Who Can Enroll in a Medicare Advantage Plan?


For many, Medicare Advantage Plans seem ideal because of the extra coverage they offer. However, not everyone can enroll. There are a few requirements that must be met for a Medicare beneficiary to enroll in a Medicare Advantage Plan.

Enroll in Parts A and B

One of the biggest requirements you must meet to enroll in a Medicare Advantage Plan is to be enrolled in Medicare Part A and B (Original Medicare). This is because Medicare Advantage Plans do not replace the coverage you receive with Original Medicare. Instead, it provides another way to obtain the same coverage, but with extra benefits.

To be eligible for Original Medicare, you must be turning 65 or have received disability benefits for at least 24 months from Social Security or the Railroad Retirement Board.

Pay the Part B Premium

Because you are still enrolled in Original Medicare when you have a Medicare Advantage Plan, you must pay the costs associated with those plans, including premiums. For many, they receive premium-free Part A or have a Medicare Advantage Plan that has a $0 premium. Thus, you are stuck with the Part B premium. You cannot stop paying this premium or drop the Part B plan; otherwise, you will lose your Medicare Advantage Plan.

Live in the Service Area

Even if you qualify for Medicare Advantage, you must be within your desired plan’s service area to enroll. Some Medicare Advantage Plans also require you to receive services from certain network providers and facilities, so you must sign up for a plan that is available in your area to receive this coverage.

What If You Have ESRD?

Suppose you have permanent kidney failure, or End-Stage Renal Disease (ESRD). In that case, you may be covered by Original Medicare but not be eligible for a Medicare Advantage Plan. However, you may also be eligible for a Medicare Advantage Special Needs Plan, which provides coverage for those with chronic health conditions.

Do You Qualify?

If you qualify for a Medicare Advantage Plan, contact Galina-Balboa Global Insrance Group today! We can walk you through each plan and help you determine which one may be right for you — based on your coverage and budget needs.