Medicare provides millions of people with affordable federal health insurance to keep them healthy and minimize excessive healthcare bills. Those who qualify for this insurance type receive multiple coverage levels that can help people over 65, younger individuals with disabilities, and anyone with end-stage renal disease get the care they need to stay healthy. However, our team at Senior Insurance Solutions knows that Medicare eligibility can seem fragile for many people.
You’ve probably heard about folks who’ve suddenly lost their Medicare coverage and ended up in a pretty tough financial situation. Is it possible for people to lose their Medicare eligibility or is this just an urban legend with no basis in reality?
Yes, You Can: Here’s What Colorado Springs Residents Must Know
Unfortunately, people can lose their Medicare eligibility for a number of reasons. Before we go into these issues, it’s critical to know this fact: they vary based on why you have Medicare. At Senior Insurance Solutions, our Medicare agents can help explain why your eligibility was removed and will find Medicare providers to help you get it back. Here’s what you have to know.
Nonpayment
Even though Medicare requires smaller monthly premiums, payment is crucial. Those who miss their monthly payments may lose their eligibility. Now, it’s not an immediate problem. If you don’t pay for the current month, you won’t lose your Medicare the day after it is due. Instead, you receive two additional bills for the money you owe. These are essentially two warnings.
If you don’t pay the premium by the 25th of the month in which you received your second warning bill, you could lose eligibility. Note that people with Medicare Supplement or Medigap plans have a 90-day grace period. Therefore, you have longer to pay than you do with general Medicare. After those 90 days, though, your coverage will be terminated if you haven’t paid.
Disability Ends
If you receive Medicare due to a disability and are under 65 years old, you could lose your benefits if your specific coverage runs out. For example, SSDI provides support for Americans with disabilities but may also end someone’s benefits for various reasons. If you lose your SSDI protection, Medicare will cover you for up to 93 months to protect Colorado Springs residents.
Unfortunately, if you don’t turn 65 before those 93 months end, you will lose your eligibility until you hit 65. There’s not much you can do in this situation until you hit 65, either. Just about the only solution is to reapply for SSDI protection or appeal your denial. Otherwise, you will be stuck waiting until you hit 65. Don’t worry, SSDI denials aren’t typical for debilitating conditions.
Kidney Transplants or End Dialysis
People who receive SSDI to manage end-stage renal disease (ESRD) can only receive Medicare benefits for up to 12 months after dialysis or 36 months after a kidney transplant. At that point, your eligibility runs out. Trying to reapply to SSDI may help you get disability support through your treatment. Unfortunately, Medicare rules are very specific on this point.
Leaving Coverage Area or Plan Discontinuation
Medicare Advantage and Medicare Part D plans often have specific coverage areas because they’re provided by private companies. These firms might not include nationwide policies, meaning relocating could affect your eligibility. Note that standard Medicare is not affected by moving because it’s a federal program. Only private Medicare plans get canceled by moves.
Furthermore, private insurers might discontinue your specific Medicare coverage, including Medicare Part D and Advantage. When this happens, you lose your eligibility but can tap into a Special Enrollment Period to find a replacement. We’ll take a deeper look at this point later to ensure that you know your rights and can stay fully protected for years to come.
Lying to Medicare or Fraud
It happens to many people everyday: putting incorrect information on an official Medicare form. For most individuals, it’s probably an accident. Other people lie on purpose to try to get more money from Medicare. Unfortunately, inadvertent lies and deliberate fraud can both lead to eligibility loss. Even worse, they could result in jail time for some people if they’re caught.
Now, don’t panic about going to prison if you accidentally misspelled your name on a Medicare application! Severe punishments only occur when it’s obvious someone was trying to commit deliberate fraud. Honest mistakes won’t get you in jail. Unfortunately, they could still cause you to lose eligibility, so it’s essential to address them ASAP with a trusted Medicare team.
Colorado-Based Private Medicare Plans: Rarely Taken Away
Private Medicare protection like Advantage, Part D, and Supplement plans (Medigap) aren’t often canceled unexpectedly. The most common reason for losing this coverage is failing to pay premiums on time. That said, these private insurers often have varying standards. Review your policy carefully and talk with us to ensure you stay eligible for coverage in El Paso County.
Qualifying for Medicare After Losing It
People who lose their Medicare eligibility must take several steps to stay insured. For example, you can appeal the denial by providing an explanation for what happened. This process requires you to have evidence showing that your cancelation was unfair or not appropriate. Sometimes, you can regain Medicare eligibility, though this isn’t always an option if your case is severe.
Furthermore, you can also try reapplying for Medicare if your appeal gets denied. During open enrollment, talk with us, and we can help you reapply for and hopefully receive Medicare again. If you miss open enrollment, don’t panic because our team can still work with you by helping you find special periods during which you can try signing up for Medicare coverage again.
Special Enrollment Periods: Often a Lifesaver
Special Enrollment Periods or SEPs are times when people can apply for insurance outside of the open enrollment period. Medicare recently expanded SEPs for Medicare Part B and Part A, meaning you could apply for them after you lose eligibility and before or after the standard enrollment period. They’re not always easy to get because qualifications are very specific.
For example, you may get a SEP if you are over 65 or disabled but still work, volunteer internationally, receive some TRICARE benefits, were impacted by an emergency or disaster, were released from prison, were misrepresented by your employer, or in other extreme cases. As you can imagine, these scenarios are rare but could open you up to Medicare eligibility.
What Senior Insurance Solutions Can Do for Colorado Springs Residents
At Senior Insurance Solutions, our crew is on your side if your Medicare eligibility is canceled. Our team can help you identify Medicare plans that fit into your budget and cover what you need. We’ll also give suggestions and support for maintaining your eligibility, including completing your paperwork correctly to ensure a silly mistake doesn’t affect your health.
Furthermore, we’ll meet with you during open Medicare enrollment to discuss what protection you need, sort through your options, and do all the tough work for you. Our goal is to make your Medicare protection easy to understand and comprehensive. If necessary, we can help you find private plans that expand your protection and ensure you’re as protected as possible.
Don’t worry if you lost your eligibility or simply didn’t apply on time during the open enrollment period. We’ll fight for you by finding a SEP exception that gets you the coverage you need to stay healthy. With our help and support, your Medicare eligibility should stay active. If not, we’ll fight for your right to Medicare until we get the results needed for your specific policy.
Senior Insurance Solutions Can Help You Keep Your Medicare in El Paso County
At Senior Insurance Solutions, our team of experts can help you if you lose your Medicare eligibility and can’t afford to stay uninsured. We genuinely believe in doing the right thing and helping people out in frustrating situations like these. When you call us at (719) 440-4242 or use our Medicare resource center, you will get support from a team that knows Medicare law inside and out. So please call us or use our contact form to ensure you get the necessary insurance.
