Q. What happens when you don’t pay your Medicare premiums?
A. Failing to pay your Medicare premiums puts you at risk of losing coverage, but that won’t happen without warning.
Though Medicare Part A – which covers hospital care – is free for most enrollees, Parts B and D – which cover preventive care and prescription drugs, respectively – charge participants a premium. If you’re enrolled in Social Security, your Part B premiums will be paid from your benefits automatically, so there’s generally no need to worry about missing a payment. You can also arrange to have your Part D premiums paid from your Social Security benefits. The same holds true if you opt for Medicare Advantage (Part C) over Original Medicare.
If you’re not on Social Security, you’ll need to pay your Medicare premiums directly. Signing up for an automatic debit from your checking account or automatic credit card payment will help ensure that you don’t miss payments accidentally. But if you opt to pay your premiums manually, you’ll need to make sure to stay on top of them. If you miss a payment, you’ll risk having your coverage dropped – but you’ll be warned of that possibility first.
When you miss a Part B premium
Your Medicare Part B payments are due by the 25th of the month following the date of your initial bill. For example, if you get an initial bill on February 27, it will be due by March 25. If you don’t pay by that date, you’ll get a second bill from Medicare asking for that premium payment. That second bill will be due by the 25th of the following month – in this case, April 25.
If your second bill remains unpaid by its due date, you’ll receive a delinquency notice from Medicare. At that point, you’ll need to send in the total overdue amount by the 25th of the following month to avoid losing coverage. In our example, that would put you at May 25.
All told, you’ll have a three-month period to pay an initial Medicare Part B bill. If you don’t, you’ll receive a termination notice informing you that you no longer have coverage.
Now if you manage to pay what you owe in premiums within 30 days of that termination notice, you’ll get to continue receiving coverage under Part B. If you don’t do that, your coverage will be discontinued. At that point, you’ll need to sign up for Part B once again during the general Medicare enrollment period that runs from January 1 to March 31 every year.
When you miss a Part C or Part D premium
If you miss a Part C or Part D premium, the consequences will depend on your specific plan. Either way, your coverage can’t be dropped without warning.
All Part C and D plans must have a grace period that’s at least two months in length, and some plans have a longer grace period. If you fail to make a premium payment, your plan must send you a written notice of non-payment and tell you when your grace period ends. Only once you fail to make your payment by the end of your grace period do you risk disenrollment from your plan. In some cases, you’ll be given the option to contact your plan administrator if you’re behind on payments due to an underlying financial difficulty.
If you’re disenrolled from your Part D plan, you’ll have the option to reenroll during the Annual Election Period, which runs from October 15 to December 7 of every year. Keep in mind that if you’re disenrolled due to a failure to pay your premiums, you may be required to make good on your outstanding premiums before getting back on the plan you once had. Furthermore, if you go without drug plan coverage for 63 days or more, you may be liable for a Part D late enrollment penalty once you sign up for a new plan.
Once disenrolled, you can also attempt to get back on your Part D plan under Medicare’s “Good Cause” policy if you had a valid reason for not paying your premiums, such as a prolonged illness that rendered you incapable of dealing with financial matters or the recent death of a spouse. If your request is approved, you’ll have to pay your outstanding premiums within three months of disenrollment to resume coverage.
If you’re disenrolled from Medicare Advantage, you’ll be automatically enrolled in Original Medicare. During this time, you may lose drug coverage. You can then enroll in Medicare Advantage again during the Annual Election Period of October 15 through December 7.
If you elect for your Part C or Part D premiums to be paid from your Social Security benefits and that doesn’t happen – thereby resulting in a delinquency on your part – your plan must work with Medicare to determine the reason and attempt to resolve the issue. During this time, you cannot be disenrolled from your plan. Similarly, if your Part D premium is paid by a State Pharmacy Assistance Program, your plan must work with the SPAP to resolve the issue and cannot disenroll you automatically.
Keep track of your payments
Medicare eligibility begins at 65, whereas full retirement age for Social Security doesn’t start until 66, 67, or somewhere in between, depending on your year of birth. Therefore, it’s common for seniors to enroll in Medicare without signing up for Social Security.
If that’s your situation, and you can’t have your premiums deducted from your benefits, automating the process via recurring debits or credit card payments is the best way to avoid accidentally falling behind on Medicare bills and putting your coverage at risk of termination.