5 Things Clients Get Wrong About Medicare

Every client you sit down with is going to come in with assumptions about Medicare. Some of what they think they know is close. A lot of it is wrong. And the wrong assumptions are what cause bad decisions. If you can identify and correct these misconceptions early in the conversation, you immediately become the most helpful person they've talked to about their coverage. Here are the five things clients get wrong most often.

Number one. Medicare is free. Clients hear that Medicare is a government program and assume it doesn't cost them anything. Part A is premium-free for most people, and that's where the confusion starts. But Part B has a monthly premium. Part D has a monthly premium. If they choose a Medicare Supplement plan, that has a premium. Even many Medicare Advantage plans that advertise zero-dollar premiums still require the client to pay their Part B premium. On top of premiums, there are deductibles, copays, and coinsurance. When you can walk a client through what they'll actually pay each month and each year, you're giving them clarity nobody else has provided.

Number two. Medicare covers everything. Clients assume that once they're on Medicare, all their healthcare is taken care of. It's not. Original Medicare does not cover most dental care. It does not cover routine vision exams or eyeglasses. It does not cover hearing aids in most cases. It does not cover long-term custodial care like assisted living or nursing home stays beyond a limited skilled nursing benefit. And as we covered earlier, Part B has no out-of-pocket maximum, which means there is no cap on what a client could owe in a given year under Original Medicare alone. When clients understand the gaps, they understand why additional coverage matters.

Number three. They can enroll anytime they want. Most clients don't realize that Medicare has specific enrollment windows. They assume they can sign up or make changes whenever it's convenient. We covered this in detail in the last video, but it's worth reinforcing because your clients will not know this. If they miss their Initial Enrollment Period, they could face late enrollment penalties that last for the rest of the time they have Medicare. If they want to change their plan outside of the Annual Enrollment Period, they usually can't unless they qualify for a Special Enrollment Period. This misconception is one of the most costly, and correcting it early is one of the most valuable things you do.

Number four. All Medicare plans are the same. Clients often think Medicare is Medicare, one size fits all. In reality, there are major differences between Original Medicare and Medicare Advantage, between different Medicare Advantage plans, between different Supplement plans, and between different Part D drug plans. Two Medicare Advantage plans in the same zip code can have completely different networks, different copay structures, different drug formularies, and different out-of-pocket maximums. A Part D plan that covers one client's medications affordably might not cover another client's prescriptions at all. Your role is to show clients that the specific plan matters, and that choosing the right one requires looking at their individual doctors, medications, and how they use healthcare.

Number five. Their employer coverage automatically coordinates with Medicare. This one catches a lot of people turning 65 who are still working. They assume their employer plan and Medicare will just work together seamlessly. The reality depends on the size of the employer. If the employer has 20 or more employees, the employer plan is typically primary and Medicare is secondary. If the employer has fewer than 20 employees, Medicare is usually primary. Getting this wrong can result in claims being denied or the client paying far more than they expected. Clients who are still working at 65 need to understand how their employer coverage interacts with Medicare before they make enrollment decisions.

Those are the five. Medicare isn't free. It doesn't cover everything. You can't enroll anytime. Plans are not all the same. And employer coverage doesn't automatically coordinate. When you can address these misconceptions confidently and clearly, your client trusts you. And trust is what turns a first conversation into an enrolled client and a long-term relationship.

Your action step is simple. Pick two of these five misconceptions and practice explaining them out loud in your own words. Keep it under 30 seconds each. If you can correct a client's wrong assumption in plain language without stumbling, you're ready to handle it at the kitchen table.

Part A is premium-free for people who worked and paid Medicare taxes for at least 40 quarters (about 10 years) — but that is the only "free" piece. Part B carries a standard monthly premium of $202.90 in 2026, Part D has its own premium that varies by plan, and Medicare Supplement plans have premiums on top of Part B. Even $0-premium Medicare Advantage plans require the client to keep paying their Part B premium. On top of premiums, clients still owe deductibles, copays, and coinsurance when they use care.

Original Medicare does not cover most routine dental care, routine vision exams or eyeglasses, hearing aids in most situations, or long-term custodial care such as assisted living and most nursing home stays. It also has no out-of-pocket maximum under Part B, which means there is no annual cap on what a client could owe. These gaps are the main reason clients add a Medicare Supplement, a Medicare Advantage plan with extra benefits, or standalone dental, vision, and hearing coverage.

No. Medicare has specific enrollment windows. The Initial Enrollment Period is the 7-month window around the 65th birthday. The Annual Enrollment Period runs October 15 through December 7 each year for plan changes effective January 1. The Medicare Advantage Open Enrollment Period runs January 1 through March 31 for MA-to-MA or MA-to-Original Medicare switches. Outside of those, a client generally needs a qualifying Special Enrollment Period to make changes.

Two Medicare Advantage plans in the same ZIP code can have completely different provider networks, different drug formularies, different copay structures, and different out-of-pocket maximums (the in-network MA max is $9,250 in 2026). A Part D plan that covers one client's medications affordably may not cover another client's prescriptions at all. Matching the plan to the client's specific doctors, medications, and healthcare usage is the entire value of working with an agent.

It depends on employer size. If the employer has 20 or more employees, the employer group health plan is typically primary and Medicare is secondary. If the employer has fewer than 20 employees, Medicare is usually primary and the employer plan is secondary. Getting the order of coverage wrong can result in denied claims and unexpected bills, so clients still working at 65 should confirm how their specific employer plan coordinates with Medicare before making enrollment decisions.