Medigap Plans

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Medicare Advantage plans vary by location, but eligibility rules are standard. In this article, we dive into Medicare Advantage eligibility and give you all the tools you need to make the best coverage choice.

Who Qualifies for Medicare Advantage?

You are eligible for a Medicare Advantage plan if you have Original Medicare (Part A and Part B). Even those on Medicare under 65 due to disability may enroll. You may sign up for a Medicare Advantage policy if you live in your chosen plan’s service area.

When you enroll in a Medicare Advantage plan, you will pay your chosen plan’s monthly premium in addition to your Medicare Part B premium.

Low-income or Medicaid-eligible beneficiaries may qualify for extra help paying for premiums, deductibles, and copayments. Extra Help qualification is based on your annual income and can change anytime.

Those with End-Stage Renal Disease (ESRD) may also qualify for Medicare Advantage. For beneficiaries who enroll in Medicare with ESRD, coverage generally starts on the fourth month of dialysis. However, in some instances, coverage can begin within the first month of dialysis:

• If the patient plans on completing home dialysis training to carry out self-dialysis treatments at home
• ESRD Patients who start home dialysis training early (before the third month of their dialysis treatment)
• Patients who participate in a home dialysis training program

If you have Medicare due to ESRD, your Medicare coverage can stop under two conditions:

• 12 months after the month your dialysis treatments end
• 36 months after receiving a kidney transplant.

Special Needs Plans are also available for those with chronic issues. Depending on where you live, a Special Needs Plan may or may not be available.

What Are the Medicare Advantage Eligibility Requirements?

If you are Medicare-eligible, you can enroll in a Medicare Advantage plan in your area. Not all locations have Medicare Advantage plans, so you should check plan availability before you decide on a policy.