For many Americans, having Medicare coverage is crucial, but it is not a lifelong certainty. You may lose access to these benefits for a number of reasons, including unpaid invoices, administrative mistakes, or even choices made by third parties. You may prevent issues and keep your health insurance uninterrupted by being aware of these circumstances.
You can reapply if you do lose your Medicare coverage. In certain circumstances, you might be eligible for a Special Enrollment Period (SEP), which would let you to re-enroll without waiting for the annual open enrollment period, which takes place from October 15 to December 7. Nonetheless, it is preferable to stop the loss of coverage before it occurs.
Reasons why you can lose Medicare
There are many reasons why you could lose your Medicare coverage. Some reasons depend on administrative errors or decisions made by the insurers, but others are directly related to the actions of the beneficiary. Below, we detail the main factors that can lead to the loss of these benefits.
- 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, check if you can qualify for a Special Enrollment Period (SEP) and apply for re-registration as soon as possible. Keep up to date with your payments, avoid fraud and always check that your address is within the coverage area so you don’t lose your medical benefits. Also, consider contacting a Medicare advisor for guidance on the best options available for your particular case.
Last but not least, keep in mind that the secret to avoiding issues with your health insurance is preparation and knowledge. You may take advantage of Medicare coverage without needless disruptions by routinely checking your statement, adhering to enrollment rules, and being aware of your rights as a beneficiary.
