Misconceptions and myths about Medicare are surprisingly common, and they can misguide both beneficiaries and the agents working to support them.
As you prepare to work with a new potential client, it is important to be aware of their perceptions of Medicare and its coverage. Many people new to Medicare don’t fully understand it, and may bring some Medicare myths to the table. This article unpacks some of the top Medicare myths so you can better guide your clients and protect their financial health.
Medicare Myth 1: It’s Free
Many people assume that Medicare pays for all medical expenses, but this simply isn’t true, and it’s a top Medicare myth you may deal with. Agents need to help clients understand where gaps exist so they can plan accordingly. Explain fully to the client that:
- Part A: Covers hospital stays, skilled nursing facilities, and some home health care.
- Part B: Includes outpatient visits, preventive services, and durable medical equipment.
- Part C (Medicare Advantage): Combines Parts A and B, often with added benefits like dental, vision, and hearing—but coverage varies based on the plan.
- Part D: Covers prescription drugs, but only for medications included in the plan’s formulary.
Even with Medicare, expenses can add up. Beneficiaries might encounter premiums, deductibles and costs outside of the plan they choose, so education and careful explanation of coverages is essential on your part.
Medicare Myth 2: I Can Enroll Any Time After 65
Late enrollment is one of the most misunderstood aspects of Medicare and is a top Medicare myth. Many think they can enroll whenever they want without penalties, but this isn’t true.
The Initial Enrollment Period (IEP) is a seven-month window. It includes the three months before the month your client turns 65, their birthday month, and the three months after. Missing this period can lead to costly penalties.
If someone delays enrolling in Part B or Part D without qualifying for an exception, they could face permanent penalties added to their premiums.
Agents should stress the importance of timely enrollment and advise clients who are still working to confirm they have creditable coverage through their employer.
Medicare Myth 3: Medicare Advantage is the Same as Medigap
As you educate the seniors you work with, realize that some beneficiaries confuse Medicare Advantage Plans and Medigap policies. As you know, these are two entirely different options with unique benefits, and here are some quick thoughts you can use to clarify:
- Medicare Advantage (Part C): These are private health plans that bundle Part A and Part B and often include extras like dental, vision, and prescription drug coverage.
- Medigap: A supplemental insurance for Original Medicare that helps cover out-of-pocket costs like deductibles, coinsurance, and copayments. Medigap doesn’t typically include standalone coverage for vision, dental, or prescriptions.
Summary
As a Medicare agent, your role goes beyond selling policies about educating clients on the realities of Medicare, and you need to realize they will come to the table with these top Medicare myths. By addressing misconceptions head-on, like those covered in this article, you’ll save your clients frustration and ensure they make informed decisions.
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