Joanne: Have you ever received Medicare advice from friends or family or online sources that just didn't seem right to you? Even if you haven't, in today's episode, we're going to debunk common Medicare myths so you can avoid some of the traps that Medicare beneficiaries get caught in.

Cameron: But of course, before we start, my name is Cameron Giardini and together with my co-host Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan. Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states to find the right Medicare coverage for them.

Now, if we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the right coverage that you want. Last but not least, we now have a free online course available for you that you can register for to learn about any Medicare topic you can think of.

And you can do this by going to gmedcourse.com.

All right, let's get started with myth number one, and that is that Medicare is free. So what do people often think? Sometimes people, believe that since Medicare is funded in part by payroll taxes and other government funds, Medicare is provided at no cost to you, the beneficiary. Now, the reality is, although the vast majority of consumers do not pay a premium for Medicare Part A, and this is as long as you or a spouse have paid Medicare taxes through payroll taxes for at least 40 quarters or 10 years, Medicare Part B, on the other hand, does come with a monthly premium.

And in 2024, the base Medicare Part B premium is $174.70/month and this can be as high as 594 per month. If you have a higher income that is due to a surcharge called Irma that we talk about in other episodes. Now, in reality, the only people that might get their part B premiums paid for. It's still technically not free.

They're out there, but they are getting covered by somebody. This would be people who qualify for what is called a Medicare savings program. And this is when you get help from your state to pay Medicare premiums and, or out-of-pocket costs. This is from your state's Medicaid program. Just know that these Medicare savings programs are generally designed for individuals.

Like I said, with Medicaid, you have to qualify for them based on income and asset levels. we will link to the qualification details for these 2024 Medicare savings programs, income limits, and asset limits in the description for this podcast.

And then also keep in mind that Medicare Part B premiums are just the beginning for most people. You will still likely have to choose either Medicare Advantage or Medicare Supplement plus Part D coverage, which may come with an additional premium on top of Part B. Although you may have heard us talk in past episodes about the fact that the majority of Medicare Advantage plans, do have a $0 per month premium on top of what you pay for Part B.

Joanne: Let's move to Medicare myth number two. And this one is everyone needs Medicare at age 65. So no doubt you have heard this from some person. So here's what most people think many people are vaguely familiar with the fact that they are eligible for Medicare at age 65.

But many people also think that everyone Has to enroll in Medicare at age 65. So the reality of this one is surprising to most people, but many, many consumers, can delay their Medicare coverage beyond age 65 without any penalty or any issue at all. This is always going to depend on the health insurance coverage that you have when you become eligible for Medicare.

So, if you're covered by a group health insurance program due to active employment through yourself or your spouse, and that particular employer has over 20 employees, you actually will not technically need Medicare when you're eligible for Medicare at age 65. So that means that you can delay your Medicare enrollment while you're covered by that group insurance program without any penalty or any coverage issue since your employer coverage would remain primary to Medicare.

Now, if you are not covered by active employer coverage with more than 20 employees as you approach age 65, you're going to very likely need to enroll in both Medicare Part A and Part B when you are first eligible to do so. So this might include situations like you're covered by the marketplace or ACA coverage.

You're covered by a religious or nonreligious health share. Program. you have retiree coverage, you have COBRA, or you have no health insurance at all. And there are some other situations, but we can't list them all. Okay. So just remember, it's only going to be based on essentially what kind of health insurance you have at the time you are eligible for Medicare.

So just remember that even if you don't need Medicare at age 65, you can still enroll in it if you want to, but make sure to listen to our other episode called, do you need Medicare? And that's going to walk you through those situations. 

Cameron: Yeah. Not everyone has to start Medicare at age 65. Something that a lot of people think that is not always true. 

Joanne: It shocks people. It's just amazing how many people think you have to do that.

Cameron: Now, another thing related to age 65 for Medicare is myth number three, which is Medicare is only for people age 65 plus. Again, that's the myth. So what people think is that because there is a large emphasis placed on becoming eligible for Medicare, When you're turning 65, this leads a lot of people to incorrectly believe this is the only time you can get Medicare is age 65 or later.

