The Medicare Myths That Cost
Florida Families Thousands

You qualify for Medicare at age 65 regardless of whether you are still working, retired, or have never collected Social Security. Retirement status has nothing to do with Medicare eligibility. In fact, if you have employer coverage, you may want to delay Part B — but you still qualify.

Medicare and Social Security are two separate programs. You can enroll in Medicare at 65 without collecting Social Security. Many people delay Social Security to age 70 to maximize their benefit — but they still enroll in Medicare at 65 to avoid the late enrollment penalty.

The 40 quarters requirement is only for premium-free Part A. You have several options: (1) Pay a Part A premium (~$278–$505/mo in 2026). (2) Your spouse's work history counts — if they have 40 quarters, you get premium-free Part A. (3) If you are 65+ and on Medicaid, apply for a Medicare Savings Program (MSP) — depending on the level you qualify for, MSP can pay your Part B premium, your Part A premium, or both. QMB covers both; SLMB and QI cover Part B only.

Once you turn 65, your spouse's employer plan may become secondary to Medicare — even if you enroll in Medicare. Depending on the size of the employer, Medicare may become your primary insurance. If your spouse's employer has fewer than 20 employees, Medicare pays first. This can significantly affect your coverage and costs. Always check with the employer's HR department before assuming coverage is the same.

Part A is free for most people (if you or your spouse worked 40+ quarters). But Part B has a standard monthly premium of $185 in 2026 — deducted from your Social Security if you're collecting, or billed directly if not. Higher-income earners pay more (IRMAA surcharges). There are also deductibles and copays. Medicare is comprehensive, but it is not free.

Original Medicare (Parts A and B) does NOT cover routine dental cleanings, eyeglasses, contact lenses, or hearing aids. This surprises many new enrollees. However, many Medicare Advantage plans (Part C) include these benefits as extras — often at no additional premium. If you want dental and vision coverage, compare Medicare Advantage plans or purchase a standalone plan.

Medicare Supplement (Medigap) plans cover the gaps in Original Medicare — like deductibles, copays, and coinsurance. They do NOT cover prescription drugs. If you choose Medigap, you must also enroll in a separate Medicare Part D drug plan. Skipping Part D when you first enroll can result in a permanent late enrollment penalty.

Medicare Advantage plans vary dramatically by carrier, ZIP code, and plan. The same insurer can offer very different plans in different counties. Benefits, premiums, out-of-pocket maximums, doctor networks, and drug formularies all differ. In Miami-Dade alone there are dozens of plans. Picking the wrong one can cost you thousands in uncovered services or lock you out of your preferred doctors.

Original Medicare generally does NOT cover care received outside the United States. There are very limited exceptions for emergencies near the US-Canada or US-Mexico border. Some Medigap plans (Plans C, D, F, G, M, N) include foreign travel emergency coverage at 80% after a deductible. If you travel internationally, this is an important factor when choosing your plan.

You have specific windows to enroll in Medicare. Your Initial Enrollment Period (IEP) is a 7-month window around your 65th birthday. Miss it without qualifying coverage, and you face a permanent 10% penalty on Part B for each 12-month period you delayed — for life. Part D carries a separate 1% per month penalty. These are not one-time fees. They follow you forever.

This is one of the most costly Medicare myths. COBRA is NOT considered active employer coverage. When your employer coverage ends, your Special Enrollment Period clock starts immediately — COBRA does not pause or extend it. If you retire at 65, take COBRA for 18 months, and then try to enroll in Medicare, you may face late enrollment penalties. Always enroll in Medicare when you lose active employer coverage.

You can only change Medicare plans during specific enrollment periods. The Annual Enrollment Period (AEP) runs October 15 – December 7 each year, with changes effective January 1. There is also a Medicare Advantage Open Enrollment Period (OEP) from January 1 – March 31. Outside these windows, you generally cannot switch plans unless you qualify for a Special Enrollment Period.

Medicare Savings Programs help more people than most realize. In Florida, income limits for the Qualified Medicare Beneficiary (QMB) program are higher than many expect, and assets are often not counted the same way as for Medicaid. Many people assume they don't qualify without ever applying. The application is free and takes minutes. If you qualify, Florida pays your Part B premium — saving you $185/month or more.

They are completely different programs. Medicare is a federal health insurance program for people 65+ (and some younger people with disabilities), based on work history. Medicaid is a state and federal program for people with low incomes, regardless of age. Some people qualify for both — called Dual Eligible — and can get significant help covering Medicare costs through the Medicare Savings Program.

A $0 premium means you pay nothing extra per month beyond your Part B premium — but that doesn't mean the plan is free to use. Every time you see a doctor, go to the ER, or get a procedure, you pay copays and coinsurance. The annual out-of-pocket maximum on some $0 plans in Florida can be $5,000–$9,350. If you use your plan heavily, a plan with a small premium but lower copays and OOP max may save you thousands.