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Medicare myths and facts

Enrolling in Medicare can be daunting; knowing which parts to pick and what clinicians are covered can present a laundry list of questions. 

Heather Dyke is the revenue cycle director in the administrative offices of Tryon Medical Partners. Though Heather understands the ins and outs of Medicare, she sympathizes with patients as they approach 65 and get completely overwhelmed. 

“Watching my mother go through the arduous process of comparing traditional Medicare and Medicare Advantage plans certainly illustrated just how nuanced this can be,” Heather says. “Having a firm grasp of how the Medicare program works can certainly bring our patients peace of mind”.

Here are the most common myths about Medicare enrollment and coverage, with facts to help you avoid these pitfalls:

Myth: Medicare is free. 

Fact: Each part of Medicare can incur a different premium (which is specific to each individual and whether or not you signed up during the Initial Enrollment Period): 

  • Part A: People who have at least 40 work credits (roughly 10 years of work paying Social Security tax) or qualify based on their spouse’s work history do not pay a premium. All others pay a premium for Part A. 
  • Part B: All beneficiaries pay a minimum premium of $148.50 (as of 2021). This amount may increase based on your tax return filings. 
  • Part C (Medicare Advantage): For some Medicare Advantage plans, there is an additional premium that is separate from Parts A and B premiums.
  • Part D: Given that these are prescription drug coverage plans sold by private insurance carriers, costs vary. If you go more than 63 days without Part D coverage OR creditable prescription coverage through another source, you will owe a penalty for the life of your Part D coverage.
  • Medigap: Enrollees carry an additional variable premium cost.

Myth: I will automatically be enrolled in Medicare or I can enroll at any time I want.

Fact: You will not be automatically enrolled in Medicare upon your 65th birthday if you do not already receive Social Security benefits. For those not already receiving Social Security benefits, you have a seven month Initial Enrollment Period, which runs from three months prior to your 65th birthday to three months following your birthday month. This is true even if you plan to wait to receive Social Security benefits until you are 66 years old. During this Initial Enrollment Period, you can select either Original Medicare (Parts A and B), Medicare Advantage and Part D plans.

Myth: I’m still working past the age of 65, so I don’t need to worry about Medicare yet.

Fact: Even if you plan to continue working past your 65th birthday, there are many reasons that you should think about enrolling in Medicare. For those working for employers with fewer than 20 employees (or those who are dependents on a spouse’s health insurance that requires Medicare enrollment), beneficiaries must enroll during their Initial Enrollment Period or face penalties. Even in situations where one works for a firm with more than 20 employees, there are instances where it could make sense to enroll in Part A, Part B or Part D. If an employer’s drug coverage is not deemed to be “creditable” (i.e., it is at least as good as a standard Part D plan), you will be required to enroll in a Part D plan during your Initial Enrollment Period or pay a penalty. 

Myth: Medicare Advantage and Medigap are the same thing.

Fact: Medicare Advantage plans replace Original Medicare (Parts A and B), while typically offering Part D prescription coverage and additional medical coverage (depending on the plan). Medigap, on the other hand, is a separate private plan that one can buy to cover gaps if one selects to enroll in Original Medicare. It is illegal for beneficiaries to enroll in both Medicare Advantage and Medigap.

Please keep in mind that all Tryon clinicians accept the same Medicare Advantage plans! Familiarize yourself with the insurance Tryon accepts and check out the Medicare DIY section of the Tryon Medical Partners website for more information.