A new survey has found a significant gap between how confident Medicare beneficiaries feel about their coverage and how well they actually understand the program. Research from eHealth found that 89% of current Medicare beneficiaries said they were confident in their understanding of their benefits and coverage options, but only 13% could correctly identify the definitions of four major Medicare coverage types.
- 89% of Medicare beneficiaries said they were confident they understand their coverage options.
- Only 13% correctly identified the main Medicare coverage categories.
- 88% did not know that Original Medicare has no annual out-of-pocket spending cap.
- 42% did not know or underestimated the typical 20% coinsurance for covered medical services under Original Medicare.
- Among adults ages 55 to 64 who were not yet enrolled, only 24% said they were confident about their future Medicare coverage options.
- Many people approaching Medicare eligibility were also unaware of potential late-enrollment penalties.
Confidence Does Not Match Knowledge
The survey, based on responses from more than 1,000 Americans, found that most current beneficiaries feel comfortable navigating Medicare. Among the 89% who expressed confidence, 43% described themselves as very confident, while another 46% said they were confident.
However, respondents had difficulty answering basic questions about the program. Only 42% could correctly define Original Medicare, while 44% correctly identified Medicare Part D. Just 45% were able to accurately define both Medicare Advantage and Medicare Supplement, or Medigap, plans. Only 13% could correctly identify all four.
The results indicate that familiarity with Medicare does not necessarily mean beneficiaries understand the differences between its major coverage options.
Gaps in Understanding Healthcare Costs
The survey identified particularly large gaps around potential out-of-pocket expenses.
Nearly 88% of Medicare beneficiaries did not know that Original Medicare does not have an annual limit on out-of-pocket spending. That distinction can be important when beneficiaries evaluate their potential financial exposure under different coverage arrangements.
The study also found that 42% of beneficiaries either did not know or underestimated the typical 20% coinsurance associated with covered medical services under Original Medicare. The 20% cost-sharing requirement generally applies after the Part B deductible, although preventive services covered by Medicare can have different cost-sharing rules.
Among Americans approaching Medicare eligibility, the knowledge gap was even more pronounced. 82% of adults ages 55 to 64 who were not yet enrolled were unaware of the 20% coinsurance requirement identified in the survey.
Pre-Medicare Adults Face Additional Knowledge Gaps
People approaching Medicare eligibility reported substantially less confidence than those already enrolled.
Only 24% of adults between 55 and 64 who were not yet enrolled in Medicare said they were confident about their coverage options. The survey also found that many in this age group were unfamiliar with potential consequences of delaying enrollment.
For example, 88% did not know that a late enrollment penalty could increase their Medicare Part B premium by 10% for each 12-month period they were eligible but did not enroll. Another 80% were unaware that delaying Part D enrollment can result in a penalty under applicable circumstances.
The survey found another knowledge gap surrounding Medicare Supplement coverage. 71% of respondents in the pre-Medicare group did not know that delaying enrollment could affect their ability to obtain Medigap coverage or result in higher costs, depending on their circumstances.
Certain late-enrollment penalties do not apply when people qualify for exceptions, such as having other qualifying health coverage, according to eHealth’s survey methodology.
Medicare’s Coverage Choices Can Be Complex
The findings come as beneficiaries navigate several different Medicare coverage arrangements. Original Medicare consists primarily of Part A and Part B, while beneficiaries can also choose Medicare Advantage plans offered by private insurers. Prescription drug coverage is available through Part D, and some beneficiaries purchase Medicare Supplement insurance to help cover certain costs associated with Original Medicare.
Each option has different rules involving premiums, cost-sharing, provider access and prescription coverage. Understanding these differences can therefore affect both healthcare access and potential expenses.
The complexity is particularly relevant as Medicare Advantage has become a major component of the Medicare program. Beneficiaries enrolled in private Medicare Advantage plans must evaluate factors such as provider networks, drug formularies, premiums, deductibles and maximum out-of-pocket limits when comparing coverage.
The survey was conducted by a third-party research vendor between July 15 and July 25, 2026, among more than 1,000 U.S. adults. The overall margin of error was reported as approximately plus or minus three percentage points.
What the Findings Mean for Beneficiaries
The results point to a continuing challenge for Medicare beneficiaries: understanding the program requires more than simply knowing that different coverage options exist.
Cost-sharing rules, enrollment deadlines, prescription coverage and supplemental insurance can all affect a beneficiary’s healthcare expenses. The survey suggests that many people may enter enrollment decisions with a higher level of confidence than their actual knowledge supports.
For people approaching Medicare eligibility, the findings also highlight the importance of learning about enrollment requirements and coverage options before their eligibility period arrives. Medicare provides official educational resources, including its Medicare & You 2026 handbook, which outlines benefits, coverage decisions, rights and protections.
Medicare beneficiaries can face a complicated set of rules involving coverage, costs, enrollment periods, provider networks, and prescription drug benefits. As plan structures become more complex, understanding the differences between Original Medicare and Medicare Advantage can be challenging. Medicare officially offers both options, with Medicare Advantage plans often adding network and plan-specific requirements.
Medicare Beneficiaries Struggle With Plan Differences
For Medicare beneficiaries, one major source of confusion is understanding how Original Medicare differs from Medicare Advantage. Original Medicare generally allows beneficiaries to visit any Medicare-participating doctor or hospital, while Medicare Advantage plans may require members to use specific provider networks and follow plan rules.
This difference can affect how Medicare beneficiaries access specialists, receive services, and manage their healthcare expenses.
Medicare Beneficiaries and Changing Plan Choices
The need for better information is becoming even more important as Medicare Advantage markets change. Recent reporting indicates that some insurers are reducing or exiting Medicare Advantage markets for 2027, potentially requiring affected Medicare beneficiaries to review alternative coverage options.
For Medicare beneficiaries, reviewing plan information carefully each year can help identify changes in premiums, benefits, provider networks, and prescription coverage.
The Future for Medicare Beneficiaries
The growing complexity of Medicare highlights the importance of accessible and understandable healthcare information. Medicare beneficiaries need reliable resources that explain coverage rules without unnecessary complexity.
Better education, transparent plan information, and easier access to official guidance could help Medicare beneficiaries make more confident healthcare decisions and avoid costly coverage misunderstandings.
