Some common Medicare myths are that Part A and Part B cover every cost, Medicare Advantage and Medigap are the same, and turning 65 automatically settles every decision.
In Texas, a reliable way to sort fact from fiction is to check the rule with Medicare.gov, Social Security, or Texas SHIP/HICAP and then discuss your individual questions with a licensed insurance agent before reviewing coverage options.
Texas Medicare Solutions is a BBB-accredited Medicare insurance agency serving Texas seniors. Our licensed insurance agents explain Medicare in plain language so you can separate general rules from questions that depend on your work history, income, prescriptions, doctors, and other coverage.
Does Original Medicare Cover Every Health Care Cost?
No. Original Medicare, which includes Part A and Part B, uses deductibles, coinsurance, and other cost-sharing rules.
Part A generally helps cover inpatient hospital care, skilled nursing facility care under qualifying circumstances, hospice care, and certain home health services. Part B generally helps cover doctor services, outpatient care, preventive services, durable medical equipment, and other medically necessary services.
Each part has its own rules, and not every health care service or item is covered in every situation.
Original Medicare also does not function as a single all-inclusive policy for every health care need. Routine dental care, routine eye exams, and most long-term custodial care generally are not covered by Original Medicare.
Check Medicare.gov or the applicable Medicare coverage information before assuming that a particular service is or is not covered.
Are Medicare Advantage and Medigap the Same Thing?
No.
Medicare Advantage, also called Part C, is another way to receive your Medicare Part A and Part B benefits through a private Medicare-approved plan. Most Medicare Advantage plans also include Medicare prescription drug coverage, although benefits, provider networks, costs, and other rules vary by plan and service area.
Medigap, also called Medicare Supplement Insurance, works with Original Medicare. A Medigap policy can help pay certain out-of-pocket costs in Original Medicare, such as copayments, coinsurance, and deductibles, depending on the policy.
Medigap is not a replacement for Part A or Part B. Medigap policies sold today do not include prescription drug coverage, so someone who wants Medicare drug coverage generally reviews a separate Part D plan.
Because these coverage options work differently, Texas seniors should compare doctors, prescriptions, travel needs, costs, networks, and other plan rules rather than treating the terms as interchangeable.
Do I Automatically Get Every Part of Medicare When I Turn 65?
Not always.
Some people who are already receiving Social Security benefits when they become eligible for Medicare are automatically enrolled in Medicare Part A and Part B. Other people need to enroll through Social Security.
Medicare prescription drug coverage and other coverage decisions are separate and may require additional action.
Your Initial Enrollment Period is generally a seven-month window around the month you turn 65. If you have qualifying group health coverage based on current employment, a Special Enrollment Period may apply instead.
Retiree coverage, COBRA, and individual health coverage do not necessarily provide the same Part B enrollment protections as coverage based on current employment, so confirm your coverage source and important dates before delaying enrollment.
Is Turning 65 My Only Chance to Change Medicare Coverage?
No.
Medicare has several enrollment periods, and each serves a different purpose.
The yearly Medicare Open Enrollment Period provides an opportunity to review and change certain Medicare Advantage and prescription drug coverage.
The Medicare Advantage Open Enrollment Period applies specifically to people already enrolled in Medicare Advantage and has different rules.
Special Enrollment Periods can also become available after certain qualifying events, such as moving or losing particular types of coverage.
These enrollment periods are not interchangeable. When a change happens, write down the event, the date it occurred, and the type of coverage involved.
Medicare.gov can explain which official enrollment period may apply to your circumstances. A licensed insurance agent with Texas Medicare Solutions can explain coverage categories and help you organize questions about available options.
Is Medicare Free for Everyone?
No.
Many people qualify for premium-free Part A based on their or a spouse’s work history, but that does not mean all Medicare coverage is free.
Part B generally has a monthly premium as well as deductibles and cost-sharing. Medicare Advantage plans, Medicare drug plans, and Medigap policies can also involve premiums or other costs depending on the coverage selected.
Original Medicare also does not have a yearly out-of-pocket maximum unless the beneficiary has other coverage that provides additional financial protection. Medicare Advantage plans do have an annual limit on out-of-pocket costs for covered Part A and Part B services.
Some higher-income beneficiaries also pay an Income-Related Monthly Adjustment Amount, or IRMAA, in addition to certain Medicare premiums.
Social Security determines IRMAA using federal income information under specific rules. A qualifying life-changing event may allow someone to request a new determination.
Do Spouses Have to Choose the Same Medicare Coverage?
No.
Medicare coverage is individual. Spouses may have different doctors, prescriptions, travel patterns, health needs, eligibility dates, and budgets.
Even when two spouses become eligible for Medicare around the same time, each person should review coverage based on his or her own circumstances.
Can I Keep Contributing to My HSA After Medicare Begins?
Generally, you cannot make HSA contributions for months in which you are enrolled in Medicare.
This issue requires particular attention when someone enrolls in Medicare after age 65 because premium-free Part A may, in some situations, begin retroactively.
If you have an HSA, ask a qualified tax professional or benefits administrator when contributions should stop and how your Medicare effective date affects your account.
Do not rely on a general internet recommendation when the result could affect your taxes.
What Is the Best Way to Check a Medicare Claim or Myth?
Use a simple process:
- Identify the exact question.
- Check the current rule using Medicare.gov, Social Security, or another appropriate official source.
- Write down relevant enrollment and coverage dates.
- Review your own doctors, prescriptions, other insurance, and financial circumstances.
- Ask for help when your situation is not straightforward.
A licensed insurance agent with Texas Medicare Solutions can explain Medicare coverage categories and help you review questions related to Medicare Advantage, Medicare Supplement, and prescription drug coverage.
You can also contact Medicare.gov, Social Security, or Texas SHIP/HICAP for official or unbiased Medicare information.
Frequently Asked Questions
What Medicare Myths Should Texas Seniors Know Before Enrolling?
Common misconceptions include believing that Original Medicare covers every health care cost, that Medicare Advantage and Medigap are the same type of coverage, or that every Medicare decision happens automatically at age 65.
Medicare rules can depend on enrollment timing, employer coverage, income, prescriptions, doctors, and other individual circumstances.
What Official Resources Can I Use for Medicare Questions?
Medicare.gov and 1-800-MEDICARE provide official Medicare information. Social Security provides information about Medicare Part A and Part B enrollment and certain premium-related matters.
Texas SHIP/HICAP provides free Medicare benefits counseling in Texas.
Are Medicare Advantage and Medigap Interchangeable?
No. Medicare Advantage is another way to receive Medicare Part A and Part B benefits through a private Medicare-approved plan. Medigap works alongside Original Medicare to help pay certain out-of-pocket costs.