Five things you're (probably) getting wrong about Medicare

If you’ve ever scratched your head while trying to figure out the Medicare maze, you’re not alone. A recent survey tells us there are plenty of misconceptions about the program. Let’s break down these misunderstandings, and put you on the path to more informed decision-making.

26% of beneficiaries don’t know when AEP starts

Over ¼ of enrollees don’t know that the Annual Enrollment Period (AEP) begins on October 15 and ends on December 7. (Remember to mark those dates on your calendar!). Think of AEP as an annual checkup for your health coverage – a chance to ensure it’s still the right fit for you. There’s never any harm in looking, especially if you anticipate your health, income, or other factors will be changing soon.

48.7% of enrollees believe there is no Part A deductible.

If you’re a Medicare Advantage enrollee, you might be forgiven for not knowing this one. Many Medicare Advantage plans do not have a deductible for inpatient hospital or skilled nursing services; instead, you’ll be responsible for a copay for a certain amount of days. 

But, if you’re on Original Medicare, you need to know there will be a $1,632 deductible per benefit period in 2024. Some Medicare Supplement plans may cover all or part of this expense for you. If not, you’ll be responsible for this charge each time you begin a new benefit period. Speaking of which…

54.2% of beneficiaries aren’t quite sure how Part A benefit periods work

Medicare Part A doesn’t work like many other sources of insurance – you may have to pay that $1,632 deductible several times per year. Here’s why:

When you’re hospitalized, you’ll be responsible for fulfilling that deductible before Medicare Part A pays for any part of your care. Once the deductible is satisfied, you’ll pay $0 for days 1-60 in this hospital, $408 per day (in 2024) for days 61-90, then $816 per day (in 2024) for days 92-150 (if you’re using your lifetime reserve days). After that, if you still need more care, you’re on the hook for all costs.  

Once you’re released from the hospital, another 60-day countdown begins. If you’re re-admitted during the next 60 days, it will be treated as part of the same benefit period. You’ll be responsible for any appropriate copay.

But, if you stay out of the hospital for at least 60 days,  you’ll begin a new benefit period the next time you’re hospitalized. That will require you to again meet the deductible, and then pay any applicable copays.

And so, someone can be responsible for the Part A deductible several times within a calendar year. Still confused? Check out our video on Part A benefit periods.

73.5% of enrollees aren’t familiar with excess charges

If you’re on Original Medicare, it’s important to ask your doctors whether they accept assignment from Medicare – not just whether they’ll see you. Accepting assignment means they agree to take the Medicare-approved payment for any services they provide. If they don’t accept assignment, they may charge you up to 15% more than the Medicare-approved amount for your care. Unless you have a Medicare Supplement policy that accounts for excess charges, that means you may be spending more than you planned.

You’re not sure what Original Medicare covers

Besides the inpatient hospital care we’ve already discussed, Original Medicare covers various other services. 73.4% of beneficiaries correctly believe that Medicare Part B covers an Annual Wellness Visit, but things get dicey after that.

• Only 64.2% correctly believe that Medicare Part B will cover a flu shot
• Only 54.3% believe that preventive services are covered
• Only 30.7% know that Part A covers hospice care
• Only 29.1% correctly identify  durable medical equipment like walkers and wheelchairs as covered
• 28.8% realize Medicare covers inpatient and outpatient mental health treatment

But, here’s the most dangerous misconception: 23.6% of beneficiaries believe that Original Medicare will cover the drugs you get at the pharmacy. It won’t. Instead, you’ll need to obtain Part D Prescription Drug Coverage through either a stand-alone plan or a Medicare Advantage plan with prescription drug coverage (MAPD). Check out our video on Part D coverage to learn more.   

Knowing is half the battle

Now that you’re better informed about Medicare than a lot of beneficiaries, you’ll need to answer one question: What’s next? Fortunately, our licensed insurance agents are well qualified to help you evaluate your options, and help you find a solution that best fits your unique needs. Reach out today for a friendly chat about your benefits – it’s on the house!