How You Can Lose Your Medicare Benefits
Your Medicare coverage can be disrupted or lost through your own actions or for reasons outside of your control. Don't let that happen to you.


If you have Medicare, losing your health coverage is still possible. You can lose Medicare coverage through your own actions or for reasons outside of your control, such as an insurance provider deciding to discontinue a plan.
If you lose your Medicare coverage, you can reapply. Depending on circumstances, you may be able to apply outside of the Medicare open enrollment period, which runs from October 15 to December 7 each year. You can reapply outside of that window if you've experienced what is considered to be a qualifying life event. In order to do this, you would typically qualify for a Special Enrollment Period (SEP).
Here's a look at five ways you can lose your Medicare benefits.

Sign up for Kiplinger’s Free E-Newsletters
Profit and prosper with the best of expert advice on investing, taxes, retirement, personal finance and more - straight to your e-mail.
Profit and prosper with the best of expert advice - straight to your e-mail.
1. Failure to pay your premiums
Not paying your premiums is an easy way to lose your Medicare coverage. Everyone enrolled in an Original Medicare/Medicare Advantage plan must pay a monthly premium for Part B, which is $185 for 2025. If you haven’t paid Medicare taxes for 40 quarters or more, you will also pay premiums for Part A. In 2025, the monthly premium is either $285 or $518, depending on how long you or your spouse worked and paid Medicare taxes.
Due on the 25th of every month, failure to make your premium payments for a month will result in a second notice. This notice will give you a deadline by which you must make your payment. Continuing to not pay will result in a third delinquent notice.
Your third delinquent notice will include the past-due amount (amount owed from prior billing notice) plus premiums for the next month. If you don't pay the past-due amount or if a partial payment leaves a balance of more than $10.00, your Medicare coverage will terminate by the billing due date.
If you Medicare coverage is terminated, so will your Medigap, and Part D prescription drug coverage. These insurance policies work in tandem with your Medicare coverage.
2. Committing Medicare fraud or engaging in “disruptive behavior”
Defrauding Medicare in any way will get your coverage terminated. For instance, if you let someone else use your Medicare card, you can lose coverage.
Other types of patient fraud:
- Kickbacks. If you receive money or other benefits in exchange for referring patients to a specific provider or facility
- Phantom billing. If If you receive money or other benefits when you agree to receive unnecessary medical treatment or attest to care not actually received allowing a provider to bill Medicare for or services or procedures they did not give or were unnecessary
- Upcoding. If you receive money or other benefits in exchange for involvement in billing schemes that inflate the cost of procedures
Medicare Advantage plans and Part D plans. You may also lose coverage for “disruptive behavior,” which varies from plan to plan and will be defined by your insurance company. To be clear, this does not have to do with the use of medical services or whether or not you’re listening to your doctor’s advice.
An MA plan enrollee is considered disruptive if their behavior substantially impairs the plan's ability to arrange for or provide services to the individual or other plan members. Generally, it means substantially interfering with your plan’s ability to render services or provide care for you or other plan members; it is a lengthy process that requires three written notices.
3. Lying on your application
Medicare Advantage and Part D prescription drug plans. If you provide misleading information on your plan application, you risk losing your Medicare Advantage of Part D coverage. An enrollment is not legally valid if a plan sponsor or CMS determines at a later date that an incorrect permanent address was provided at the time of enrollment to get access to a plan that is outside the service area.
Medigap or Supplemental Insurance. If you provide dishonest information on your application in an attempt to get a lower premium, you could lose your coverage when the insurance provider confirms/investigates. Dishonest information includes falsely claiming you have a lower income or that you’re a nonsmoker.
4. Moving outside your plan area
If you move, your current plan may not cover you at your new address.
You can switch to a new Medicare Advantage Plan or to Original Medicare and a Part D drug plan if you move outside your plan’s service area. This rule also applies if you move to a new address in your plan's service area but have new plan options in your new location.
5. Medicare doesn't renew or terminates your Medicare Advantage plan
If your Medicare Advantage Plan or Medicare Part D drug plan is not renewed or is terminated by Medicare, you will need to select a new provider or switch to Original Medicare. It may also be the case that your MA provider decides not to renew their contract with Medicare.
If you plan is sanctioned and not cancelled by Medicare, you also have the option to select a new MA provider or enroll in Original Medicare.
What is a Special Enrollment Period (SEP)?
If you lose your coverage due to many of the reasons discussed above, such as moving or losing other insurance coverage, you may be able to use a Special Enrollment Period (SEP) to get new coverage.
A SEP is a time outside of the regular enrollment periods during which Medicare beneficiaries have an opportunity to enroll in or make changes to their Medicare coverage. SEPs are available to individuals who experience certain qualifying life events or meet specific criteria.
Bottom line
If you've suffered a disruption to your Medicare benefits, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to get more information and possible solutions to your issues. Help from Medicare is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.
The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one assistance and counseling to Medicare beneficiaries about their Medicare rights and billing problems. It can also help beneficiaries compare plans, get enrolled, and find financial assistance to pay for health care premiums and costs.
Related Content
Get Kiplinger Today newsletter — free
Profit and prosper with the best of Kiplinger's advice on investing, taxes, retirement, personal finance and much more. Delivered daily. Enter your email in the box and click Sign Me Up.
Donna joined Kiplinger as a personal finance writer in 2023. She spent more than a decade as the contributing editor of J.K.Lasser's Your Income Tax Guide and edited state specific legal treatises at ALM Media. She has shared her expertise as a guest on Bloomberg, CNN, Fox, NPR, CNBC and many other media outlets around the nation. She is a graduate of Brooklyn Law School and the University at Buffalo.
-
Why You May Need a Medallion Stamp
Transferring securities from one account to another often requires this extra step.
By Emma Patch Published
-
How Dividend Reinvestments Work for Retirement
Want your retirement investments to keep growing? Here's what you should know about dividend reinvestment.
By Robert H. Yunich Published
-
What Is a Medallion Stamp? The Requirement for Transferring Securities
Transferring securities from one account to another often requires this extra step.
By Emma Patch Published
-
ABLE Account: A Savings Tool to Empower People With Disabilities
An ABLE account can improve quality of life for individuals with a disability — it permits tax-free saving for ongoing expenses without jeopardizing benefits.
By Ella Vincent Published
-
Social Security Fairness Act: Five Financial Planning Issues to Revisit
More money as a public-sector retiree is great, but there could be unintended consequences with taxes, Medicare and more if you're not careful.
By Daniel Goodman, CFP®, CLU® Published
-
Social Security Warning: Five Missteps Too Many Women Make
Claiming Social Security is complicated, and for women the stakes are high. What you don't know can cost you, so make sure you do know these five things.
By Daniela Dubach Published
-
To Buck the Third-Generation Curse, Focus on the Family Story
The key is to motivate the next generations to contribute to the family business in a productive way. You can look to Lawrence Welk's family as a prime example.
By John M. Goralka Published
-
20 Ways to Clean Up Your Finances This Spring
Spring cleaning is therapeutic and stops costly problems from building up around the home. Why not tackle the dusty corners of your finances at the same time?
By Lisa Gerstner Published
-
How Roth Accounts Can Ease Your Tax Burden in Retirement
Strategic Roth IRA conversions can set you up for tax-free income in retirement and a tax-free inheritance for the people you love.
By Jim Hanna Published
-
Are You a High Earner But Still Broke? Five Fixes for That
If you're a HENRY (a higher earner, not rich yet) but feel like you still live paycheck to paycheck, there are steps you can take to get control of your financial future.
By Mallon FitzPatrick, CFP®, AEP®, CLU® Published