AEP brings good information and bad information in roughly equal measure. Here are ten of the most
common myths, misunderstandings, and half-truths that trip people up every fall — and what’s actually true
instead.
By Mike Miligi, Certified Medicare Insurance Planner- Michael M Insurance Services
Every fall, Medicare beneficiaries get buried in advice — from TV ads, mailers, call centers, well-meaning
neighbors, and yes, agents. Some of it is excellent. A meaningful amount of it is confidently wrong. The tricky
part is that bad Medicare advice rarely sounds bad. It usually sounds simple, reassuring, and easy to repeat,
which is exactly why it spreads. Below are ten of the most common examples, paired with what’s actually
true.
Worth knowing before AEP starts this year
Federal marketing rules for Medicare Advantage and Part D plans changed on October 1, 2026, making it
easier for agents to move from an initial conversation into a sales pitch, and even enrollment, more
quickly than in past years. That’s not necessarily a bad thing, but it does mean it’s on you to notice the
moment a conversation shifts from “let me explain your options” to “let’s sign you up,” and to slow down
if you need to.
THE MYTH
“If nobody called me about my plan, that means nothing changed.”
THE REALITY
Insurers can adjust premiums, drug formularies, and provider networks every single year, whether or not anyone
reaches out to tell you. The one document that actually spells out what’s different is the Annual Notice of Change,
mailed each September — silence from a call center isn’t the same thing as no changes to your coverage.
01
THE MYTH
“A $0 premium Medicare Advantage plan means free healthcare.”
THE REALITY
A $0 premium only covers the monthly cost of the plan itself. You can still owe copays, coinsurance, and cost
sharing up to the plan’s annual out-of-pocket maximum, which can run into the thousands in a year with real
medical needs.
02
THE MYTH
“I can never be turned down for a Medicare Supplement plan.”
THE REALITY
Guaranteed issue protections apply during specific windows — your initial enrollment period or certain qualifying
events. Outside of those, insurers in most states are allowed to ask health questions and can decline coverage or
charge more based on the answers.
03
THE MYTH
“Any licensed agent can show me every plan on the market.”
THE REALITY
Some agents are “captive” and can only sell plans from one insurance company. Others are independent brokers
appointed with multiple carriers. Neither one is automatically better, but it’s worth asking directly which kind
you’re speaking with before assuming you’re seeing every option available to you.
04
THE MYTH
“Once AEP ends, I’m locked in no matter what happens.”
THE REALITY
Certain events open a Special Enrollment Period outside of AEP entirely — moving out of your plan’s service area,
losing other creditable coverage, or newly qualifying for Medicaid or Extra Help, among others. AEP is the most
predictable door, but it isn’t the only one.
05
THE MYTH
“My neighbor loves their plan, so it’ll probably work well for me too.”
THE REALITY
Star ratings and premiums mean little without matching a plan to your specific doctors, medications, and
pharmacy. Two people in the exact same ZIP code can have completely different “best” plans, because their actual
healthcare needs aren’t the same.
06
THE MYTH
“I’m healthy and take no medications, so skipping Part D costs me nothing.”
THE REALITY
Going 63 days or more without creditable drug coverage after you’re first eligible can trigger a permanent late
enrollment penalty added to your Part D premium for as long as you have Medicare — even if you never end up
filling a single prescription.
07
THE MYTH
“The caller said they were from Medicare, so it must be legitimate.”
THE REALITY
Medicare itself does not place unsolicited outbound calls to enroll you or sell you anything. Anyone claiming
otherwise on a cold call is, at best, using misleading language, and at worst, attempting fraud.
08
THE MYTH
“Switching Medicare Advantage plans and switching Medigap plans carry about the same risk.”
THE REALITY
Medicare Advantage switches during AEP require no health questions. Leaving a Medigap policy and trying to get
back in later, on the other hand, usually means going through medical underwriting again in most states. These
two moves are not comparable in risk.
09
THE MYTH
“AEP is the only time all year I can make changes to my Medicare, period.”
THE REALITY
AEP (October 15–December 7) is the broadest window, but it isn’t the only one. The Medicare Advantage Open
Enrollment Period (January 1–March 31) and a range of Special Enrollment Periods also exist. Treating every
decision as an AEP-or-nothing deadline creates unnecessary panic — and can also mean missing a legitimate
opportunity later in the year.
10
How to Protect Yourself From Bad Advice
- Ask who an agent represents before you talk plans. A direct answer to "are you captive or independent, and which carriers do you work with?" tells you a lot.
- Get it in writing. A real plan recommendation can be backed up with the plan's official Summary of Benefits — not just a verbal description.
- Treat friendly advice as a starting point, not a final answer. A recommendation from someone who knows your specific doctors and medications is worth more than a general opinion, however well-meaning.
- Use free, unbiased help when you want a second opinion. Your State Health Insurance Assistance Program (SHIP) offers free, one-on-one counseling with no connection to any insurance carrier.
- Slow down the moment urgency appears. "You have to decide right now" is a pressure tactic, not a Medicare rule — nothing about AEP requires an on-the-spot decision.
Quick Questions, Straight Answers
How can I check if an agent is actually licensed?
Every state’s Department of Insurance keeps a public producer license lookup. You can also ask the agent directly for their
National Producer Number (NPN) and verify it through the National Insurance Producer Registry.
What's the real difference between a captive agent and an independent broker?
A captive agent can only sell plans from one insurance company. An independent broker is appointed with multiple
carriers and can compare plans across them. Both can be knowledgeable and ethical — the difference is simply how much
of the market they’re able to show you.
Is it safe to rely on advice from friends or family?
It’s a reasonable starting point, but not a substitute for a personalized review. Their plan was chosen around their doctors,
medications, and health needs — not yours — so use their experience as a conversation starter rather than a final
decision.
Where can I get free, unbiased help if I don't want to work with an agent?
Your State Health Insurance Assistance Program (SHIP) provides free, one-on-one Medicare counseling and has no
financial connection to any insurance company. It’s a genuinely neutral resource.
What's one document I should always ask to see before trusting a plan recommendation?
The plan’s official Summary of Benefits or Evidence of Coverage. If a recommendation can’t be backed up with the plan’s
actual documentation, treat it as incomplete.
Did anything about Medicare marketing rules actually change this year?
Yes — new federal rules took effect October 1, 2026, that make it easier for agents to move more quickly from an
educational conversation into a sales pitch and enrollment. It’s a legitimate change, not a scam, but it’s a good reason to
pay closer attention to when a conversation shifts from information to a sales decision.
Related Reading
Good Medicare advice isn’t about finding someone who talks confidently — it’s about finding someone willing to
slow down, show their work, and put your specific situation ahead of a quick close. I’ve spent over 10 years helping
people sort good information from bad, and I’m a Medicare beneficiary myself, so I understand exactly how much
noise is out there. If you’d like a second opinion on something you’ve heard, or just want to talk through your
options in Babylon, give me a call. That conversation is always free.
Mike Miligi
Owner, Michael M Insurance Service
For over 10 years, Mike has helped seniors and other Medicare-eligible individuals understand their options, including
Medicare Advantage Plans (Part C), Medicare Supplement Plans (Medigap), Prescription Drug Plans (Part D), and dental
and vision programs. Mike is licensed in seven states and certified with 11 insurance carriers. As an independent
Medicare health insurance broker, he works for the client, not the insurance carriers, providing accurate, unbiased
options. Mike recertifies with CMS annually and completes continuing education to stay current on industry standards.
(631) 774-3786 | mmilinsurance@gmail.com | www.mymedicaremike.com
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