Ashford Insurance

Common Medicare Myths Debunked

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Sonia Ashford

Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.

Medicare, because of its many unique regulations and rules along with the fact that it is ever-changing and evolving, is outright confusing.

I receive many questions on a daily basis on the phone and on our social media. Medicare, because of its many unique regulations and rules along with the fact that it is ever-changing and evolving, is outright confusing. Here are some of the top myths/concerns that I hear on a regular basis, to explain the truth to you. 

Myth: The cost of Medicare is free

Truth: Medicare is far from free. You may pay monthly or quarterly premiums, along with deductibles, coinsurance, and co-pays. The amounts for 2020 are as follows:

Part A: Usually there is no premium charge for Part A IF you and/or your spouse has worked and paid into Medicare taxes for 40 quarters (10 taxable years). If you have a premium payment for Part A you may pay up to $458 a month. Also, the “per benefit period” deductible for Part A is $1408.

Part B: The monthly premium for 2020 is $144.60. People with income over specific limits will pay more. The annual deductible is $198. After having met your deductible you will typically pay 20% of the “Medicare-approved amount” for most of your doctor services, outpatient therapy, and durable medical equipment.

Part C: Medicare Advantage Plans. Part C monthly premiums and co-pays vary by plan. Some may even have a 0 (zero) dollar premium.

Part D: These monthly premiums also will vary by plan.

Myth: When I turn 65 I can enroll in Medicare whenever I choose

Truth: For first-time enrollees, it is wise to enroll at age 65. You will have a 7-month Initial Coverage Enrollment Period (ICEP) that begins 3 months preceding your 65th birthday and will cover the month of your birth, and the 3 months immediately following in which to enroll. As far as enrollment goes, the sooner the better. Procrastinating too long could mean facing financial penalties later.

If you are continuing to work past age 65 and have coverage through an employer, or if you are 65 and plan to remain on your spouse’s health plan, you could delay your Medicare enrollment as long as your current coverage is considered “creditable”, meaning it’s as good as Medicare. OR you may elect Part A only (which is usually premium-free) and delay Part B until you retire. Depending on the size of the group health plan, one would pay primary while the other pays secondary. Always consult with your HR department to first make sure your current coverage is considered creditable. Once no longer employed you will be able to enroll in Medicare within an 8 month period of time.

For existing Medicare beneficiaries, there is an Annual Open Enrollment Period that runs from October 15th to December 7th every year. This is the time when everyone on Medicare can change their Medicare health plans and prescription drug plans for the next year if they see the need to. During this time period, I suggest that you take the time to review your plan, and any changes providers may implement for the upcoming year to make sure your needs will be covered and that you are still in the right plan.

Myth: Medicare Pays for Everything

Truth: There are a number of services that Medicare does not cover. For example, Medicare does not cover standard dental, vision, or hearing care. If these are services that you find yourself in need of, you may want to consider a Medicare Advantage plan that has these extras, or you may wish to purchase separate health insurance plans for these services from a private insurer. If you find that these are needs your current Medicare coverage does not provide and you need some guidance in this area, give me a call and I can provide assistance with that.

Myth: My bad health will disqualify me for Medicare Coverage

Fact: Sadly, many people think that they can be denied Medicare coverage because of preexisting conditions or are in poor health. However, this is not the case. You can receive Medicare coverage once you qualify for it by either turning 65 or after having been on Medicare disability for 23 months.

Note, Medicare supplement plans are different when it comes to their acceptance. If you are in your Medicare Supplement (Medigap) Open Enrollment Period- the 6 month period that coincides with your 65th birthday or your Medicare Part B start date, supplemental insurers cannot deny your application for Medigap insurance. Once outside of this Open Enrollment period, they may be able to deny you coverage depending on your health in some cases.


So, are there any concerns or questions about Medicare that we can answer for you?


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Picture of Sonia Ashford

Sonia Ashford

Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.