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Can I Lose My Medicare Benefits

Can I Still Get Medicare Coverage If My Disability Benefits Stop

Do I Need Medicare If I’m On My Spouse’s Employer Health Plan?

Even if your Social Security Administration disability benefits stop, your Medicare benefits may continue. This is the case if:

  • You have not recovered from your qualifying medical condition
  • Your benefits stopped because you are able to work

If you get better, and the SSA reports to Medicare that youre no longer eligible for benefits, your Medicare coverage will end because youve recovered from the disability that made you eligible in the first place. The coverage typically ends one month after you receive notice from the SSA.

When To Enroll In A New Plan

If your plan changes, a special enrollment period will usually be available for 3 months. During this time, you can review your plan options and sign up for a new plan. You can compare Medicare Advantage plans and Medicare Part D plans through a tool on the Medicare website.

Youll also be able to enroll in a new plan during open enrollment. This takes place each year from If you miss both your special enrollment window and open enrollment, your coverage will continue automatically through original Medicare.

Because your Medicare Advantage plan will no longer be active, you wont be able to enroll in a new Advantage plan during Medicare Advantage open enrollment. This takes place from each year for people with an active Medicare Advantage plan.

You can enroll in a new plan at Medicare.gov or through your new plans provider.

Tips for finding the right plan

  • Make a list of your preferred doctors and providers, so you can make sure theyre on the provider list of the plans youre considering.
  • Check whether any medications you take regularly are included in a plans formulary, a list of prescription drugs the plan covers.
  • Add up the money you spend on medical treatments annually to figure out how much you can afford to spend on a Medicare plan.
  • Think about potential health conditions or concerns you may have for the upcoming year.
  • Compare plans available in your area here.

Failure To Pay Monthly Premium

A failure to pay your monthly premiums for most plans will lead to a loss of coverage. However, many health insurance plans offered through the marketplace allow their customers a grace period.

This grace period is usually a short time – typically 90 days after your original insurance payment due date. A failure to make your payment by the end of the grace period will lead to a termination of your coverage. In that case, you will only be covered until the end of the month for which you made your last payment.

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Reasons You Can Lose Your Medicare Benefits

A few scenarios can cause a beneficiary to lose Medicare benefits. The way you became eligible for Original Medicare plays a major role in how benefits can be taken away. If any of the following apply to you, you could be at risk of losing your Medicare coverage.

  • Nonpayment of your monthly premium
  • Qualifying disability ends
  • Receiving a kidney transplant or end dialysis
  • Moving outside your plans coverage area
  • Lying or providing misleading information to Medicare
  • Discontinuation of your plan
  • Committing Medicare fraud

When Your Coverage Starts

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The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.

Part B : Coverage starts based on the month you sign up:

If you sign up:

1 month after you turn 65

In 2022: 2 months after you sign up

Starting January 1, 2023: the next month

2 or 3 months after you turn 65

In 2022: 3 months after you sign up

Starting January 1, 2023: the next month

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Things To Do Before Signing Up For Medicare

  • Ask the employer or benefits administrator how its retiree coverage works with Medicare. Youll want to know if your current benefits will change, if they offer retirement coverage or other supplemental coverage that works with Medicare, and if any drug coverage they offer is . Get questions to ask.
  • Check when your current coverage ends and sign up for Medicare about a month earlier. Signing up for Medicare before your current coverage ends can help you avoid a gap in coverage.
  • Ask the employer to fill out the employment form. Youll need this extra form to qualify for a Special Enrollment Period to sign up without penalty.
  • Find Medicare plans in your area, if you dont have retiree coverage or if the employer doesnt offer . If you join a Medicare Advantage Plan or Medicare drug plan, coverage starts the first day of the next month.
  • To avoid a tax penalty, you and your employer should stop contributing to your Health Savings Account 6 months before you retire or apply for benefits from Social Security . Why should I stop contributions before I retire?
  • You Move Outside Your Plans Coverage Area

    For Medicare Part C and Part D, coverage is typically offered within a specified service area through certain providers. If you move to an area that is not covered by your Part C or Part D plan, you stand to lose your Medicare benefits.

