If you are a Medicare beneficiary, your plan will include some duties you must satisfy to keep your Medicare benefits. One way to lose Medicare coverage is if you fail to meet your plan’s standards and guidelines.
You can join Medicare in two ways: because of a disability or because you have reached the age of 65. If you qualify due to a disability, it is possible to lose your Medicare, but if you are eligible due to age, you will not lose your eligibility unless you do not pay your premiums. Other reasons for losing coverage vary depending on the sort of plan you’re enrolled in to obtain your benefits. Because insurance coverage is critical to ensuring you can receive the medical care you need without paying for it all out of pocket, it’s crucial to understand how you can lose Medicare coverage, the qualifying requirements, and what you can do if it happens.
Reasons You Can Lose Your Medicare Benefits
Medicare benefits are typically provided for life to people who qualify due to age and, in some situations, to those with specific disabilities. However, in the following cases, you may lose your Medicare coverage:
Failing to pay premiums:
In most circumstances, if you are enrolled in Original Medicare, you will not be required to pay any Part A payments. Medicare Part B, which covers medical services such as doctor visits and medical devices, is usually subject to a charge. Your Medicare benefits will be terminated if you do not pay your Part B premium. You will usually receive two notices when you fail to pay your premium. You will be sent a Delinquent Notice if you do not pay your premium by the deadline specified on the second notice. You must pay your delinquent premium by the 25th of the month following the Delinquent Notice, or your Medicare benefits will be canceled.
Committing Medicare fraud:
Medicare fraud or incorrect information can result in the termination of Medicare coverage. Depending on the severity of the deception, you may also face different consequences, such as fines or jail time. Fraud situations, such as allowing someone else to use your Medicare coverage, will result in losing your coverage. Other reasons for benefit termination include submitting incorrect health information or personal information. To avoid having your plan benefits canceled, ensure all the information you submit when enrolling in Medicare plans is correct.
Your SSDI benefits end:
Suppose you have a qualifying disability and receive Social Security Disability. In that case, you will be eligible for Medicare coverage whether or not you reach the age of 65. However, Medicare benefits for a disability are not necessarily permanent and may end when your SSDI benefits expire. This means that if your SSDI benefits stop before age 65, your Medicare coverage will last only 93 months before your benefits are discontinued. The grace period for Medicare coverage after your SSDI benefits stop, on the other hand, varies depending on your condition. For example, suppose you obtain SSDI benefits because of end-stage renal disease. In that case, your Medicare coverage will continue for up to a year after dialysis or three years after a kidney transplant.
You move outside your plan’s coverage area:
Certain providers within a defined service area often provide Medicare Part C and Part D coverage. You may lose your Medicare benefits if you move to a place not covered by your Part C or D plan. If you need to relocate to an area not covered by your current plan, you can apply for a new program during enrollment. This enables you to enroll in a Medicare plan in your new community outside the typical open enrollment period. Because Original Medicare does not have service zones, beneficiaries who move from one location to another will not lose their coverage.
Your Medicare plan is discontinued:
Because commercial insurance firms provide Medicare Advantage and Medicare Part D plans, they may be canceled in some situations. Medicare Part C and Part D policies may be phased out by Medicare or dropped by the insurance company. You would lose your Part C or Part D plan benefits in such instances, but you can enroll in a different one during the enrollment period.
Returning to work will not automatically terminate your Medicare benefits if you were eligible for Medicare before age 65 due to a disability. According to the SSA, if you still have a debilitating handicap after your trial employment term, you may be eligible for 93 months of hospital and medical insurance (Medicare Part A and Part B). There will be no premiums for your Medicare Part A coverage. If you still have a disability at the end of the 93 months, you can purchase Medicare Part A and Part B insurance after your premium-free Medicare coverage ends. You can also generally keep Medicare if you get health insurance through your job. Medicare is frequently the secondary payer, with your employer coverage serving as the primary payer.
Remember that you must notify Social Security if you return to work or if your medical condition improves. The SSA anticipates that medical advances and rehabilitation will aid in the recovery of many people with impairments.
You may be eligible for Medicaid if you lose your Medicare eligibility and do not have health insurance. Your Modified Adjusted Gross Income is used to determine your Medicaid eligibility.
Want to Learn More About Your Medicare Coverage?
Reach out to Toni Buffington Medicare Solutions today! We are guaranteed to help you find the coverage you need, and will educate you on all the ins and outs of your Medicare plan.