WHAT TO DO IF A PLAN DROPS YOU
It’s unlikely, but you should still be prepared
Medicare guarantees you certain rights. As long as you pay your premiums, you should be guaranteed the right to all of Medicare regardless of your age, your health, or where you live. Suppose you abide by Medicare deadlines (and pay your premiums). In that case, you should have access to Part D coverage, Medigap, and Medicare Advantage plans as well. However, there are some situations in which you may lose your coverage. Take care to avoid the following:
Failing to Pay Your Premium
Original Medicare is meant to be accessible. Many people are enrolled automatically and have their premiums automatically deducted from their Social Security payments. However, if for any reason you do stop paying your premiums, you will eventually lose your coverage. You’ll receive multiple notices that your bill is overdue. And finally, in about four months after your initial missed payment, Medicare will be able to drop your coverage.
When this happens, you also lose eligibility for Part D. You can re-enroll. Still, you’ll need to wait until general enrollment (January 1 to March 31) to sign up—and your coverage won’t begin until July. Plus, you’ll probably be stuck with higher premiums as a penalty for late enrollment.
Remember that missing any income-related monthly adjustment amounts you owe on Part B or Part D can also lead to loss of coverage.
Committing Medicare Fraud
Medicare fraud can take many forms, including misrepresenting other coverage you have, such as insurance through an employer. Or frauds like allowing someone else to use your Medicare card to access care. The simplest ways to avoid losing your coverage: Be honest, ask questions, and don’t let others use your card to obtain care.
“Disruptive Behavior”
Though Medicare doesn’t go into specifics, you can lose your MA coverage if you behave in a way that “substantially impairs” the plan’s ability to do its job—namely, providing services to you and/or other beneficiaries. While this possibility may sound scary, MA plans must follow specific steps before they can drop you for this reason. MA plans must also provide reasonable accommodations for beneficiaries with mental illness and developmental disabilities. So this particular clause can’t be used to discriminate based on cognitive conditions. Suppose your MA plan does attempt to disenroll you for disruptive behavior. In that case, it must also inform you of your rights to file a grievance. If your MA plan does ultimately drop you, you’ll be put back onto Original Medicare.
What Happens If Your Plan Closes Up?
If your insurance company goes bankrupt or decides to stop dealing with Medicare, you’ll lose that plan’s coverage. However, you’ll receive notice from your company or from Medicare beforehand. You’ll be entitled to a special enrollment period during which you can select a new plan that will kick in when your old plan ends. Your Medicare Advantage, Part D, and Medigap coverage get the same protection.