Medicare Advantage Eligibility: 5 Things To Know

Medicare Advantage (Medicare Part C) plans now make up more than half of all Medicare enrollment. In 2023, 51% of all Medicare beneficiaries had a Medicare Advantage plan, and enrollment in this type of coverage has increased every single year since 2007.¹

With nearly 31 million Americans now enrolled in a Medicare Advantage plan, you may be wondering if you too may be eligible for one.²

Medicare Advantage plans are sold by private insurance companies and are required by law to provide all of the benefits found in Original Medicare (Medicare Part A and Part B). Medicare Advantage plans can provide benefits not covered by Original Medicare.

The Medicare Advantage plans and benefits available where you live may vary, so it’s helpful to compare plan options that are offered in your area. At MedicareAdvantage.com, we make it simple to view local plans side by side to find one that best meets your needs. Then, you can easily apply online right on your phone, tablet or computer. You can also call 844-919-3456 to get help from a licensed insurance agent directly.

Read more below to learn 5 important aspects of Medicare Advantage eligibility.

1. You must be enrolled in Medicare Part A and Part B

You must first be enrolled in both Medicare Part A and Medicare Part B before you can sign up for a Medicare Advantage plan. And you must maintain Part A and Part B enrollment for the duration of your Medicare Advantage membership.

You must continue to pay your Medicare Part B premium in addition to any premiums included with your Medicare Advantage plan.

2. Medicare Advantage plan selection varies based on where you live

You are only allowed to enroll in a Medicare Advantage plan that is sold where you live. Plan selection is typically separated by ZIP code, and you may only enroll in a Medicare Advantage plan that’s available where you live.

Some ZIP codes can have more Medicare Advantage plans from which to choose than others.

You can quickly learn how many plans are available in your ZIP code by visiting MedicareAdvantage.com or speaking directly to a licensed insurance agent at 844-919-3456.

3. Special Needs Plans are a type of Medicare Advantage plan

There’s a certain type of Medicare Advantage plan called a Special Needs Plan that is only available to beneficiaries with particular health conditions or who qualify for both Medicare and Medicaid.

For example, if you are eligible for both Medicare and Medicaid, you might be eligible to apply for a Dual-eligible Special Needs Plan (D-SNP) if any are offered where you live. These plans are reserved for beneficiaries who have Medicare and Medicaid and include benefits designed to fit some of their specific needs.

Or, for example, perhaps you have a health condition such as diabetes. You may be eligible to apply for a Chronic Condition Special Needs Plan (C-SNP) that is designed specifically for people with diabetes and contains more focused coverage on diabetes care when compared to other traditional Medicare Advantage plans.

It’s important to note Special Needs Plans aren’t available in all locations. Be sure to compare your local options to find out what’s available where you live.

4. You cannot be enrolled in Medicare Advantage and Medigap at the same time

You will not be eligible to sign up for a Medicare Advantage plan if you are currently enrolled in a Medicare Supplement Insurance, or Medigap, plan. To learn more about this, watch this video below or continue reading.

If you already have a Medigap plan and wish to enroll in Medicare Advantage, you may be able to disenroll from your Medigap plan and then enroll in a Medicare Advantage plan.

You can typically only enroll in a Medicare Advantage plan during the fall Medicare Open Enrollment Period, also called the Annual Enrollment Period (AEP). The fall Open Enrollment Period takes place each year from October 15 to December 7 (unless you qualify for a Special Enrollment Period).

If you’re reading this, you’re in luck because the Medicare Annual Enrollment Period is happening right now! That means that you can switch or change your Medicare Advantage coverage options for next year. This window will close on December 7th, so if you want to see what your options are, get started online in 3 simple steps. We make it easy to compare plans side by side and apply online right over your phone, tablet or computer.

5. You may not enroll in a Medicare Advantage plan that includes prescription drug coverage if you are already enrolled in Medicare Part D

A Medicare Advantage plan that includes prescription drug coverage is known as a Medicare Advantage Prescription Drug plan, or MA-PD.

If you have a Medicare Part D plan, you will not be eligible to enroll in an MA-PD plan unless you drop your current Part D plan.

Check your Medicare Advantage eligibility

If you are eligible to enroll in Medicare Advantage, a Medicare-licensed insurance agent can help guide you through the process and address any questions or concerns you may have.\

Call 844-919-3456 to speak to a licensed insurance agent today or compare plans online at MedicareAdvantage.com to find Medicare Advantage plan options available where you live.

1. Ochieng N. (Aug 9, 2023). Medicare Advantage in 2023: Enrollment Update and Key Trends. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends.

2 CMS.gov, “Contract Summary 2023 05,” May 2023, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/mcradvpartdenroldata/monthly/contract-summary-2023-05.

Copyright © 2023 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is powered by TZ Insurance Solutions LLC, a non-government licensed health insurance agency. Not affiliated with or endorsed by any government agency.

TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage HMO, PPO and PFFS organizations that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

Not all plans offer all of these benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays, coinsurance, limitations, and exclusions may apply.

Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.