Can I Lose My Medicare Benefits?

by | Feb 23, 2021

You can lose your Medicare benefits if you become ineligible for Medicare, you’re no longer covered by your current plan, your plan is discontinued, you lie on your Medicare plan application, or you engage in Medicare fraud.

Losing Medicare Eligibility

If you qualify for Medicare due to a disability, there’s a chance you may become ineligible. To qualify due to a disability, you must have been receiving Social Security Disability Insurance (SSDI) for at least 24 months. Your Medicare coverage begins in the 25th month of receiving SSDI, and depending on your qualifying condition, you may not have to pay premiums to receive Part A. If your medical condition improves and you no longer have a qualifying condition, you’ll lose Medicare eligibility.

If you recover from kidney failure and are under 65, you may lose benefits. Medicare coverage for people with End-Stage Renal Disease will end 12 months after you stop receiving dialysis treatments or 36 months after you have a kidney transplant.

If you’re under 65, receive Medicare due to a disability, and return to work, your time of receiving premium-free Part A is limited. For the first 93 months after your trial work period, you will still receive Part A and Part B while paying $0 in premiums for Part A. After these 93 months, if you still qualify for Medicare due to a disability, you can purchase Part A and Part B. You can also keep Medicare if it’s the secondary insurer after employee coverage through work. You will need to report to Social Security when you return to work and if your condition improves.

If you qualify for Medicare because you are 65 or older, you will not lose your benefits due to age.

Losing Your Medicare Coverage

You can lose your Medicare coverage under a few different scenarios.

Not paying your premiums is the quickest way to lose coverage. You receive a bill for your costs related to Medicare. This is your first notice. If you do not pay, Medicare will send you a Second Notice which will clearly define the deadline you need to submit payments by. If this goes unanswered, you’ll be given a Delinquent Notice. Pay by the 25th of the month you receive this notice, or you will lose your Medicare coverage.

If you move to a new location outside of your Medicare Advantage or Part D plan’s coverage area, you’ll lose your current coverage. This situation may grant you a special enrollment period during which time you can choose a new plan.

Some low-performing plans are discontinued. If your plan is discontinued, you may qualify for a special enrollment period to sign up for a new plan.

Lying on your application or otherwise engaging in Medicare fraud can make you lose your coverage. Medicare fraud can include letting someone else use your Medicare card or aiding in Medicare fraud such as scamming other users into disclosing their Medicare card information for fraudulent use.

Call The Fussell Group

Medicare decisions don’t have to be stressful; we’re here to guide you through the process and answer any questions you have. If you’re looking for skilled advice, call us at (877) 874-0711.