Losing Your Medicare Coverage

• by Christian Worstell
• January 12, 2024
• Reviewed by John Krahnert

Can your Medicare benefits be taken away after you've started collecting them?

There are, in fact, a few scenarios in which you can lose certain types of Medicare coverage. Depending on what type of Medicare plan you have, there are different rules you should be aware of in order to maintain your enrollment.

Why would my Medicare be cancelled?

You could potentially lose your benefits for a number of reasons, including no longer being disabled, failing to pay premiums, and living outside of your covered area. 

Select the situation below that most closely applies to you in order to jump to that section of information in this guide:

• You no longer have a qualifying disability
• You fail to pay your plan premiums
• You move outside your plan’s coverage area
• Your plan is discontinued
• You lied or provided misleading information on your plan application
• You engage in Medicare fraud or “disruptive behavior”

You no longer have a qualifying disability

If you are under 65 years old and qualified for Medicare because of a disability, you might lose your coverage if you recover from your disability that qualified you for Medicare. If this happens, you will need to consider other forms of health insurance coverage.

If you receive disability benefits from the Social Security Administration (SSA) and are under age 65, your Medicare benefits might continue even if you return to work, as long as you have not recovered from your initial qualifying disability.

Contact your local SSA office to find out more information regarding your personal situation by calling 1-800-772-1213, TTY users can call 1-800-325-0778, Monday through Friday, 7 a.m. to 7 p.m.

You fail to pay your plan premiums

Not paying your premium is perhaps the easiest way to lose Medicare coverage.

If you fall behind on your premium payments for Original Medicare, you will receive a Second Notice (the first notice is your usual bill). If you do not pay by the deadline indicated on the Second Notice, you will receive a Delinquent Notice. If you do not pay your premium by the 25th day of that month, your Medicare coverage may be terminated.

For other types of Medicare plans such as Medicare Advantage, Medicare Part D or Medicare Supplement Insurance, the protocol for termination may vary by carrier. But it’s important to remember that enrollment in these types of Medicare coverage is contingent on your enrollment in Medicare Parts A and Part B.

This means that if you lose Medicare Part A or Part B because of failing to pay plan premiums, you may also lose your private Medicare plan coverage. Be sure to contact your plan carrier for more information.

You move outside your private plan’s coverage area

If you’re enrolled in Medicare Advantage or Medicare Part D, you may lose your current private coverage if you move to a new address that is located outside of the plan’s service area.

These plans are sold by private insurance companies and may be designed for use only in specific locations with plan-approved provider networks. If you move outside of your plan’s network area, you may no longer be covered by that plan.

Because Medicare Part A and Part B (Original Medicare) do not have provider networks or service areas within the United States, moving should not affect your enrollment in either. Original Medicare is accepted by any medical provider who accepts Medicare.

If you lose your Medicare coverage because you relocate, you may be granted a Special Enrollment Period to enroll in a different plan offered in your new location.

Your plan is discontinued

There are a variety of reasons why a Medicare plan might cease being offered, and all of them could mean that your private coverage is taken away.

• Low-performing Medicare Advantage or Medicare Part D plans may be discontinued by the Centers for Medicare and Medicaid Services (CMS).  
• A private insurer may decide to restructure their plan offerings and drop a particular plan from their selection.
• An insurance company could go insolvent and shut their doors altogether.

Each of these scenarios would lead to the loss of your Medicare plan, but each would also grant you a Special Enrollment Period to sign up for a different plan.

If your Medicare Supplement Insurance plan is discontinued, you should be granted enrollment in a new plan under guaranteed issue rights, which means no medical underwriting would be used in your application process.

You lied or provided misleading information on your plan application

If you wish to enroll in a Medicare Supplement Insurance plan outside of your Medigap Open Enrollment Period, you may be subject to medical underwriting in order to determine your rates.

If you were dishonest on your application in an attempt to secure a lower rate (such as lying about not smoking, for example), your plan could be taken away from you if your plan provider discovered that you lied on your application.

You engage in Medicare fraud or “disruptive behavior”

If you let someone else use your Medicare card in order to obtain services, or if you attempt to defraud Medicare in any other way, your coverage would likely be taken away from you.

Some Medicare Advantage plans could also potentially take away your coverage if you engage in “disruptive behavior.” The definition of disruptive behavior could vary depending on your plan provider, but it generally means engaging in any type of behavior that impairs the insurers ability to arrange for or provide care for you or other plan members.

Can my private Medicare plan be taken away?

Yes, but rarely. There are three primary types of private Medicare insurance sold by insurance companies around the U.S.

• Medicare Advantage plans (Part C)
• Medicare Part D prescription drug plans
• Medicare Supplement Insurance plans (Medigap)

These types of are not provided by the federal government like Medicare Part A and Part B (Original Medicare).

The eligibility rules for private plans can be different than the rules for Original Medicare, so be sure to speak with a representative from your plan carrier if you are concerned about losing your privately-provided Medicare benefits. At the very least, you should contact medicare customer service. 

Get help finding a new Medicare Advantage plan

Are you in a position where you might lose your Medicare coverage? Do you need help finding a new plan?

You can compare Medicare Advantage plans available where you live and find an option that fits your unique coverage needs.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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