6 Reasons Why You Could Lose Your Medicare Coverage

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Once you’ve started collecting Medicare benefits, can they be taken away from you?

Yes, there are some scenarios where you can lose certain kinds of Medicare coverage. Different Medicare plans have different rules — which you should know so that you can stay enrolled. Depending on the Medicare plan you’re enrolled in, you could lose your benefits for a variety of reasons. Here are six of them, most of which you can control.  

1.You Don’t Pay Your Plan Premiums

Failing to pay your premium is probably the easiest way to lose Medicare benefits. 

Sometimes people fall behind on their premium payments for Original Medicare. If this happens, you’ll get a Second Notice — the first notice is your typical bill. If you don’t pay by the deadline that the Second Notice shows, you’ll get a Delinquent Notice. Then, if you don’t pay your premium by the 25th of that month, your Medicare coverage could be taken away. 

For Medicare Advantage, Medicare Supplements, or Medicare Part D plans, the termination protocol may differ by carrier. But remember that you need to enroll in both Parts A and B to be able to enroll in these types of coverage. So, if you lose Part A or Part B because you don’t pay plan premiums, you might also lose your private Medicare insurance plan. Contact your plan carrier or call (662) 844-3300 for more information.

2.You Recover from a Qualifying Disability

If you’re under 65 and qualified for Medicare due to a disability, you could lose your coverage if you recover from that disability. If this occurs, consider other types of health insurance.

Suppose you’re under 65 and get disability benefits from the SSA. In that case, your Medicare coverage may continue — even if you go back to work — as long as you haven’t recovered from the disability. To get more info regarding your situation, you can call 1-800-772-1213.

3.You Relocate

If you’re enrolled in Medicare Advantage (Part C) or prescription drug coverage (Part D), you might lose your current benefits if you move to a new home that’s located outside of the plan’s coverage area.

Private insurance carriers sell these plans, which may be intended for use only in certain locations with provider networks approved by the plan. Should you move away from the network area, your plan may not cover you any longer.

Original Medicare (A and B) doesn’t have service areas or select provider networks. So if you have A and B and you move, it shouldn’t impact your enrollment in either Part. Any medical provider who accepts Medicare will accept Original Medicare.

There’s good news. If you lose your coverage due to relocation, you may be given a Special Enrollment Period to sign up for a different Medicare plan — that’s offered in your new area.

4.Your Plan Gets Suspended

There are many reasons why a Medicare plan may stop being offered, which could mean your private coverage is gone. These situations are out of your control, though.

  • The Centers for Medicare and Medicaid Services (CMS) may discontinue Medicare Advantage or Part D plans that aren’t performing well. 
  • A private carrier may choose to restructure their selection and drop a certain plan.
  • An insurer could go bankrupt and close their doors altogether.

In each of these scenarios, you’d lose your Medicare plan. HOWEVER, you’d be granted a Special Enrollment Period to register for a different plan, because it wasn’t your fault. 

Furthermore, if your Medigap plan is discontinued, you should also be granted enrollment in a new policy under guaranteed issue rights. This means an insurer wouldn’t use medical underwriting in your application process.

5.You’re Dishonest on Your Plan Application

If you want to enroll in a Medigap plan outside of your Medigap Open Enrollment window, you may be liable to medical underwriting to determine your rates. 

If you lied or provided misleading info on your application —  attempting to get a lower rate — your plan could be removed if your provider finds out you were dishonest. An example would be lying about not smoking. 

6.You Take Part in “Disruptive Behavior or Medicare Fraud

This last reason is somewhat similar to #5. If you let somebody else use your Medicare card to get services, or if you try to defraud Medicare in any way, your coverage will likely be terminated. 

Some Medicare Advantage programs could also withdraw coverage if you participate in “disruptive behavior.” Generally, this means engaging in any behavior that makes it hard for the insurer to set up or provide care for you — or other plan members.  

We Can Find You a New Medicare Plan

Are you in a situation where you could lose your Medicare benefits? No worries. We can help you find a new plan. An agent at Bobby Brock Insurance will compare plans where you live and find the best fit for your coverage needs. Contact us today for FREE Medicare help!  

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Justin Brock

President & CEO of Bobby Brock Insurance