Medicare Myths

Equip yourself with accurate information to make the best decision when signing up for Medicare

Myth 1: The lowest premium plan is always the best deal.

When considering your Medicare options, make sure you compare not only the premiums – but also factor in coinsurance, copays, deductibles and out-of-network expenses and limits for a more complete picture of each option’s costs.

Medicare Supplement plans often have higher premiums but lower out-of-pocket expenses. This is a good option for those who want predictability in their health care expenses and lower out-of-pocket expenses.

If you choose a low- or $0-premium Medicare Advantage plan, you likely will need to plan ahead and budget for higher out-of-pocket expenses. This is a good option for people who want the lowest premium and are willing to save money for future expenses. In 2021, the maximum out of pocket limit that Medicare Advantage plans could charge was $7,550.

Myth 2: The best plan is the one that fits my needs now.

The best plan for you is the one that serves you well at 65, 75 and beyond. Many people are enjoying relatively healthy years in their 60s, and we hope that’s true for you. It’s important to recognize that many people have more health issues as they age, so you’ll likely have higher health costs later – whether that’s hospitalizations, new diagnoses or in-patient/out-patient rehabilitation care. You’ll want to look for a plan that can serve your needs whatever the future holds.

Myth 3: I have access to the same providers through both Medicare Advantage and Medicare Supplement plans.

Choice of doctors and hospitals is a key difference between selecting Original Medicare with a Medicare Supplement plan and a Medicare Advantage plan. With Medicare Supplement plans, you can choose any provider or hospital that accepts Medicare across the U.S., which most do. Also, keep in mind that if you qualify for rehabilitation after a hospital stay, you can go to any rehabilitation facility that accepts Medicare.

With Medicare Advantage, you choose from the plan’s network of providers, hospitals and rehabilitation facilities. Review the list to see if your local and preferred providers are there and what the plan covers beyond your local region. In most cases, your expenses rise dramatically if you choose an out-of-network provider.

While some Medicare Advantage plans have in-network providers beyond your local area, you’ll want to investigate the robustness and geographical scope of any Medicare Advantage plan’s network if you travel frequently or live part of the year in another area.

Myth 4: I can try Medicare Advantage and change to Medicare Supplement plans in the future and vice versa.

This is not entirely the case. With Medicare Advantage, you have the option to enroll in a plan during open enrollment each year.

But with original Medicare and Medicare Supplement plans, you have the option to enroll without underwriting when you first become eligible – either by age or employment status beyond age 65. Then, you have a 6-month period after that in which you can make changes. Beyond that initial enrollment period, you will need to undergo medical underwriting if you want to transfer to a Medicare Supplement plan. If you do not pass underwriting, an insurer can turn you down for coverage.

Myth 5: The best plan for my friends and family is the best plan for me.

The plan that your relative raves about may not work as well for you.

Your individual situation can determine whether or not you can stay on your employer’s insurance past 65 (based on company size), how frequently you travel, whether you should contribute to your HSA right before retiring and what to consider in terms of your goals.

That’s why discussing your options with a Medicare specialist like Bill Parson, Certified Senior Advisor (CSA)®, who has helped people make health care decisions for 29 years, can be very helpful in determining your long-term goals and which Medicare option is best for you.

Want to learn more about an option that is best suited for your individual situation? Request a free consultation.

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Everence Staff

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