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Medicare Advantage Eligibility Requirements

Medicare Advantage eligibility terms and rules are essential for you to understand. Depending on your situation, a Medicare Advantage plan could be the coverage you need. Your location determines which options are available to you. Eligibility can be a tricky thing to understand. We’re going to dive into Medicare Advantage eligibility and give you all the tools you need to make the best choice for you.

Who Qualifies for Medicare Advantage?

You may be eligible for a Medicare Advantage plan if you have Part A and Part B. Even those under 65 on disability could enroll! Further, you must live in the plan’s service area and continue to pay your Part B premiums. You’ll pay for the Advantage plan and Part B.

Low-income or Medicaid eligible beneficiaries may qualify for extra help paying for premiums, deductibles, and copayments.

Those with End-Stage Renal Disease may qualify for a Medicare Advantage plan. Also, there are Special Needs Plans for those with chronic issues.

Depending on where you live, a Special Needs Plan may or may not be available. 

Medicare Advantage Eligibility Checklist

There are a few things you must do to qualify for a Medicare Advantage plan.

  1. You need to know your Part A and B effective date
  2. Have your Medicare card number
  3. You need to live in the plan’s service area

Those unsure of Medicare eligibility can always call Social Security to ask.

What are the Requirements for Medicare Advantage Plans?

If you’re Medicare-eligible you can enroll in an Advantage plan in your area. Not all areas have Advantage plans; so, you’ll want to check before you get your heart set on a policy.

Several Medicare Advantage enrollment periods exist. These are instances when you’re eligible to change plans, such as the Annual Enrollment Period, the Medicare Advantage Open Enrollment Period, and during a Special Enrollment Period.

If you move out of the service area or the plan leaves Medicare, you can switch policies using Special Enrollment rights.

Further, if you have a Medigap plan and want to “try’ a Medicare Advantage plan, you have eligibility for “trial rights.” You get to “try” the Advantage plan for up to 12 months.

Then, before the 12 months, if you decide the Advantage plan isn’t right, you can switch back to Medigap. You must first see if your original policy is still available through your previous company.

If not, you can choose any policy of equal or lesser value with any company.

When Can I Apply for Medicare Advantage?

There are several times you can select a Medicare Advantage plan. First, the Initial Enrollment Period allows you to sign up when you first turn 65. Those that delay Part B qualify for the Initial Coverage Enrollment Period, which gives you Medicare Advantage eligibility when you do enroll in Part B.

The Annual Enrollment Period is every fall from October 15th through December 7th. Then, the Medicare Advantage Open Enrollment Period is one last chance to make changes to Advantage plans.

Finally, there are Special Enrollment Periods that allow you to switch plans during life-changing or policy changing situations.

How to Enroll in a Medicare Advantage Plan?

Once you find the right policy enrolling is the next step. It’s always a good idea to consult an agent about your options. Our agents are Medicare experts. It’s important to consider if your doctor is in-network, your specialist, and your drugs have coverage. Further, you want to compare those costs.

Our agents work with the top carriers in the nation for Medicare. We can compare Medigap to Advantage and answer all your questions.

What are the Medicare Advantage Rules?

There is a reason people ask “why Medicare Advantage plans are bad?” The thing is, you HAVE to use the network of doctors they allow. So, if you’re visiting family in Florida, a doctor’s visit could be 100% your responsibility. Or, if you have a specialist that isn’t in the network, if you see that doctor, the cost is all on you.

On top of following the doctor network, you may need a referral every time you want to see a specialist. With Medigap, a referral is a thing of the past.

While there are many reasons to say Medigap is more comprehensive than Advantage, some coverage is always better than no coverage.


Can I join a Medicare Advantage plan if I have End-Stage Renal Disease?
Yes, in 2021 Medicare Advantage plans are available to those with End-Stage Renal Disease.

What are the Medicare Advantage income limits?
There are no income limits for Medicare Advantage; you can make as much or as little as you want. But, if you qualify for a Low-income subsidy or Medicaid, there may be a Special Needs Plan in your area that caters to low-income individuals.
Should I get a Medicare Advantage plan?
If you don’t qualify for Medigap or it’s too far out of your budget, please consider a Medicare Advantage plan. Whether you choose Medigap or Advantage, it’s always better to have some coverage. You don’t want to find yourself in a situation where you owe tens of thousands of dollars in healthcare costs. The Advantage plan will at least provide some protection.
Can you go back to Original Medicare from an Advantage plan?
Absolutely, during certain times of the year, you can drop your Advantage plan and return to Medicare. But, you should have a policy in place. Medicare, by itself, can be costly. Never leave your policy until you have a new plan in place. You never want to have a lapse in coverage. If you rely on an Advantage plan to give you Part D benefits, don’t forget to enroll in a stand-alone policy.

How to Get Help Finding a Medicare Advantage Plan

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Don't waste time trying to figure it out on your own. We have an expert ready to help you every step of the way. From education to enrollment, we know how to make the process easy.

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Jagger Esch

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Medicare Advantage Eligibility Requirements

  1. I am enrolled in Parts A and B and also have a supplement. I moved to Florida and would like to enroll in a Medicare Advantage plan. Is moving from another state considered a life event which would allow me to make this change in the middle of the year?

  2. I am totally confused about Medicare Plan B? I read that if you buy a Medicare Advantage plan (Plan B), you will be reimbursed from Social Security on your monthly Premiums. This will be from my own doctor where I live who is listed on the Medicare Advantage plan. I will have Governmental original Plan B Medicare (I already have Plan A) starting March 1, 2021. I already have an employee FEHB plan from Blue Cross and Blue Sheild Anthem coverage in Virginia Beach currently.

    1. Hi Ernest! Medicare Advantage plans are known as Part C. To get a Medicare Advantage plan, you must still enroll in Part B. Some Medicare Advantage plans have what’s called a premium reduction benefit. This is only available in some states. You’re reimbursed through your Social Security check. You will see a reduced amount taken out for the premium. Your doctor is not the one who reimburses you. Normally, those enrolled in FEHB do not need to enroll in a Medicare Advantage plan. It’s recommended to have Part B & FEHB, but not necessary to have FEHB, Part B, and Medicare Advantage.


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