Can Medicare Benefits Be Terminated?

In this article...
  • It’s possible to have your Medicare benefits terminated under certain circumstances. Read about 5 situations in which your coverage may be put at risk.

If you qualify for Medicare based on your age, you won’t lose your Medicare eligibility. If you qualify because of a disability or other health condition, you could potentially lose your Medicare benefits if your situation changes.

If you have a private Medicare plan such as a Medicare Advantage (Part C) plan, a Part D prescription drug plan or a Medicare Supplement (Medigap) plan, you could lose your benefits if your Medicare plan is cancelled for any number of reasons.   

Below is an overview of five reasons in which your Medicare coverage could be taken away.

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1. You stop paying your premiums

If you owe any premiums for Medicare Part A or Part B and fall behind on the payment of those premiums, you will be sent a notice from Medicare. If your payments remain delinquent after receiving the initial notice you will receive a delinquent notice. If your premiums are still not paid by the date specified on the delinquent notice, your Medicare coverage may be terminated. 

For private Medicare plans, the guidelines for terminating coverage because of missed payments will depend on the plan’s terms and conditions. It should be noted that enrollment in a private Medicare plan is dependent upon enrollment in Original Medicare, so missing any Medicare Part A or Part B payments can also jeopardize your private Medicare coverage.

2. You qualified for Medicare because of a disability but no longer have the disability

If you are younger than 65 years old and qualified for Medicare because of a disability, your benefits may be terminated if you recover from the disability and stop collecting disability payments from Social Security or from the Railroad Retirement Board.

3. You move to a new location where your plan is not offered

Original Medicare can be used all over the U.S., but private Medicare plans generally cover beneficiaries in a specific service area. If you move to a new service area – which is typically defined as a county, zip code or state – your benefits may cease under your old plan. However, you will typically be eligible for a Special Enrollment Period (SEP) to enroll in a new plan. 

4.  Your plan is discontinued

A private Medicare plan may be discontinued by the Centers for Medicare & Medicaid Services (CVS) due to poor plan performance.

An insurance carrier might also stop offering a plan due to company insolvency or policy restructuring. When this happens, the benefits of any plan members will be terminated and a Special Enrollment Period will typically be granted to plan members so they can find and enroll in a new plan. 

5. You were dishonest on your application or engaged in Medicare fraud

If you had to undergo medical underwriting as part of the application process for a Medicare Supplement Insurance plan and were later found to have lied about your lifestyle or medical history, your coverage may be terminated. Likewise, if you engaged in any fraudulent behavior or abused your coverage, your plan carrier may have grounds to terminate your policy. 

Need Help With Your Medicare Benefits?

If you’re concerned about losing your private Medicare coverage, contact your plan carrier directly. For questions about Original Medicare, call 1-800-MEDICARE (1-800-633-4227).