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10 Medicare myths

Click on a myth to see the answer:

If you are turning 65 and are already receiving Social Security benefits, you should get a Medicare card in the mail about three months before your birthday. If you are not receiving Social Security at age 65, you usually need to contact Social Security to sign up for Medicare. You can do this starting three months before your birthday month. If you do not automatically receive a card, contact your local Social Security office. ​

Everyone turning 65 should understand how their employer's insurance works with Medicare. People generally start Medicare Part A (hospital coverage) at age 65 since it is premium-free for most people. If you have an health savings account, you should stop contributing to it at least six months before your Part A becomes effective. However, you may need to decide whether to delay enrollment in Part B (doctor coverage) and Part D (prescription drug coverage). The decisions will depend on how your employer's coverage works with Medicare. Is your employer's medical and prescription drug coverage “creditable," or as good as Medicare's? Talk to your employer's benefits administrator and Social Security to avoid problems. ​

Unlike Social Security full retirement, which starts at an age determined by your birth date, Medicare starts at 65. It has enrollment deadlines and lifetime penalties if you miss them. If you are not already in the Social Security system, individualized information is not going to arrive from Medicare; it's your responsibility to keep track of your deadlines.​

Being on COBRA doesn't count as actively working. To delay Part B enrollment without penalty, you or a spouse must be actively working and receiving coverage under the group health plan. Plus, if you are already on COBRA and your Medicare starts, turning 65 will change your status. Your COBRA will end. You will not qualify to delay your Part B without a penalty. You may even have a delay in the start of your Part B, and there could be a significant lapse in your coverage. ​

Individual insurance products are not available to you once you are eligible for premium-free Medicare Part A. Whatever health insurance you have before you enter Medicare eligibility (an employer or union plan, veterans, Medicaid, or an individual policy), you need to talk to your plan, benefits administrator, or case manager to find out if your coverage will coordinate with Medicare.​

Medicare Supplement Insurance (also known as Medigap) and Medicare Advantage plans all require that you have Part A and Part B in order to qualify for purchase or enrollment. You may, however, enroll in a Part D prescription drug plan if you have only Part A or Part B (or both).​

Medicare and Social Security are two different programs. Medicare starts at age 65, regardless of when you draw Social Security. If you wait until you turn 66 to take care of your Medicare, you could find yourself with premium penalties and delayed coverage. ​

Medicare Advantage plans are an alternative to the traditional way of getting Medicare benefits administered by the government. These plans are offered by private companies and can include prescription drug coverage. Medicare supplements (Medigap), in contrast, are additional medical coverage that you can buy if you want to fill in the gaps of what traditional Medicare covers. You can have one or the other, but it doesn't work to have both. Assembling the best Medicare for you depends on many personal factors, ranging from your health and budget to what other coverage you might have and what coverage your doctor accepts. A Senior Health Insurance Benefits Assistance (SHIBA) counselor can help you make your decisions.​

How well a particular drug plan works for you depends on the prescription drugs you take, whether the plan covers your drugs, and how it treats your drugs (there may be rules about quantity limits or requiring you to try other drugs before the plan pays for a preferred drug). There are a lot of differences between Medicare prescription drug plans; a SHIBA counselor can help you find out which ones cover your list the best.​

Part A or Part B eligibility and enrollment questions are answered by Social Security. In fact, if you delay Part B enrollment because you have other coverage, confirm your decision with Social Security to avoid a late enrollment penalty. Document your call. Call 800-772-1213 (toll-free) or visit socialsecurity.gov.

Part C (Medicare Advantage) and Part D (prescription drug coverage) questions go to Medicare. Call 800-633-4227 (toll-free) or visit medicare.gov.

For personalized help in your community, contact SHIBA. Call 800-722-4134 (toll-free) and use the telephone keypad to enter your ZIP code. Your call will be routed to a trained volunteer in your area.

If you are employed or have retiree or union coverage – or any other medical coverage through a government agency or program – contact your benefits administrator to see what happens when you become Medicare eligible.

If you get wrong information from federal officials (Social Security or Medicare) and you documented the conversation (date, name of person you spoke with, and the key information provided), you may get relief from any resulting problems or penalties. This is less likely to happen if you get wrong information from anyone else.​


​​​​​​​​​​Resources

Phone:
800-722-4134 (toll-free)

Email:
shiba.oregon@odhsoha.oregon.gov​

​ ​Guide to Me​dicare​​
​Medicare counselors in your area
Medicare classes and other event​s​
Not from Oregon?
Top 10 Medicare insurance myths​
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