Many Americans rely on Medicare coverage, but it is not guaranteed for life. You may lose access to these benefits for a variety of reasons, including unpaid invoices, administrative errors, or decisions made by third parties. Being aware of these circumstances can help you avoid problems and maintain your health insurance coverage.
You can reapply if you lose your Medicare coverage. In certain circumstances, you may be eligible for a Special Enrollment Period (SEP), which allows you to re-enroll without having to wait for the annual open enrollment period, which runs from October 15 to December 7. Nonetheless, it is preferable to prevent the loss of coverage before it happens.
Reasons why you can lose Medicare
There are several reasons why you may lose your Medicare coverage. Some of the reasons stem from administrative errors or decisions made by insurers, while others are directly related to the beneficiary’s actions. The main factors that can cause the loss of these benefits are listed below.
- Failure to pay monthly premiums: All Medicare Part B beneficiaries must pay a monthly premium, which will be $185 in 2025. In addition, if you have not worked for at least 40 quarters contributing to Medicare, you will also have to pay a premium for Part A, which will range from $285 to $518.
Payments must be made by the 25th of each month. If you are late, you will receive a warning notice. After three notifications without payment, you will lose Medicare coverage, as well as any Medigap (Medicare Supplement) or Part D (Prescription Drug) insurance. - Committing fraud or disruptive behavior: If you misuse your Medicare card, such as by lending it to someone else, you could lose your benefits. It is also illegal to accept bribes or benefits in exchange for unnecessary treatment or to validate false medical bills.
On the other hand, if your behavior prevents your Medicare Advantage (MA) plan from providing services effectively, you could be expelled. This process is not immediate, but involves getting at least three written warnings. - Providing false information on the application: If you provided incorrect information when enrolling in Medicare Advantage, Part D or Medigap, such as an address outside the coverage area or false income to obtain discounts, you could lose the benefit once the fraud is detected.
- Moving out of the coverage area: If you move to a new address where your Medicare Advantage plan does not operate, you will have to change plans or enroll in Original Medicare with Part D to remain covered.
- Plan cancellation or non-renewal: Sometimes, Medicare decides to cancel or not renew certain Medicare Advantage or Part D plans. If this happens, you will need to choose a new provider or switch to Original Medicare to continue getting coverage.
Keeping all this in mind can help us maintain our Medicare Coverage and thus enjoy the associated advantages.
What to do if you lose your Medicare coverage
If you lose your coverage, see if you are eligible for a Special Enrollment Period (SEP) and apply for re-registration as soon as possible.
Keep up with your payments, avoid fraud, and always ensure that your address is within the coverage area to avoid losing your medical benefits. Also, consult a Medicare advisor for advice on the best options for your specific situation.
Finally, remember that preparation and knowledge are the keys to avoiding problems with your health insurance. You can avoid unnecessary disruptions to your Medicare coverage by checking your statement on a regular basis, following enrollment rules, and being aware of your beneficiary rights.
