MEDICARE MYTHS VS MEDICARE FACTS

Michael T. Braden January 20, 2026 Medicare 101

There are a large number of well-intended individuals who seem to think they know everything about everything; in fact, you may even know someone who fits the bill. However, when it comes to Medicare, the initial choices you make are crucial to your future healthcare, and it would be a shame to rely on hearsay or Myths that are not 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, we want to take the most common Medicare myths head-on and let everyone know the truth, before someone makes a mistake that they cannot take back.

BIGGEST MYTHS OF MEDICARE

MEDICARE IS FREE

I wish this were true, but the truth is, Medicare is not free. And, not everyone automatically qualifies for Medicare either.

MEDICARE HAS 5 PARTS

Including Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, and Medicare 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 - Medicare Part C stands for Medicare Advantage Plans.

Medicare Part D - Covers Prescription Medications.

MEDICARE PART A COVERS LONG-TERM CARE AND HOSPICE

This is false. Medicare Part A covers Inpatient Hospitalization, Skilled Nursing Care, and Hospice Care, as well as some in-home Health visits. However, Medicare Part A does not cover Long-Term Care/Custodial Care/Nursing Home Care.

TO QUALIFY FOR MEDICARE PART A, YOU MUST HAVE PAID MEDICARE TAXES FOR AT LEAST 10 YEARS

This is incorrect. Individuals can qualify for premium inpatient hospitalization and skilled nursing care, and for free Medicare Part A, if their spouse has at least 40 Quarters in which they paid Medicare Taxes. You may even qualify for coverage if you or your spouse worked less than 40 quarters, but you will have to pay a monthly premium for Medicare Part A.

IF MEDICARE ADVANTAGE PLANS ARE AN OPTION, MEDICARE ADVANTAGE PLANS MUST COVER EVERYTHING THAT IS COVERED UNDER MEDICARE PART A, PART B, AND MEDICARE PART D

This is a myth. Medicare Advantage plans are offered by private, for-profit insurance companies. And while most Medicare Advantage plans include Prescription Drug coverage, most plans also provide additional items not covered under Original Medicare. (Original Medicare = Medicare Part A and Medicare Part B), However, they are not required to cover things exactly as Medicare does. For example, Medicare Advantage plans have copays, Coinsurance, and maximum out-of-pocket costs that members must meet. They also have specified networks of doctors that their members must use, and they are typically only covered in their home county.

MEDICARE PART D ENROLLMENT IS MANDATORY

False. No one is required to enroll in a Medicare Part D Prescription Drug plan, but they may face penalties that never go away if they do not enroll promptly.

ORIGINAL MEDICARE DOES NOT COVER ROUTINE HEARING, DENTAL, OR VISION, BUT MEDIGAP PLANS DO.

False. Medicare Supplement Plans, also referred to as Medigap Plans, by law cannot cover or pay for anything that is not covered under Original Medicare.

ALL MEDIGAP PLANS OF THE SAME LETTER (C, F, G, N) PROVIDE THE SAME LEVELS OF COVERAGE FOR THE SAME PRICE

This is not true. Medicare Supplement/Medigap Plans are standardized, meaning that each Lettered Medigap Plan has the same coverage benefits in all 50 states; however, the costs differ by state, based on Age, Sex, and the Rating Methods used by the state.

TO BE ELIGIBLE FOR MEDICARE PART A AND PART B, YOU MUST BE A U.S. CITIZEN OR A PERMANENT LEGAL RESIDENT OF THE US FOR A MINIMUM OF 10 YEARS.

This is false. You must be a US citizen or a permanent legal resident for only five years, and you must be 65 years of age or older and be eligible for Social Security payments; be permanently disabled and receive disability payments for a minimum of two years, or have permanent Kidney Failure, requiring dialysis or a kidney transplant, or been diagnosed with ALS (Lou Gehrig's Disease).. are not permitted to enroll in both a Medicare Advantage plan and a Medigap plan. Medigap (Medicare Supplement) plans are intended only for use with Original Medicare.

IF YOU ENROLL IN A MEDIGAP PLAN YOU WILL BE LIMITED TO THE PLANS NETWORK OF DOCTORS AND HOSPITALS

This is false. Since a Medicare Supplement or Medigap plan works hand in hand with Original Medicare, you can see any doctor and receive services at any hospital in the United States and in all US Territories that accept Medicare Assignment.

YOU MUST ENROLL IN MEDICARE PART B WHEN YOU FIRST BECOME ELIGIBLE OR PAY A PENALTY OF UP TO 10% OF YOUR MEDICARE PREMIUMS FOR THE YEAR YOU ENROLL

This is false. Yes, there is a penalty if you miss your Medicare Part B enrollment deadline, but it is10% for every year between when you were first eligible and when you finally enrolled 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 PROGRAM KNOWN AS "EXTRA HELP" PROVIDES FINANCIAL ASSISTANCE FOR UNCOVERED HOSPITAL COSTS

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

MEDICARE SAVINGS PROGRAMS ALLOW WORKERS AGE 55 AND OLDER TO SAVE MONEY IN A TAX-ADVANTAGED ACCOUNT TO BE USED FOR MEDICARE-RELATED EXPENSES AFTER RETIREMENT.

False. A Medicare Savings Program is a state-mandated program that can pay all or a part of your Original Medicare Premiums and Out-of-Pocket expenses, if you have limited income and resources.

HERE ARE SOME OTHER FACTS ABOUT MEDICARE YOU MAY NOT BE AWARE OF

THERE ARE NO OUT-OF-POCKET MAXIMUMS WITH MEDICARE

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.

MEDICARE PART D BENEFICIARIES PAY MONTHLY PREMIUMS, DEDUCTIBLES, AND CO-PAYMENTS, OR CO-INSURANCE

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

IF YOU DO NOT BUY A MEDIGAP/MEDICARE SUPPLEMENT POLICY WITHIN SIX MONTHS OF ENROLLING IN MEDICARE PART B, YOU COULD BE TURNED DOWN FOR COVERAGE DUE TO A PRE-EXISTING CONDITION

If you do not purchase a Medigap policy within six months of enrolling in Medicare Part B, you can be declined for coverage due to a pre-existing condition.

CREDITABLE MEDICAL COVERAGE IS INSURANCE THAT ALLOWS YOU POSTPONE ENROLLING IN MEDICARE PART B

Having creditable medical coverage (coverage that is equal 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 who work for companies with more than 20 employees. If your employer has less 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) CAN ALERT YOU TO ERRORS OR SIGNS OF FRAUD

Everyone should make a habit of reviewing their Medicare Summary Notice (MSN) for any errors or signs of fraud. Record 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

We hope you enjoyed this article highlighting Medicare Myths VS Medicare Facts. If you have any questions about what we covered today or for any other Medicare-related items, please feel free to contact me anytime. I can be reached via email at mike@bradenmedicare.com, by text or phone at (480) 225-1393, and anytime, 24/7, on our website at www.bradenmedicare.com