About half of older adults rely on original Medicare (Part A and Part B) for their hospital and medical coverage. However, many myths persist about what it covers, what it doesn’t, and how it works alongside other Medicare options. These myths can lead to gaps, unexpected expenses, or missed enrollment deadlines. Below are seven common myths about original Medicare and how the program actually works in real life.
Myth #1: Original Medicare covers all medical costs
The misunderstanding: Many hear the word “Medicare” and assume it covers 100% of medical costs.
The truth: While original Medicare provides broad coverage, it doesn’t pay for everything. Part B (medical insurance), for example, generally pays about 80% of approved medical costs. You would be responsible for the remaining 20%, plus any deductibles and other out-of-pocket expenses.
Original Medicare has no annual out-of-pocket maximum, which is why many people choose to add a Medigap policy (a private Medicare supplement) to help manage uncovered costs.
Myth #2: Original Medicare includes prescription drug coverage
The misunderstanding: Prescription drugs are so routine in health care that people naturally assume they’re included.
The truth: Original Medicare doesn’t include outpatient prescription drug coverage. Medications you pick up at a pharmacy are covered under Medicare Part D, which you have to buy separately from a private insurance company.
Without Part D, you may have to pay full price for prescriptions unless you have manufacturer assistance or a discount card. You could also face late-enrollment penalties if you don’t enroll when first eligible (during the seven months around your 65th birthday), unless you have qualifying coverage in the interim, such as from employer insurance.
Myth #3: You can go to any doctor, and everything will be covered
The misunderstanding: Original Medicare is often described as offering freedom of choice, which can be misunderstood.
The truth: You can visit any doctor or hospital anywhere in the U.S. that accepts Medicare. You won’t need referrals or be limited to a network. However, the provider must accept Medicare assignment for Medicare to pay its share. “Medicare assignment” means the provider formally accepts Medicare’s payment rules.
Most doctors accept assignment, but if they don’t, they may charge more than Medicare’s approved amount, and you could be responsible for those excess charges unless you have supplemental coverage that protects you against them.
Myth #4: Medicare covers long-term care
The misunderstanding: People often associate Medicare with aging and assume it covers services like nursing homes or assisted living.
The truth: Original Medicare doesn’t cover long-term custodial care, such as extended stays in nursing homes or help with activities of daily living like bathing, dressing, or eating.
Medicare may cover short-term skilled nursing care after a qualifying hospital stay, but only under specific conditions and for a limited time. Long-term care planning requires separate financing strategies. These can include using personal savings, purchasing long-term care insurance, or preparing to qualify for Medicaid assistance.
Myth #5: Enrollment timing doesn’t really matter
The misunderstanding: Many people believe they can enroll in Medicare whenever it’s convenient.
The truth: Medicare has specific enrollment periods. Missing them can result in lifetime penalties or coverage gaps. For most people, the key window is the initial enrollment period, which begins three months before they turn 65 and lasts seven months.
Delaying enrollment in Part B or Part D without qualifying employer coverage can result in permanent premium increases, something many retirees don’t realize until it’s too late.
Myth #6: Original Medicare is only for people with serious health problems
The misunderstanding: People in good health may assume original Medicare is necessary only if they expect frequent or severe medical care.
The truth: Original Medicare works well for a wide range of people, including those in good health, especially when you pair it with the right supplemental coverage like Part D drug coverage and Medigap supplement insurance. That combination offers predictable benefits, nationwide easy access to care, and stability that doesn’t change annually, unlike Medicare Advantage plans.
Original Medicare can also be a convenient choice for people who travel frequently, live in multiple states, or value broad provider access.
Myth #7: Original Medicare and Medicare Advantage work the same way
The misunderstanding: Both options fall under the Medicare umbrella, which can blur the differences for people who don’t look closely at their options.
The truth: Original Medicare and Medicare Advantage operate very differently. The federal government administers original Medicare and allows beneficiaries to add other coverages, such as Part D and Medigap, to expand their protection.
On the other hand, Medicare Advantage plans bundle services and are administered by private insurers. Policyholders often must deal with specific doctor and hospital networks, prior authorizations, and annual benefit changes.
Neither option is inherently better, but understanding how they differ is essential to choosing the option that best meets your needs.
Wrapping up
Most Medicare myths come from reasonable assumptions, not from carelessness. The Medicare program has evolved since its introduction, and its rules are not always easy to understand.
Understanding what original Medicare does and doesn’t cover can help older adults and their families make confident decisions. This will help them avoid costly surprises and let them choose add-on coverages that fit their health and financial priorities.
When in doubt, seek accurate information from trusted sources and ask informed questions. Use resources like the Medicare Plan Finder or a State Health Insurance Assistance Program (SHIP) counselor to help ensure your choice suits your health needs and lifestyle.
