Earlier this month, we received the kind of phone call we dread. It came from Paul, a client, who explained that upon arriving for a scheduled MRI, he was told he had no insurance — he had been terminated from Medicare Part B.
Paul didn’t know what happened, so we began our investigation. Our first question (as always): “Did you receive a notification by mail?” He said he had no idea.
Medicare Is Different
When working with clients in their transition from insurance received through employment, we make sure to review the many differences they can expect under Medicare. A very important one is that now, the components of coverage are no longer paid by means of a payroll deduction. Rather, they are paid directly by the individual in question.
Which means… you need to make sure the payments are made!
And it’s not just one payment. There are several components and a range of options for accomplishing this. It can be confusing, something that can lead to inadvertent termination for lack of payment.
The reason we dread these calls so much is that by the time termination occurs, it is often too late to reenroll. Further, even if you can reenroll, at that point, your options may be limited and penalties may apply.
What Must Be Paid and How to Pay
With Medicare, what you choose determines how many bills you must pay.
# 1 — Part B and Part B IRMAA – Income Related Monthly Adjustment Amount (if you have one)
Everyone enrolled in Medicare must pay for Part B. In 2026, the cost is $202.90 per month. Payment must go to the Centers for Medicare and Medicaid Services, either monthly or quarterly.
If you are receiving monthly Social Security benefits, this part is easy, as the amount is automatically withdrawn from your monthly benefit.
If you are not receiving monthly Social Security benefits, you will receive a paper bill around the 10th of each month (sometimes quarterly). It is due on the 25th of the month. Here is how you can pay:
- By mail using a check, money order, credit card, debit card, or Health Savings Account.
- Online via your Medicare account, payable by credit card, debit card, or bank account.
- Autopayment via Medicare Easy Pay.
- Through your own bank’s online bill pay system, utilizing your savings or checking account.
# 2 — Medicare Supplement/Medigap Plan
If you elected to supplement Medicare Parts A and B with a Medicare Supplement/Medigap Plan, you purchased this plan from a private insurance company. Here, options for payment are outlined by the carrier and may include the following:
- By mail using a check, money order, credit card, or debit card. (You are not allowed to use a Health Savings account.)
- By creating a specific account with the carrier and going online and paying manually each billing cycle, or by autopay using a credit card, debit card, or automatic funds transfer from a savings or checking account.
- Through your own bank’s online bill pay system, utilizing your savings or checking account.
# 3 — Medicare Advantage Plan (MAP) and #4 — Medicare Part D Prescription Drug Plan (PDP)
If you elected a Medicare Advantage Plan (MAP) in lieu of traditional Medicare, it generally includes the Part D prescription drug component and it may or may not have a premium associated with it. These plans are purchased from private insurance companies, so options for payment are outlined by the carrier and might include all the options noted above.
If you choose traditional Medicare, you must also enroll in a separate Medicare Part D Prescription Drug Plan (PDP) that may or may not have a premium associated with it. These plans are purchased from private insurance companies, so options for payment are outlined by the carrier and might include all the options noted above.
If you are receiving monthly Social Security benefits, payment for your Medicare Advantage Plan and your Medicare Part D Prescription Drug Plan can be deducted from your monthly Social Security benefit. However, you must elect this option upon enrollment; it does not happen automatically.
Why You Should Read Your Mail
Medicare is required to notify you if you have not paid your Part B premium. However, these notifications are by mail only to the address Medicare has on file. (The address is updated through Social Security, so it’s the same address on file there.)
Notifications include:
- First bill
- Second bill including the missed amount
- Delinquent notice
- Delinquent Bill/final warning
- Termination notice
There is a generous grace period — coverage is not cancelled automatically if you miss a single payment. In fact, when you count it up, you have a 90-day grace period to clear things up, with one more chance of 30 additional days after termination to pay everything owed.
If you don’t pay and you are terminated, you can only reenroll the following year during the General Enrollment Period (January 1 – March 31), and you will have penalties. As Medicare Part B pays for all outpatient care, this can result in an expensive financial liability for you.
Additionally, because having Medicare Part B is a condition of enrollment in a Medicare Supplement/Medigap Plan and a Medicare Advantage Plan, the ripple effect can add more financial liability.
For Medicare Supplement/Medigap, Medicare Advantage or separate Medicare Part D Prescription Drug premiums, the carrier determines its own grace period, a timeframe that may not be as generous as 90 days.
All of these notifications, whether from Medicare or a private insurance company, come via paper mail. So if you don’t open your mail, like Paul, you may have no idea you are in arrears until it is too late.
Recommendations
- When you enroll in Medicare and its additional products, identify the specific premiums you must pay and outline a plan for each component. If you enroll as a couple and one person takes responsibility for bill paying, you may have as many as six individual monthly payments — and not necessarily to the same carriers.
- Once you have set up a system for payment, check and double-check to be sure payments are being made.
- If you close a bank account or a credit card, be sure to notify the carrier with your new information.
- If you make any changes to your plans during the Annual Medicare Open Enrollment Season, do this all over again at the beginning of the new plan year and stop any automatic payments to previous carriers.
- If you initiate your monthly Social Security Benefit, pay close attention to the transition to automatic withdrawal from your monthly benefit for Part B, Part B IRMAA and Part D IRMAA, and be sure to discontinue autopay functions, especially if you use Easy Pay. Termination of payment via Easy Pay does not automatically happen — you must act.
- If you elect to have payments for your Medicare Advantage Plan or Medicare Part D Prescription Drug Plan deducted from Social Security, recognize there may be a delay before deductions begin and you may need to pay the carrier directly for a month or two.
- Open and read your mail! This way, even if something slips through the cracks, you will learn about it in time to make corrections as needed.
Summary
Unfortunately for Paul, by the time he got in touch, he was well beyond his 90-day grace period. As of July 1, he became woefully underinsured. We can reenroll him on 01/01/2027, but the earliest we can have everything back in place for him is 02/01/2027. For now, we are discussing mitigation of financial risk from medical bills — not a conversation I enjoy having with a client.
Please, READ YOUR MAIL!!!!