Medicare provides essential health coverage to millions of Americans, but certain circumstances can lead to a loss of eligibility. As February 2025 approaches, it’s important to know who is at risk and how to avoid disruptions in coverage.
Table of Contents
Non-Payment
Medicare isn’t always free—many beneficiaries must pay monthly premiums, especially for Part B (medical insurance) and Part D (prescription drug coverage).
- Failure to pay premiums can result in coverage termination.
- There is usually a grace period, and reinstatement may be possible during the Annual Enrollment Period (AEP) or a Special Enrollment Period (SEP).
Moving
Medicare does not cover healthcare services abroad. If a beneficiary moves outside the U.S., their coverage may become inactive.
- They can continue paying for Part B, but benefits won’t be usable until they return to the U.S..
Incarceration
If a beneficiary is incarcerated in a federal or state prison, Medicare benefits are suspended.
- The prison facility is responsible for their medical care during incarceration.
- Coverage resumes automatically upon release, but beneficiaries may need to update their records with Medicare.
Health
Some beneficiaries qualify for Medicare due to specific medical conditions, but coverage isn’t always permanent.
- End-Stage Renal Disease (ESRD): 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.
- Not knowing plan details could lead to unexpected coverage gaps.
Medicare Savings Programs (MSPs)
Medicare Savings Programs help low-income individuals pay for Medicare costs like premiums and co-pays.
- 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 Medicare eligibility, but it can make coverage 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.
