Who is eligible for Medicare advantage?

Medicare Advantage is a type of health insurance plan available to Medicare beneficiaries. It is an alternative to Original Medicare (Part A and Part B) and is offered by private insurance companies that Medicare approves. Medicare Advantage plans they provide the same benefits as Original Medicare, but they often have additional features such as coverage for prescription drugs, vision, and dental services.

Eligibility for Medicare Advantage

To be eligible for Medicare Advantage, an individual must:

Be enrolled in Medicare Part A and Part B.

To enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A, and Part B. Medicare Part A covers hospital insurance. In contrast, Medicare Part B covers medical insurance. Most people automatically enroll in Medicare Part A and Part B when they turn 65. Still, you may also be eligible for Medicare if you are under 65 and have a disability or certain medical conditions.

Live in the plan’s service area.

Medicare Advantage plans are only available in certain areas, so you must live in the plan’s service area to enroll. You can check with the project or use the Medicare Plan Finder tool on the Medicare website to find out if a specific program is available in your area.

Not have End-Stage Renal Disease (ESRD)

Individuals with End-Stage Renal Disease (ESRD) are not eligible for Medicare Advantage. ESRD is a severe kidney disease that requires dialysis or a kidney transplant to maintain life. If you have ESRD, you will be enrolled in Original Medicare and can enroll in a Medicare Part D prescription drug plan to receive coverage for your medications.

Exceptions to eligibility

There are a few exceptions to the eligibility requirements for Medicare Advantage. These include:

Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are Medicare Advantage plans for individuals with certain health conditions or living situations. SNPs are available to individuals who meet the Medicare Advantage eligibility requirements and specific criteria based on their health condition or living situation. Examples of SNPs include plans for individuals with chronic conditions, institutionalized individuals, and dual-eligible individuals (individuals eligible for both Medicare and Medicaid).

Medicare-Medicaid Plans (MMPs) Medicare advantage

Medicare-Medicaid Plans (MMPs) are Medicare Advantage plans that are available to individuals eligible for both Medicare and Medicaid. MMPs provide the same benefits as Original Medicare and often include additional benefits such as coverage for long-term care services and prescription drugs.

Enrolling in Medicare Advantage

There are several ways to enroll in a Medicare Advantage plan:

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity to enroll in a Medicare Advantage plan. Your IEP starts three months before you turn 65 and ends three months after you turn 65. You can enroll in a Medicare Advantage plan or switch from Original Medicare to a Medicare Advantage plan.

Annual Election Period (AEP)

The Annual Election Period (AEP) is when you can change your Medicare coverage. It runs from October 15 to December 7 each year. You can enroll in a new Medicare Advantage plan, switch from one Medicare Advantage plan to another, or switch from a Medicare Advantage plan back to Original Medicare.

The Medicare Advantage Open Enrollment Period (MA OEP)

The Medicare Advantage Open Enrollment Period (MA OEP) is when you can change your Medicare Advantage coverage. It occurs annually from January 1 to March 31. You can switch from one Medicare Advantage plan to another or from a Medicare Advantage plan back to Original Medicare. It’s important to understand your options and consider your healthcare needs during this period, as your choices will affect your coverage for the rest of the year.