Can You Lose Medicare Coverage?

Health Line

7 hours ago

Medicare coverage is a lifelong benefit for individuals who meet eligibility criteria. However, there are certain situations where a person may have their coverage canceled.
To be eligible for Medicare, the federal health insurance program for older adults in the United States, you need to be 65 years of age or older.
If you're younger than 65 years old, you may qualify for Medicare if you:
have disability and collect Social Security Disability Insurance
have end stage renal disease (ESRD)
have amyotrophic lateral sclerosis (ALS)
If you meet the eligibility requirements for Medicare, you have a right to coverage for the rest of your life.
However, it's possible for your coverage to be canceled or discontinued. In this article, we discuss when this might occur and how to reenroll.
Why might you lose Medicare coverage?
A person may lose their Medicare coverage if they:
stop paying their plan's premiums
move out of their plan's service area
no longer meet the eligibility criteria for the plan
Nonpayment of Medicare premiums
If you stop paying your monthly premiums, Medicare may terminate your coverage. Individuals enrolled in Original Medicare may have premium payments for Part A and Part B.
Generally, there is a grace period of a couple of months after a person stops paying their premium. During this time, you can get caught up on your payments. However, if you don't resume them, Medicare will disenroll you from your coverage.
If you're enrolled in a Medicare Advantage (Part C) or Part D plan, you'll also need to continue paying your monthly premiums or risk termination of your coverage.
Moving out of a plan's service area
If you move your permanent residence outside of your plan's service area, it may affect your coverage.
Original Medicare coverage works anywhere in the United States. If you move abroad, you can stay enrolled in Medicare, but it won't cover any healthcare services you receive. Likewise, if you're incarcerated, you can keep your Original Medicare coverage, but it won't be applied toward any of your healthcare costs, which will be covered by the penal institution.
Medicare Advantage plans work a bit differently. These plans have regional service areas, and your home address determines which plans you're eligible for. If you move out of your county or state, it's possible that you'll no longer be in your plan's service area.
If you have a Medicare Advantage plan and become incarcerated, the plan will consider you outside its service area and disenroll you.
If this happens, you may be disenrolled from the plan.
No longer meeting eligibility criteria
If you're eligible for Social Security Disability Insurance (SSDI), you're also eligible for Medicare. Eligibility involves having a condition that:
prevents you from working at the substantial gainful activity (SGA) level
prevents you from working at the same level you once did
is expected to last for at least a year or be fatal
If you no longer meet the eligibility requirements for disability with the Social Security Administration, and you're younger than 65 years old, your Medicare coverage may be discontinued.
However, if you have a qualifying disability but end up returning to work, you won't automatically lose your Medicare coverage, provided your disability persists.
If you qualify for Medicare due to ESRD, your Medicare coverage will end 12 months after you stop receiving dialysis and 36 months after a successful kidney transplant.
Depending on why you lost Medicare coverage, you can likely reinstate it.
If you are disenrolled from Original Medicare, a Medicare Advantage plan, or a Part D plan due to nonpayment of the plan's premium, you'll have to wait until the Medicare open enrollment period to sign back up.
However, if you go without Medicare coverage for an extended time, you may be responsible for paying late enrollment penalties after you do enroll.
People who lost coverage due to leaving their plan's service area may be able to avoid late enrollment penalties by qualifying for a special enrollment period (SEP). SEPs allow people to enroll in coverage outside of traditional enrollment periods.
If you have questions about reenrolling in Medicare after losing coverage, consider speaking with a Medicare representative about your situation or contacting your local State Health Insurance Assistance Program (SHIP).
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.