However, in reality, there are a few ways that you may be able to qualify for Medicare before age 65. These include the following. So if you have a disability, if you're a person entitled to monthly Social Security or Railroad Retirement Board benefits based on disability, you might be eligible for Medicare Part A and Part B after receiving those disability benefits for 24 months.

Now also, if you have ALS Which is individuals who have the disability, Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's disease. You are entitled to Medicare the first month that you are entitled to Social Security or railroad retirement board benefits. There's no waiting period in this case.

And then you might have end-stage renal disease, also known as ESRD. According to the Centers for Medicare and Medicaid Services, individuals are eligible for premium-free Part A and they are eligible for Part B if they receive regular dialysis treatments or a kidney transplant, have filed an application for Medicare, And meet the different conditions of social security or RRB benefit eligibility.

And we're going to link to those in the show notes since it's a little too much to talk about right now. Now, a little bonus myth, if you will, is that some people also think that becoming eligible for just social security retirement benefits at age 62 will make you eligible for Medicare, but that does not Remember, there is a big difference between when you're first eligible for Social Security, the normal retiree benefits, versus actually getting Social Security disability coverage or disability insurance. Myth 

Joanne: Myth number four Medicare provides family coverage. That is the myth. So here's what people think We just talked about how some people can be eligible for Medicare before age 65 But some people mistakenly also think that you can get Medicare before age 65 because of a spouse or a family member So, again, here's the reality of this.

this myth may come from the fact that if you don't qualify for premium-free Part A coverage based on your work history, you may be able to qualify based on your spouse's work history. But again, this is only for premium-free Part A of Medicare. Medicare eligibility and coverage are based on you, the individual.

So, as an example, if you're 60 years old. and your spouse is turning 65 and becomes eligible for Medicare, that does not make you eligible. The same thing applies to the children of Medicare beneficiaries. Your children are not eligible when you are turning 65. So this can be an important aspect to consider if you're working.

and your employment is providing your health insurance coverage for your spouse or your dependents. So in that case, you'll want to consider how your Medicare eligibility and your enrollment might impact other family members' coverage if they need to now get coverage on their own.

So that is essentially why a lot of people turning 65 may have to wait a couple of years to go to Medicare because their spouse needs coverage. After all, they might be 62, for example. 

Cameron: now moving on to myth number five is that you are automatically enrolled in Medicare at age 65. So many people will sit back and they'll wait for their Medicare card to arrive in the mail as they approach their 65th birthday, only to be left empty-handed without coverage at the right time.

So in reality, You're only automatically enrolled in Medicare when you turn 65 if you are getting retirement benefits from Social Security or the RRB, the Railroad Retirement Board, at least four months before you turn 65. Now, this is not Social Security disability as we talked about, this is just regular Social Security retirement benefits.

Now, if that does apply to you and you're receiving those benefits before you turn 65 in this case, you'll get a welcome to Medicare package, and your Medicare card will arrive in the mail about three months before the month you turn 65. however, more than ever, it is becoming the norm that people are not collecting social security or railroad retirement board benefits before age 65.

 some of this has to do with the fact that the full retirement age for retirement benefits is now close to age 67, and a lot of people are working even past age 65. But if you are not collecting retirement benefits before age 65, you will not be enrolled automatically in Medicare, but you do want it to begin at age 65 when you're first eligible. We recommend that you apply for Part A and Part B of Medicare online using the ssa.gov website. This is ssa. gov. You can do this three months before the month you turn 65, and that's usually the easiest way to apply.

And just as another bonus, if you are automatically enrolled in Medicare at age 65, but you find yourself in the opposite situation where you do want to delay at least Part B of Medicare due to having employer coverage, make sure to follow the instructions in the Welcome Packet about giving back your Medicare Part B.

Joanne: Moving on to myth number six, this myth states that Medicare Advantage plans are Supplements to Medicare. This one makes me crazy. So here's what people think. They think Medicare Advantage Is a confusing topic on its own for Medicare beneficiaries, but often people mistakenly think that a Medicare Advantage plan Provides supplemental coverage to original Medicare.

