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Can You Lose Your Medicare Benefits


Not having health insurance can be frightening, especially as an aging senior. As Medicare experts, we constantly receive questions asking if you can lose Medicare benefits, how long Medicare benefits last, if you can put Medicare benefits on hold, and more. While losing Medicare benefits is possible, it rarely happens.

Like everything in life, if you are a Medicare beneficiary, there are specific rules you must follow to maintain your Medicare benefits

Reasons You Can Lose Your Medicare Benefits

A few scenarios can cause a beneficiary to lose Medicare benefits. The way you became eligible for Original Medicare plays a major role in how benefits can be taken away. If any of the following apply to you, you could be at risk of losing your Medicare coverage.

  • Nonpayment of your monthly premium
  • Qualifying disability ends (Only applies to those under 65)
  • Receiving a kidney transplant or end dialysis (Only applies to those under 65)
  • Moving outside your plan’s coverage area (Only applies to those under 65)
  • Lying or providing misleading information to Medicare
  • Discontinuation of your plan
  • Committing Medicare fraud

Not Paying Your Monthly Premiums

It is essential to pay your Medicare premiums on time. If you don’t, you could potentially lose your Medicare benefits. For Medicare Part A (if you do not qualify to receive it premium-free) and Part B, beneficiaries receive two additional bills before their coverage is terminated. After the second notice, if the premium payment isn’t received by the 25th day of the current month, your Medicare coverage could be terminated.

The rules are a bit different for Medigap plans, Medicare Advantage, and Medicare Part D prescription drug coverage. Beneficiaries receive a 90-day grace period to pay delinquent premiums. Once the grace period ends, your Medicare Supplement coverage will be terminated if the premiums have not yet been paid.

SSDI Benefits Ending

If you receive Medicare benefits before age 65 due to Social Security Disability, your Medicare benefits may not last until you’re 65. SSDI is a federal program that assists Americans with disabilities. Individuals who stop receiving SSDI benefits can continue Medicare coverage for 93 months. However, unless they turn 65 within 93 months, beneficiaries will lose Medicare coverage until they turn 65 and age in.

Additionally, those who stop receiving SSDI become eligible for premium-free Medicare Part A for 8.5 years if they finish a nine-month working trial work period.

If you receive SSDI due to End-Stage Renal Disease (ESRD), your situation differs from the typical SSDI recipient. If you receive SSDI due to ESRD, you will only receive Medicare benefits up to 12 months after dialysis ends or up to 36 months after you receive a kidney transplant.

Your Medicare Plan Is Discontinued or You Move

If you relocate to a new address and have a Medicare Advantage or Medicare Part D plan, you could lose Medicare coverage. These plan types are available through private insurance companies and don’t provide the same coverage throughout the country.

However, if you move out of your service area, you are not out of options. You will likely receive a Special Enrollment Period that will allow you to enroll in a new plan in your new service area.

Additionally, if your carrier discontinues your Medicare plan, you will lose your current coverage and receive a Special Enrollment Period. During this time, you can enroll in a new Medicare plan.

Providing Misleading Information or Medicare Fraud

When applying for Medicare, you should never lie or attempt to mislead. Doing so can lead to the cancelation of your coverage, or in extreme cases, jail time. This can be something as small as intentionally answering a health question incorrectly on an application or as big as Medicare money laundering. Although these examples are two extremes, they can both lead to the termination of Medicare coverage.

Another example of Medicare fraud is allowing someone else to use your Medicare benefits. The only person eligible for Medicare is the person whose name appears on the red, white, and blue identification card. Committing coverage fraud is a surefire way to lose Medicare benefits.

How Long Do Medicare Benefits Last?

For those under 65 who are eligible due to disability, Medicare benefits can last anywhere from one year to the rest of your life. The extent of your coverage depends on your situation. However, for those who age into Medicare at 65, benefits last a lifetime.

FAQs

How do I check my Medicare benefits?
To check your Medicare benefits you will need to create an account at SSA.gov.
Will I lose Medicare if I get married?
You can only lose premium-free Medicare Part A if you were eligible through your ex-spouse and got remarried and both you and your new spouse didn’t pay enough quarters.
Can I put Medicare on hold?
Yes, Medicare is not mandatory, However, if you don’t have creditable coverage you are subject to paying a penalty.
What if I don't want Medicare?
By law, you don’t have to enroll in Medicare. However, you will face late enrollment penalties for Parts A, B, and D.
How long does it take for Medicare to kick in?
Medicare benefits start on the first day of the month of your 65th birthday if you’re getting Social Security. It could take up to three months if you apply during your Initial Enrollment Period, or longer if you apply using the General Enrollment Period. If you receive SSDI, Medicare begins on the first day of the 25th month you receive benefit checks.

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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