Medicare Advantage Eligibility

If you are eligible for Medicare, you are eligible for an Advantage plan. You must be enrolled in both Medicare Part A and B before you can purchase a Medicare Advantage plan. And you cannot drop Part B. If you do so, you will lose your Advantage plan.

The main qualification for Medicare Advantage plans is that you already have been enrolled in Original Medicare (Parts A and B) and that you live in the network area of the Part C provider you are considering applying to. Since 2021, people diagnosed with End Stage Renal Disease (ESRD) are also eligible to enroll in almost every Medicare Advantage plan, which was not the case before so most plans would not accept you with diagnosed ESRD.

As for the requirements, the same eligibility criteria for Original Medicare are applied to Part C as well. So firstly you need to be a U.S. Citizen or a permanent resident of the United States for at least 5 years in a row, and you need to reside for six months each year in the plan`s service area.

Medicare Advantage Enrollment

If you are eligible for Medicare, then you will want to know when is the time for enrollment. There are specific enrollment times during which you can enroll in a Medicare Advantage plan:

Initial enrollment period — Your initial enrollment period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll in an Advantage plan three months before your month of eligibility until three months after you became eligible.

Open enrollment period — Also known as annual enrollment or AEP, the open enrollment period for Medicare Advantage is from October 15 through December 7 every year. Coverage for the Part C plan you choose during this time will start on January 1 next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — During this MA Open enrollment period, you are able to change from one Advantage plan to another or drop it to return to Original Medicare.

Special Election Period — There are several things that can trigger a special election period and they are unique to an individual. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period. However, there are a few common instances we can talk about. Such as, if you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into a nursing home you might qualify for a special election period. During this time you can make changes to your Advantage plan or return back to Original Medicare.

Medicare Advantage Coverage & Costs

There is a wide range of plan costs. Many people choose low-cost or free plans, and $0 Medicare Part C plans are available in 49 states. On the other side, some plans can cost several hundred dollars per month. Expensive plans usually provide better benefits such as a broader network of medical providers, more coverage for specialized care, or better cost-sharing benefits.

Medicare Part C costs are determined by several factors, such as premiums, deductibles, copayments, and coinsurance. These amounts can range from $0 to hundreds of dollars for monthly premiums and yearly deductibles. But most of your Part C costs will be determined by your chosen plan. Here below are some of the most common factors affecting Part C plan cost:

  • Premiums: Some Medicare Part C plans are free, meaning they don’t have a monthly premium. But even if it is a $0 premium, you may still owe the Part B premium.
  • Deductibles: Most Medicare Part C plans have both a plan deductible and a drug deductible. Some of the free Medicare Advantage plans offer a $0 plan deductible.
  • Copayments and coinsurance: Copayments are amounts you will owe for every doctor’s visit or prescription drug refill. Coinsurance amounts are any percentage of services you must pay out of pocket after your deductible has been met.
  • Plan type: The type of plan you choose can also have an impact on how much your Part C plan may cost.
  • Out-of-pocket maximum: One advantage of Medicare Part C is that all plans have an out-of-pocket maximum.
  • Lifestyle: Most Medicare Advantage plans are location-based because they depend on the provider`s network. This means that if you travel often, you may find yourself stuck with out-of-town medical bills.
  • Income: Your yearly gross income can also factor into how much you will pay for your Medicare Part C costs. Individuals with higher incomes will have higher Medicare costs.


Medicare Annual Enrollment Period (AEP)

        October 15 – December 7

Medicare Advantage (often referred to as Part C) plans are an alternative way for beneficiaries to receive their Medicare benefits. Instead of receiving benefits directly through Original Medicare (Parts A and B), beneficiaries can choose to receive them through a private insurance company that offers a Medicare Advantage plan. Here are some key points to understand about Medicare Advantage:

  • Coverage: All Medicare Advantage plans must provide at least the same level of coverage as Original Medicare (Part A and Part B). Many also offer additional benefits not covered by Original Medicare, such as:
    • Vision care
    • Hearing care
    • Dental care
    • Wellness programs
    • Prescription drug coverage (similar to what’s offered under Medicare Part D)

Take the Next Step to Peace of Mind

Speak to an independent expert to weigh your options and find the perfect plan for your needs. Each of our local reps are dedicated to providing the highest level of service ensuring your satisfaction.