    If you need to move to an area that is not covered by your plan, you are eligible to apply for a new plan under the special enrollment period. This allows you to enroll for a Medicare plan in your new area outside of the regular open enrollment period.

    For beneficiaries on Original Medicare, you cannot lose your coverage for moving from one area to another since Original Medicare does not have service areas.

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    Do My Disability Benefits Remain Intact If I Get Married

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    Some types of Social Security Disability are for unmarried family members of the disabled person , while other types are for married or unmarried people, but have income limits. In that case, a new husband or wifes income can be counted toward these limits and could make a disabled person financially ineligible for benefits.

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    What Happens When You Turn 65

    When you turn 65, you essentially lose your entitlement to Medicare based on disability and become entitled based on age. In short, you get another chance to enroll, a second Initial Enrollment Period if you will.6

    If you decided not to take Part B when you were eligible for disability under 65, when you do turn 65, youll now be automatically enrolled in Part B. Your Medicare card will then be mailed to you about 3 months before your 65th birthday.

    You can also decide during this time to enroll in a Medicare Advantage or Part D prescription drug plan. Additionally, once you have Part B, you can enroll in a Medigap plan if you so wish.

    Losing Your Medicare Coverage

    You can lose your Medicare coverage under a few different scenarios.

    Not paying your premiums is the quickest way to lose coverage. You receive a bill for your costs related to Medicare. This is your first notice. If you do not pay, Medicare will send you a Second Notice which will clearly define the deadline you need to submit payments by. If this goes unanswered, youll be given a Delinquent Notice. Pay by the 25th of the month you receive this notice, or you will lose your Medicare coverage.

    If you move to a new location outside of your Medicare Advantage or Part D plans coverage area, youll lose your current coverage. This situation may grant you a special enrollment period during which time you can choose a new plan.

    Some low-performing plans are discontinued. If your plan is discontinued, you may qualify for a special enrollment period to sign up for a new plan.

    Lying on your application or otherwise engaging in Medicare fraud can make you lose your coverage. Medicare fraud can include letting someone else use your Medicare card or aiding in Medicare fraud such as scamming other users into disclosing their Medicare card information for fraudulent use.

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    Most Beneficiaries Can Only Lose Their Medicare Coverage If They Fail To Pay Their Premiums

    There are two scenarios in which you can join Medicare: You qualify because of a disability, or because you turn 65. If you qualify due to a disability, there could be a circumstance where you could lose your Medicare however, if you qualify because of age, you cannot lose your eligibility unless you do not pay your premiums.

    There are a few other reasons you could lose your coverage depending on the type of plan youre enrolled in to receive your benefits.

    Because having insurance coverage is important to ensure you can get the medical care you need without having to pay for everything out-of-pocket, its essential to be familiar with how you can lose Medicare coverage, as well as eligibility requirements and what to do if you lose coverage.

    Can Medicare Advantage Drop You

    Changing from Marketplace Health Insurance to Medicare

    That’s because Medicare Advantage has its own open-enrollment period that runs from January 1 through March 31 every year. During that period, Advantage enrollees are able to drop their existing plans and sign up for a new Advantage plan. They can also drop Medicare Advantage completely and sign up for original Medicare, plus a Part D drug plan.

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    Can You Take Employer Coverage Again When On Medicare

    If you return to work for an employer who offers health insurance, you can take it. You are allowed to have both Medicare and employer coverage, and you can use them together. One will act as primary coverage and one will act as secondary.

    The only thing to keep in mind is that when you have Medicare and an employer plan, you cannot contribute to a health savings account if its offered.

    What Happens If You Don’t Pay Your Medicare Premiums

    For example, if you dont pay your premiums within the plans grace period for nonpayment, you can be dropped. Your plan can also drop you if itll no longer be offered in your area or through Medicare. Read on to learn more about why Medicare Advantage plans may end your coverage, how to find a new plan, and more.

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    Your Ssdi Benefits End

    In cases where you have a qualifying disability and receive Social Security Disability, you will be eligible for Medicare coverage regardless of whether you have attained the age of 65. However, Medicare benefits due to a disability are not always for life and may stop when your SSDI benefits end.