So here's the reality When it comes to Medicare coverage choices, you generally can choose between Medicare supplements, and true Medicare supplements, and choose between that and Medicare Advantage plans. So just to be very clear, these are completely different coverages and Medicare Advantage plans are not the same as a Medicare supplement.

Medicare Advantage plans are alternatives to original Medicare, And they're provided by private insurance companies and they're not provided by the federal government. Medicare. gov says that if you join a Medicare Advantage plan, you will not get your services using your Medicare red, white, and blue card so you can store that away.

The reason this distinction matters so much is because Medicare Advantage plans become your primary coverage and they manage your Medicare coverage. You're likely going to have to have a specific network of doctors and providers that are contracted with the insurance company. And you may be subject to referrals and prior authorization, which rarely exist with original Medicare.

So if anyone tells you that you can keep your original Medicare Part A and Part B and Medicare supplement while also enrolling into a Medicare Advantage plan to enjoy those extra benefits, they're simply lying to you. 

Cameron: Yeah, it doesn't mean Medicare Advantage plans are bad by any means. It just means that you are not getting a Medicare supplement with an Advantage plan.

So just do not fall into that trap.

Now, our final myth for this episode is myth number seven, which is that changing Medicare coverage is complicated. So, what people think is that when it comes to changing your Medicare Advantage coverage or your Medicare supplement, also known as Medigap coverage, it can seem overwhelming, but the actual process is easier than it seems.

So, first, in reality, changing to Medicare Advantage coverage, whether you're changing from a Medicare Supplement plan to a Medicare Advantage plan, or from one Medicare Advantage plan to another Medicare Advantage plan, you can enroll in a new Medicare Advantage plan regardless of your health status or pre-existing conditions.

However, you will have to enroll during a valid enrollment period. Typically, the fall annual election period, which is October 15th until December 7th, is an example, again, qualifying and filling out the application is easy, but you still have to take the time to check that the new Medicare Advantage plan will fit what you're looking for. As far as provider networks, out-of-pocket costs, drug coverage, extra benefits, and more. So again, it can take time to make the decision, but the actual process of making that switch is relatively easy.

 And then next up is changing Medigap coverage. So enrolling in new Medigap coverage is unique because, unlike Medicare Advantage plans, in most states and most circumstances, pre-existing conditions will likely come into play outside of your Medigap open enrollment period or guaranteed issue rights.

Now we often say that enrolling in a new Medigap plan is either very easy or it's impossible. What this means, or why we say this, is that If you have to go through the health underwriting, if you have to answer the health questions to qualify for a plan and you are healthy enough to qualify, it's a pretty easy conversation.

it's 15, 20 minutes, maybe 30 minutes on the phone and you fill out an online application, you answer the health questions and then you submit it to see if you're approved. So again, the process itself, the actual act of changing the plan is not complicated. However. If you have health conditions that prevent you from qualifying for the new Medigap plan, you will almost certainly not be able to get that new plan at all at that time.

So it's impossible. Like I said, either easy to do or impossible.

Whether you're looking for Medicare Advantage or Medigap coverage, though, make sure you reach out to an independent broker who can help you with the process. That way we can realistically say, okay, here are your options for if you want Medicare Advantage or Medigap coverage. Now, Medicare myths and misconceptions can run rampant in the world of social media.

Sometimes this can result in small mistakes or very drastic mistakes that can impact your health insurance and finances for many years to come. Hopefully, this episode can help you avoid some of the common myths that we see out there, but also make sure you reach out to a trusted independent source of Medicare coverage information as you approach Medicare eligibility.

And as always, please leave us a review on your podcast app and subscribe. So you can listen to future episodes. You can find more content from us by going to YouTube or Tik Tok and searching at GRD, new Medicare. Last but not least, if you want to send us any feedback or questions about this episode or any Medicare topic, you can send an email to us at info at GMedicareteam.com, thanks for listening, and have a great day.