Medicare Myths vs Reality: What Virginia Beach Seniors Need to Know

Medicare Myths vs Reality: What Virginia Beach Seniors Need to Know

In my 24+years helping Hampton Roads seniors with Medicare, I've heard every myth and misconception imaginable. Unfortunately, these myths often lead to poor decisions that cost seniors thousands of dollars or leave them without adequate coverage.

The internet, well-meaning friends, and even some insurance representatives spread misinformation that can seriously harm your Medicare planning. Today, I'm setting the record straight on the most dangerous Medicare myths I hear regularly in Hampton Roads.

Understanding the truth about Medicare will help you make better decisions and avoid costly mistakes.

Myth #1: "Medicare Is Free Once You Turn 65"

The Myth: Many people believe that Medicare is completely free government insurance that covers all healthcare costs.

The Reality: While you may not pay premiums for Medicare Part A (hospital insurance) if you've paid Medicare taxes, Medicare involves significant costs:

• Part B premiums: $206.50/month in 2026 

• Deductibles and coinsurance for medical services, will need a Medicare Supplement to cover these.

• Part D insurance covers prescription drugs subject to a deductible on some drugs

• No coverage for dental, vision, or hearing aids

The Impact: Believing Medicare is "free" leads to inadequate retirement budgeting and shock when healthcare bills arrive.

Myth #2: "All Medicare Plans Are the Same"

The Myth: Since Medicare is a government program, all plans offer identical coverage and costs.

The Reality: Medicare plans vary dramatically:

• Medicare Advantage plans have different networks, formularies, and benefits

• Medicare Supplement plans differ in premiums

• Part D prescription drug plans have vastly different costs for the same medications

The Impact: Choosing the wrong plan based on this myth can cost thousands annually and limit access to preferred doctors and medications.

Myth #3: "I Should Choose the Plan with the Lowest Premium"

The Myth: The best Medicare plan is always the one with the lowest monthly premium.

The Reality: Total healthcare costs include premiums, deductibles, copays, and coinsurance. A plan with a $0 premium might cost you thousands more in out-of-pocket expenses than a plan with higher premiums but better coverage.

The Impact: Focus on total annual costs, not just monthly premiums, when comparing plans.

Myth #4: "I Can't Change My Medicare Plan Once I Enroll"

The Myth: Once you choose a Medicare plan, you're permanently stuck with that decision.

The Reality: You can make changes during specific enrollment periods:

• Annual Open Enrollment: October 15 - December 7

• Medicare Advantage Open Enrollment: January 1 - March 31

• Special Enrollment Periods for qualifying life events

The Impact: This myth prevents people from fixing problems with inadequate plans or taking advantage of better options.

Myth #5: "Medicare Covers Long-Term Care"

The Myth: Medicare will pay for nursing home care or in-home care when you need long-term assistance.

The Reality: Medicare provides very limited long-term care coverage:

• Only covers skilled nursing care for up to 100 days under specific conditions

• Doesn't cover custodial care or assistance with daily living activities

• Most long-term care must be paid privately, through Long Term Care Insurance policies, or through Medicaid for those who qualify

The Impact: Many families face financial crisis when long-term care needs arise without proper planning.

Myth #6: "Medicare Advantage Is Always Better Because It Has Extra Benefits"

The Myth: Medicare Advantage plans are superior to Original Medicare because they include dental, vision, and other extra benefits.

The Reality: Extra benefits come with trade-offs:

• Limited provider networks

• Need for referrals to see specialists

• Geographic restrictions on coverage

• Plans can change benefits and networks annually

• Out-of-network costs can be substantial, up to 11,500 annually

The Impact: Focusing only on extra benefits without considering limitations can lead to restricted healthcare access and unexpected costs.

Myth #7: "I Don't Need Prescription Drug Coverage If I Don't Take Medications"

The Myth: Healthy people who don't currently take medications can skip Part D prescription drug coverage.

