The Truth About Medicare

  • The Truth About Medicare Some widely held beliefs about Medicare are misguided or wrong. Here, we separate fact from fiction:
  • Myth: Medicare provides cheap health care. Fact: It’s true that most people don’t have to pay premiums on Medicare Part A (which covers inpatient stays in hospitals, skilled nursing facilities, hospice and home care. But you will have to meet a deductible before your Part A coverage takes effect. This year, according to CBS Marketwatch, that deductible is $1,132.
  • Myth: Everybody pays the same premium for Part B (which covers doctor visits). Fact: For the vast majority of Medicare beneficiaries, that’s true (and for them the monthly premium this year has been $115.40.) But the cost of premiums has jumped for an individual whose maximum adjusted gross income (MAGI) is $85,000 or more, and for a couple whose MAGI is $170,000 or more. However, according to the Social Security Administration, this affects only 5 percent of beneficiaries.
  • Myth: Everybody pays the same premium for Part D (which covers prescription drugs.) Again, for most people the monthly cost of Part D is $115.40. But this year, people with individual incomes of over $85,000 or family incomes of over $170,000 will pay an additional monthly fee ranging between $12 and $69.10.
  • Myth: Medicare automatically covers everything. Fact: Not true. It generally doesn’t cover health care costs when you’re traveling outside the U.S., and you have to pick the right Medicare plan if you want some help with your vision and dental care as well as wellness services. What’s known as a Medicare Advantage Plan (Part C) will give you benefits in those areas. But unlike Part A, you’ll be much more restricted in which hospitals and doctors you can choose.
  • Myth: You should sign up for Medicare as soon as possible even if you’re working. Fact: When it comes to Part A, which covers hospitalization, that’s probably a good move. As for Part B , which covers doctors’ visits, the federal government suggests that you wait to sign up, since your at-work insurance is still the primary payer for those medical bills. Visit the Social Security Administration’s website ( to sign up, or call the SSA at 1-800-772-1213.
  • Myth: Medicare covers all hospital stays equally. Fact: Unfortunately, whether a person is classified as an actual “inpatient” or only “under observation” can make a huge difference in the amount he or she may be responsible for. To qualify for Skilled Nursing Facility care, a person must have been a patient in a hospital for three consecutive days. But if that patient is only in the hospital “for observation,” he or she may be liable for additional charges during the stay – as well as all follow-up skilled nursing facility care. To help prevent this happening, ask the patient’s doctor, and the hospital, to clarify your status.
  • Myth: When it comes to prescription drug costs, you can’t get help from anywhere but Medicaid. Fact: Many pharmaceutical companies have Prescription Assistance Programs (PAPs) to help qualified patients pay for medications. Click here to see what medicines are covered under these programs. You can also check here to see if your state has a Pharmaceutical Assistance Program.