Separating Myth from Reality During Open Enrollment
Medicare open enrollment season is here and so are the ads, mailers, and phone calls promising “$0 premiums” and “all-in-one” coverage. It all sounds easy, but before you sign up, it’s important to separate fact from fiction.
A recent Forbes article by healthcare advisor John Samuels outlines five of the biggest myths about Medicare Advantage and what you should know before choosing a plan for 2025.
Myth #1: Medicare Is Free
Reaching 65 doesn’t mean medical bills disappear. Medicare is still insurance, not an entitlement program. You’ll pay premiums, deductibles, and coinsurance, typically around 20% of most services.
Even “$0 premium” Advantage plans are funded through taxpayer dollars — insurers receive fixed monthly payments to manage your care. Understanding how those payments work helps you see what’s really “free” and what isn’t.
Myth #2: Any Medicare Advantage Plan Will Do
Every plan is different. Advantage (Part C) plans combine hospital (Part A), medical (Part B), and often prescription drug coverage (Part D) into one private plan.
While all Advantage plans must cover what Original Medicare does, they often trade flexibility for convenience — meaning smaller provider networks, prior authorizations, and managed care limits.
The right plan depends entirely on your health needs, preferred doctors, and comfort level with restrictions.
Myth #3: A 5-Star Plan Is Always Better
The Centers for Medicare & Medicaid Services (CMS) rates plans on a 1-to-5-star scale, but those stars don’t always reflect the full picture.
A 5-star plan may excel at customer service or paperwork, but still have limited provider access. Ratings are a helpful starting point, but your personal care needs and coverage priorities matter more.
Myth #4: $0 Premium Means the Plan Works for You
No Medicare Advantage plan is one-size-fits-all. Those extras like dental, fitness, or hearing benefits are attractive, but they may not offset higher copays or out-of-pocket costs later.
Start with a needs assessment — your medications, how often you see doctors, and your travel habits — before focusing on perks.
Myth #5: Once You Pick a Plan, You’re Set
The Medicare landscape changes every year. For 2025:
- The number of available plans is expected to drop by 6.5% nationwide.
- Some insurers are reducing extra benefits like over-the-counter allowances and transportation.
- CMS is tightening oversight to reduce misleading advertising and improve transparency.
- Rules for dual-eligible (Medicare + Medicaid) plans are changing.
- Telehealth access may shift if pandemic-era policies expire.
It’s crucial to review your plan’s Annual Notice of Change and confirm your providers and prescriptions remain covered before renewing.
How to Choose Wisely
Before enrolling, take time to:
- Verify your doctors and hospitals are in-network
- Review your prescription drug coverage
- Compare total costs, not just premiums
- Ask about telehealth options
- Get help from your local State Health Insurance Assistance Program (SHIP)
The right plan can protect both your health and finances. Medicare Advantage offers convenience; Original Medicare provides flexibility. The key is knowing which aligns best with your needs.
Leave a Reply