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Top 4 Medicare Myths

With a program as complicated as Medicare, it’s inevitable that some misunderstandings and myths will take root. When seniors retire and get ready to transition to Medicare it’s important to get information from a trusted source to avoid expensive coverage mistakes.


Our Medicare agents are up to date on all Medicare facts and plan options. We are here to help our clients get the information they need to ensure they choose the right Medicare plans for their needs. Call us today; we are always happy to answer your questions.

Top 4 Medicare Myths


Myth #1: Medicare covers all health care expenses like a universal healthcare program


While seniors do benefit greatly from access to Medicare insurance, it is important to prepare for the out-of-pocket expenses that are tied to the program. It is true that the vast majority of seniors qualify for premium-free Part A (hospital insurance) but that is nowhere near the whole story. Out-of-pocket Medicare expenses may include:

  • Monthly premium for Part A IF you do not qualify for premium-free

  • Monthly premium for Part B (medical insurance)

  • Monthly premium for Part D (prescription drug insurance)

  • Monthly premium for Advantage plan (Part C)

  • Monthly premium for Medicare supplement plan (Medigap)

  • Co-insurance

  • Copays

  • Deductibles

  • No annual out-of-pocket maximum for Original Medicare

There are a wide range of options for Medicare benefits that come with different out-of-pocket expenses. One of the benefits of Medicare Advantage Plans is that they come with an annual out-of-pocket maximum. Speak to a Medicare agent about Medicare costs to ensure you choose the right plan for your budget.


Myth #2: Medicare covers all health care services for seniors


Medicare is a saving grace when it comes to hospital stays, surgeries and basic office visits, among many other medical services, but it doesn’t cover everything. Most notably, Original Medicare (Parts A & B) does not cover vision, hearing, or dental services. Original Medicare also does not cover most in-home personal care services or long-term care. Without adding Medicare Part D, Original Medicare also doesn’t cover prescription drugs.


Many seniors choose to enroll in a Medicare Advantage Plan that includes dental, hearing, and vision coverage as well as prescription drug coverage.


Myth #3: All Medicare options work for every senior


While Original Medicare is meant to provide coverage for the majority of the health services required by seniors, it doesn’t cover everything. This is why most seniors on traditional Medicare opt to add a Medicare supplement plan. The other path to receive Medicare benefits is Medicare Advantage. All aspects of Part A & Part B must be included in every Advantage plan but additional benefits may vary. All seniors but especially those who have a serious illness or pre-existing condition will benefit from speaking with a qualified Medicare agent who can provide out-of-pocket cost and benefits comparisons to determine the right plan for their needs. Other factors to consider are whether a Medicare Advantage Plan’s network of doctors and facilities will work for you.


Myth #4: You can easily switch between Original Medicare and Medicare Advantage


When you first sign up for Medicare you are entitled to enroll in a Medigap policy without consideration of any pre-existing conditions. This is a “one-time pass” that is only good for the first year you are enrolled. If you decide down the road that you would like to switch from Medicare Advantage to Original Medicare with a Medigap policy, you run the risk of being offered only policies with very high premiums or even being refused coverage for six months because of a pre-existing condition.


Ideally, seniors choose their path on either Original Medicare with a Medigap policy or Medicare Advantage when they are first eligible for Medicare. The Medigap Open Enrollment Period starts automatically on the first day of the month you turn 65 and enroll in Medicare Part B.



Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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