The Reality: Skipping Part D coverage when first eligible results in permanent penalties:

• Late enrollment penalty of 1% per month for each month without creditable coverage

• Penalties continue for life once you do enroll

• Health conditions and medication needs can change suddenly

The Impact: Many seniors pay hundreds of dollars annually in preventable penalties.

Myth #8: "I Can Keep My Doctor with Any Medicare Plan"

The Myth: All Medicare plans allow you to see any doctor you want.

The Reality: Provider access varies significantly:

• Original Medicare: Can see any doctor who accepts Medicare

• Medicare Advantage: Limited to plan's network providers

• Going out-of-network with Medicare Advantage can be expensive or not covered at all

The Impact: Many seniors lose access to their longtime physicians by choosing plans based on other factors without checking provider networks.

Myth #9: "Medicare Brokers Are Salespeople Who Cost Extra Money"

The Myth: Working with a Medicare broker costs more than buying directly from insurance companies.

The Reality: Medicare brokers are paid identical commissions whether you work with them or buy direct from insurance companies. You pay exactly the same price either way.

Benefits of Working with a Broker:

• Access to all plan options, not just one company's products

• Unbiased recommendations based on your needs

• Ongoing support beyond enrollment

• Local knowledge of healthcare providers and systems

The Impact: This myth prevents people from getting expert guidance that could save them money and improve their coverage.

Myth #10: "I Should Get Medicare Information from TV Commercials"

The Myth: TV commercials provide reliable, comprehensive Medicare information.

The Reality: TV commercials are marketing tools designed to generate leads, not provide education:

• They only promote specific companies' products

• They emphasize benefits while minimizing limitations

• They use high-pressure sales tactics

• They don't provide personalized guidance for your situation

The Impact: Making Medicare decisions based on TV commercials often leads to inappropriate plan choices.

Myth #11: "Medicare Supplement Plans Are All the Same Price"

The Myth: Medicare Supplement plans offer identical coverage, so they all cost the same.

The Reality: While plans with the same letter (like Plan G) offer standardized benefits, premiums vary significantly:

• Different insurance companies charge different rates

• Pricing can vary by age, gender, and zip code

• Some companies offer discounts for non-smokers or household members

• Rate increase histories differ between carriers

The Impact: Not shopping around for Medicare Supplement insurance can cost hundreds of dollars annually for identical coverage.

Myth #12: "I Don't Need to Review My Medicare Plan Every Year"

The Myth: Once you find a good Medicare plan, you can stick with it indefinitely without reviewing alternatives.

The Reality: Medicare plans change every year:

• Networks of doctors and hospitals change

• Prescription drug formularies are updated

• Costs and benefits are modified

• New plans become available in your area

The Impact: Plans that worked well last year might no longer be your best option, potentially costing you money or reducing your access to care.

How to Get Accurate Medicare Information

Reliable Sources:

• Medicare.gov for official program information

• Local Medicare brokers who represent multiple carriers

• State Health Insurance Assistance Programs (SHIP)

• Your current healthcare providers for network information

  
  

Red Flags for Unreliable Information:

• High-pressure sales tactics

• Claims that sound too good to be true

• Refusal to show you multiple options

• Pressure to make immediate decisions

• Information that contradicts official Medicare sources

  
  

Why These Myths Persist

Medicare myths continue to spread because:

• The program is complex and difficult to understand

• Information changes frequently

• Marketing messages can be misleading

• People rely on outdated or incorrect advice from friends and family

• Some insurance representatives prioritize sales over education

  
  

Get the Facts from Local Experts

Don't let Medicare myths cost you money or compromise your healthcare. As your local Medicare broker in Virginia Beach, I provide accurate, up-to-date information tailored to your specific situation and our local healthcare market.

Call Retha Rish Insurance Agency at 757-692-8388 or 757-213-6910 to get the facts about Medicare and avoid costly myths.

Make your Medicare decisions based on accurate information, not dangerous myths. Your health and financial security depend on understanding the truth about Medicare options available to Hampton Roads residents.