Losing Your Medicare Coverage

Can your Medicare coverage be taken away once you’ve begun 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.

Concerned older adults

Reasons your Medicare benefits could be taken away

Depending on the type of Medicare plan you are enrolled in, you could potentially lose your benefits for a number of reasons, such as:

Medicare Advantage plans (Part C), Medicare Part D prescription drug plans and Medicare Supplement Insurance plans (Medigap) are provided by private insurance companies. They 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.

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.

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. Call a licensed insurance agent today at TTY Users: 711 24 hours a day, 7 days a week to get started with a free, no-obligation plan quote.

Every five minutes, we help someone enroll in a plan.1 And we can help you too.

 

1 According to internal data showing that 98,019 Medicare Advantage policies were sold by TZ Insurance Solutions in 2018.

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