Medicare provides essential health coverage for millions of Americans, but under certain circumstances, some beneficiaries could lose their eligibility. As February 2025 approaches, it’s important to know who is at risk of losing Medicare and why. Let’s break down the key reasons coverage might be affected.
Non-Payment
Medicare isn’t always free—many beneficiaries must pay monthly premiums, particularly for Part B (medical insurance) and Part D (prescription drug coverage). If premiums aren’t paid, coverage can be terminated.
However, there’s typically a grace period, and beneficiaries may have an opportunity to reinstate coverage during the Annual Enrollment Period (AEP) or a Special Enrollment Period (SEP) if they qualify.
Moving
Medicare generally does not cover healthcare services outside the U.S. If a beneficiary moves abroad, their coverage may become inactive. While they can continue paying for Part B, they won’t be able to use Medicare benefits until they return to the U.S.
Incarceration
If a Medicare beneficiary is incarcerated in a federal or state prison, their Medicare benefits are suspended. The prison facility becomes responsible for their medical care.
Coverage resumes automatically upon release, but beneficiaries may need to update their records with Medicare.
Health
Some beneficiaries qualify for Medicare due to specific health conditions, but coverage isn’t always permanent.
- End-Stage Renal Disease (ESRD): Medicare coverage typically ends 12 months after stopping dialysis or 36 months after a kidney transplant if the person doesn’t qualify for Medicare through other means.
- Disability Before Age 65: If someone qualified for Medicare due to a disability but later returns to work, they may receive up to 93 months of continued coverage. After that, they must requalify based on their disability status.
Medicare Advantage
Many people switch from Original Medicare to a Medicare Advantage (Part C) plan, which is managed by private insurers. While coverage continues, benefits may change, and misunderstanding plan details could lead to unexpected coverage gaps.
Beneficiaries should carefully review network providers, out-of-pocket costs, and coverage details before making changes.
Savings
Medicare Savings Programs (MSPs) help low-income individuals pay for Medicare costs like premiums and co-pays. However, these programs have income limits that vary by state.
If a beneficiary’s income or assets increase, they may lose their MSP benefits. This doesn’t eliminate their Medicare eligibility, but it can make Medicare more expensive due to higher out-of-pocket costs.
Final Thoughts
For most people, Medicare coverage is lifelong, especially if they qualify by age. However, staying informed about eligibility rules, payment requirements, and changes in financial status is crucial to avoid losing coverage.
If you’re concerned about your Medicare eligibility, check with Social Security or Medicare to ensure uninterrupted access to healthcare benefits.
FAQs
Can you lose Medicare for not paying premiums?
Yes, failure to pay Part B or Part D premiums can lead to coverage termination.
Does Medicare cover healthcare outside the U.S.?
No, Medicare does not provide coverage for most healthcare services abroad.
What happens to Medicare if I go to prison?
Medicare benefits are suspended but will resume upon release.
Will I lose Medicare if my income increases?
You may lose Medicare Savings Program benefits, but not Medicare itself.
How long does Medicare last for ESRD patients?
Coverage ends 12 months after stopping dialysis or 36 months after a kidney transplant.
