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Can I Lose My Medicare Eligibility?

Yes, if you qualify for Medicare by disability or health problem, you could lose your Medicare eligibility. If you qualify for Medicare by age, you cannot lose your Medicare eligibility.

How do I get Medicare eligibility?

According to the U.S. Department of Health and Human Services, there are generally three ways to have Medicare eligibility.

  1. Age: if you are 65 or older, you generally are eligible for Medicare. According to the Kaiser Family Foundation, the distinct majority of Medicare beneficiaries qualify by age.
  2. Disability: According to the Social Security Administration (SSA), everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. Generally a disability that gives you Medicare eligibility must be “severe.” According to SSA, disability is defined as “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which
  • can be expected to result in death or
  • which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Mental disorders such as schizophrenia and bipolar disorder, endocrine disorders such as diabetes mellitus, and cancer may qualify you for disability under Social Security and therefore Medicare eligibility.

  1. Certain health conditions such as end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) may also give you Medicare eligibility without the 24-month waiting period.

How can I lose my Medicare eligibility?

If you qualify for Medicare by age, you may have Medicare for life. Medicare has certain coverage limits on how many days it will pay for inpatient hospital care and skilled nursing facility care in your lifetime. However, even when these maximums are reached, you can still receive Medicare coverage for other services, such as doctor visits.

If you have Medicare eligibility because of ALS, you may have Medicare for life. According to the Mayo Clinic, there is no cure for ALS and eventually the disease is fatal.

If you have Medicare eligibility because of permanent kidney failure (and are not 65 or older and do not have another disability) your Medicare coverage will generally end 12 months after the month you stop dialysis treatments or 36 months after the month you have a kidney transplant.

If you have Medicare eligibility because of a disability, returning to work will not automatically end your Medicare benefits. According to SSA, you may receive 93 months of hospital and medical insurance (Medicare Part A and Part B) after your trial work period as long as you still have a disabling impairment. Your Medicare Part A coverage will be premium free. After your premium-free Medicare coverage ends, you can purchase Medicare Part A and Part B insurance if you continue to have a disability at the end of the 93-month period. You also can generally keep Medicare if you receive health care coverage through work. Medicare is often the secondary payer and your employer coverage is the primary payer.

Keep in mind that you are responsible for telling Social Security if you return to work and if your medical condition improves. SSA expects that medical advancements and rehabilitation can help many people with disabilities recover.

If you lose your Medicare eligibility and don’t have health insurance, you may be eligible for Medicaid. Medicaid eligibility is determined partially by your Modified Adjusted Gross Income.

To find a Medicare plan that you may be eligible for, enter your zip code on this page.

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