does. For instance, these plans often have copays, coinsurance, and maximum out-of-pocket costs that members must meet. They also have specified networks of doctors and are typically only covered in your home county.

YOU MUST ENROLL IN MEDICARE PART D

False! No one is required to enroll in a Medicare Part D Prescription Drug plan. However, if you don’t enroll promptly, you may face penalties that last indefinitely.

ORIGINAL MEDICARE DOES NOT COVER ROUTINE DENTAL OR VISION, BUT MEDICARE SUPPLEMENT PLANS DO

This is misleading. Medigap plans cannot cover anything that Original Medicare does not cover by law.

ALL MEDICARE SUPPLEMENT AND MEDIGAP PLANS OF THE SAME LETTER PROVIDE THE SAME LEVELS OF COVERAGE FOR THE SAME PRICE

This is not true. While Medicare Supplement/Medigap Plans are standardized, meaning each lettered plan has the same coverage benefits across all 50 states, the costs can differ by state. Factors such as age, sex, and the state's rating methods can/do affect pricing.

YOU MUST BE A US CITIZEN TO RECEIVE MEDICARE BENEFITS

This is false! You only need to be a U.S. citizen or a permanent legal resident for five years. You must also be 65 years old or older and eligible for Social Security benefits, or permanently disabled and receiving disability benefits for at least 2 years. Additionally, those with permanent kidney failure requiring dialysis or a kidney transplant, or those diagnosed with ALS (Lou Gehrig's Disease), may also qualify.

MEDICARE SUPPLEMENT/MEDIGAP PLANS HAVE NETWORKS JUST LIKE MEDICARE ADVANTAGE PLANS

This is incorrect. Since a Medigap plan works alongside Original Medicare, you can see any doctor and receive services at any hospital in the U.S. and its territories that accept Medicare Assignment.

YOU MUST ENROLL IN MEDICARE PART B WHEN YOU TURN 65, OR YOU WILL RECEIVE A PENALTY

This is partially true. Yes, there is a penalty if you miss your Medicare Part B enrollment deadline. However, the penalty is 10% for each year between when you were first eligible and when you finally enroll in Medicare Part B. This penalty will be added to your monthly Medicare Part B premium for as long as you are covered under Medicare Plan B.

THE MEDICARE "EXTRA HELP" PROGRAM PROVIDES FINANCIAL ASSISTANCE FOR HOSPITAL COSTS

This is false. The Medicare Part D Low-Income Subsidy (LIS) "Extra Help" assists with costs for Medicare Prescription Drug plans only, including premiums, deductibles, and co-payments.

MEDICARE SAVINGS PLANS HELP YOU SAVE MONEY OVER ORIGINAL MEDICARE

This is misleading. A Medicare Savings Program is a state-mandated program that can pay all or part of your Original Medicare premiums and out-of-pocket expenses if you have limited income and resources. over 95% of Medicare Beneficiaries do not qualify for these plans.

OTHER MEDICARE FACTS

THERE ARE NO OUT-OF-POCKET MAXIMUMS WITH ORIGINAL MEDICARE

That’s right! There is no yearly limit on out-of-pocket expenses for Medicare. This is why anyone enrolling in Original Medicare is strongly urged to consider purchasing a Medicare Supplement (Medigap) plan.

EVERY MEDICARE PART D PRESCRIPTION DRUG PLAN HAVE MONTHLY PREMIUMS, DEDUCTIBLES, AND CO-PAYMENTS

Those who enroll in a Medicare Part D Prescription Drug plan pay monthly premiums, an annual deductible, and cost-sharing for their medications. These costs can vary by plan, prescription, and the pharmacies you use.

IF YOU DO NOT CHOOSE AND ENROLL IN A MEDICARE SUPPLEMENT OR MEDIGAP PLAN WITHIN SIX MONTHS OF ENROLLING IN MEDICARE PART B, YOU CAN BE TURNED DOWN FOR COVERAGE IF YOU HAVE A PRE-EXISTING CONDITION

If you don’t purchase a Medigap policy within six months of enrolling in Medicare Part B, you could be denied coverage due to a pre-existing condition.

IF YOU HAVE CREDITABLE MEDICAL COVERAGE, MEDICARE ALLOWS YOU TO POSTPONE ENROLLING IN MEDICARE PART B

Having creditable medical coverage (coverage that is equal to or better than Medicare's offerings through an employer's group health plan) can allow you to postpone enrolling in Medicare Part B. This only applies to individuals working for companies with more than 20 employees. If your employer has fewer than 20 employees, you must enroll in Medicare when you turn 65. Everyone should enroll in Medicare Part A as soon as they turn 65.

YOUR MEDICARE SUMMARY NOTICE (MSN) ALERTS YOU TO ERRORS AND/OR SIGNS OF FRAUD

It’s a good habit to review your Medicare Summary Notice (MSN) for any errors or signs of fraud. Keep track of your medical appointment dates and save all receipts and statements from your healthcare providers to compare them with anything listed on your MSN.

WRAPPING THINGS UP

I hope you enjoyed this article highlighting Medicare myths versus Medicare facts. If you have any questions about what we covered today or any other Medicare-related topics, please feel free to reach out to me anytime. You can email me at mike@bradenmedicare.com, text or call me at (480) 225-1393, or simply visit our website at www.bradenmedicare.com anytime, 24/7.

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