    This means that if your SSDI benefits end before the age of 65, your Medicare coverage will only remain in effect for a further 93 months, after which your benefits will be terminated. However, the grace period for Medicare coverage after your SSDI benefits end can vary depending on your condition.

    For instance, if you receive SSDI benefits due to end-stage renal disease, your Medicare coverage will continue for up to a year after dialysis treatment ends or 3 years after a kidney transplant.

    When & How Do I Sign Up For Medicare

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    You can sign up anytime while you are still working and you have health insurance through that employer. You also have 8 months after you stop working to sign up.

    • Your 8-month Special Enrollment Period starts when you stop working, even if you choose COBRA or other coverage thats not Medicare.
    • Your coverage will start the month after Social Security gets your completed forms.

    Youll need to have your employer fill out a Form CMS-L564 . If the employer cant fill it out, complete Section B of the form as best you can, but dont sign it. Youll need to submit proof of job-based health insurance when you sign up.

    The way you sign up depends on if you already have Part A coverage or if youre signing up for both Part A and Part B. Get forms and ways to sign up.

    Avoid the penalty & gap in coverage

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    Paying Into The System

    People who qualify for Medicare have paid for that benefit. The number of years you or your spouse pay the federal government in payroll taxes determines not only your eligibility for the healthcare program but how much you will pay. These tax dollars are intended to safeguard entitlement benefits for you when you need them in the future.

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    How To Apply For Medicare

    If you qualify for Medicare, there are a number of ways you can apply:

    • Apply online at www.ssa.gov.
    • Visit your local Social Security office.
    • If you already have Part A and want Part B, you must complete an Application for Enrollment in Part B.

    You are eligible for free Part A coverage if youve worked a specified number of quarters and file an application for Social Security or RRB benefits. You may not be eligible if you never worked and never paid Medicare taxes, but you can still purchase Part A coverage . If you are not eligible for a free premium for Part A, you must:

    • File an application to enroll by contacting Social Security.
    • Enroll during a valid enrollment period.
    • Enroll in or already have Part B.

    Does Medicare Coverage Change If You Return To Work


    Today, its not uncommon for people who leave the workforce around Medicare eligibility age to return to work later on. In fact, its estimated that by 2026 about 30 percent of people ages 65 through 75, and 11 percent of people 75 and older, will be working1.Maybe its a passionate side-gig, a part-time job or youve gone back full-time. In any case, when you go back to work, what does that mean for your Medicare coverage?

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    I Need Or Get Help With Costs

    If you have limited income and resources, you may qualify for help to pay for some health care and drug coverage costs.

    Why Is Medicare Not Being Offered

    There are a variety of reasons why a Medicare plan might cease being offered, and all of them could mean that your private coverage is taken away. Low-performing Medicare Advantage or Medicare Part D plans may be discontinued by the Centers for Medicare and Medicaid Services . A private insurer may decide to restructure their plan offerings …

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    What Medicaid Helps Pay For

    If you have Medicare and qualify for full Medicaid coverage:

  • You’ll automatically get Extra Help with your drug costs. Learn more about Extra Help.
  • Medicaid may pay for other drugs and services that Medicare doesn’t cover.
  • Not Paying Your Monthly Premiums

    â ï¸?3 Ways You Can Lose Your Social Security Benefitsâ ï¸?

    It is essential to pay your Medicare premiums on time. If you dont, you could potentially lose your Medicare benefits. For Medicare Part A and Part B, beneficiaries receive two additional bills before their coverage is terminated. After the second notice, if the premium payment isnt received by the 25th day of the current month, your Medicare coverage could be terminated.

    The rules are a bit different for Medigap plans, Medicare Advantage, and Medicare Part D prescription drug coverage. Beneficiaries receive a 90-day grace period to pay delinquent premiums. Once the grace period ends, your Medicare Supplement coverage will be terminated if the premiums have not yet been paid.

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    The Parts Of Medicare

    Social Security enrolls you in Original Medicare .

    • Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
    • Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

    Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

    • Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
    • Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
    • Medicare Part D helps cover the cost of prescription drugs.

    Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .

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