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If you are a Medicare beneficiary, your plan will come with certain obligations that you are required to meet to maintain your Medicare benefits. Failure to meet your plan requirements and guidelines is one way in which you can lose your Medicare coverage.
If you are over 65, Medicare benefits are for life, but for beneficiaries under 65, benefits can be temporary. This means that Medicare termination of benefits will largely depend on:
- How you became eligible for Medicare
- The type of Medicare plan you have
Reasons you can lose your Medicare benefits
Medicare benefits are usually for life for those who qualified due to age and, in some cases, for those with certain disabilities. However, you can lose your Medicare coverage in the following circumstances.
You fail to pay premiums
If you are enrolled for Original Medicare, in most cases, you will not be required to pay any premiums for Part A coverage. However, Medicare Part B, which covers medical services like doctor visits and medical devices, usually attracts a premium. This means that if you fail to pay your Part B premium, you will lose your Medicare benefits.
When you fail to pay your Medicare part B premium, you will typically receive a first and second notice. If you fail to pay your premium by the deadline indicated on the second notice, you will be sent a Delinquent Notice. After the Delinquent Notice, you need to pay your overdue premium by the 25th of the month you receive the notice, or your Medicare benefits will be terminated.
Medicare Part C or Medicare Advantage plans, Medicare Part D, and Medicare supplement plans also attract premiums. This means you are required to pay premiums to maintain your plan benefits. For Medicare Advantage, Medicare Part D, and Medigap plans, you have a 90-day grace period to pay overdue premiums. Failure to do so will lead to you losing your benefits.
You commit Medicare fraud
Committing Medicare fraud or providing false information can lead to the termination of Medicare coverage. You may also face additional penalties like fines or even jail time, depending on the nature of the fraud.
Fraud cases like letting someone else use your Medicare coverage will cause you to lose your coverage. Other cases like providing false health information or personal details can also lead to termination of benefits. Make sure all the information you provide when enrolling for Medicare plans is accurate to avoid having your plan benefits terminated.
Your SSDI benefits end
In cases where you have a qualifying disability and receive Social Security Disability, you will be eligible for Medicare coverage regardless of whether you have attained the age of 65. However, Medicare benefits due to a disability are not always for life and may stop when your SSDI benefits end.
This means that if your SSDI benefits end before the age of 65, your Medicare coverage will only remain in effect for a further 93 months, after which your benefits will be terminated. However, the grace period for Medicare coverage after your SSDI benefits end can vary depending on your condition.
For instance, if you receive SSDI benefits due to end-stage renal disease, your Medicare coverage will continue for up to a year after dialysis treatment ends or 3 years after a kidney transplant.
You move outside your plan’s coverage area
For Medicare Part C and Part D, coverage is typically offered within a specified service area through certain providers. If you move to an area that is not covered by your Part C or Part D plan, you stand to lose your Medicare benefits.
If you need to move to an area that is not covered by your plan, you are eligible to apply for a new plan under the special enrollment period. This allows you to enroll for a Medicare plan in your new area outside of the regular open enrollment period.
For beneficiaries on Original Medicare, you cannot lose your coverage for moving from one area to another since Original Medicare does not have service areas.
Your Medicare plan is discontinued
Medicare Advantage and Medicare Part D plans are offered by private insurance companies, so in some cases, they may be discontinued. Medicare Part C and Part D plans may be discontinued by Medicare, or the insurance company may decide to drop the plan.
In such cases, you will lose your Part C or Part D plan benefits, but you can enroll in a different plan under the special enrollment period.
Frequently Asked Questions
To help you understand more about the termination of Medicare benefits and changes in coverage, here are answers to frequently asked questions.
If I lose SSDI, do I lose Medicare coverage?
Yes, if you are eligible for Medicare coverage due to receiving SSDI because of a disability, your coverage will end once Social Security no longer considers you disabled or you become eligible to work.
If you lose SSDI and return to work, your Medicare coverage will remain in effect for 93 months if you successfully complete a 9-month trial period. After this grace period, you will lose your Medicare coverage until you become automatically eligible at the age of 65.
Will I lose my Medicare benefits if I get married?
No, you will not lose your Medicare benefits if you get married. Medicare is an individual plan, so getting married will not affect your plan benefits or coverage. Your coverage will also remain the same if you are eligible for Medicare due to SSDI benefits and decide to get married.
Will my Medicare coverage be terminated if I return to work?
Your Medicare coverage will not be terminated if you return to work after the age of 65 and get coverage from your employer. In such cases, you will retain your Medicare coverage, but your employer’s health insurance will be considered the primary insurance.
In case you qualified for Medicare before age 65 due to a disability, your Medicare coverage will not be terminated automatically after you return to work. Your benefits will remain in effect for 93 months after you return to work, provided you still have an eligible disability.
