Basic Eligibility Requirements
To be eligible for a Medicare Advantage plan, you must:
- Be enrolled in Medicare Part A and Part B - You must have both parts of Original Medicare active before you can join a Medicare Advantage plan.
- Live in the plan's service area - Medicare Advantage plans operate in specific geographic areas. You must reside in the plan's service area to enroll.
- Not have End-Stage Renal Disease (ESRD) - Prior to 2021, people with ESRD could not enroll in most Medicare Advantage plans. The 21st Century Cures Act removed this restriction starting January 1, 2021.
Age and Disability Eligibility
You are eligible for Medicare Advantage if you qualify for Medicare, which includes:
- Age 65 or older - U.S. citizens or permanent residents who have worked at least 10 years (40 quarters) in Medicare-covered employment
- Under 65 with a disability - People who have received Social Security Disability Insurance (SSDI) for 24 months automatically become eligible for Medicare
- ALS (Lou Gehrig's Disease) - Medicare eligibility begins immediately upon receiving SSDI for ALS
- ESRD - People with End-Stage Renal Disease requiring dialysis or a kidney transplant are eligible for Medicare regardless of age
ESRD and Medicare Advantage (2021 Change)
Before January 1, 2021, people with End-Stage Renal Disease (ESRD) were generally not allowed to enroll in Medicare Advantage plans. The 21st Century Cures Act changed this, allowing ESRD patients to enroll in Medicare Advantage starting in 2021.
However, people with ESRD should carefully compare plans, as not all Medicare Advantage plans cover dialysis or kidney transplant services equally. Reviewing the plan's formulary and provider network is especially important.
When to Enroll
Once you meet the eligibility requirements, you can enroll during these periods:
- Initial Enrollment Period (IEP) - 7-month window starting 3 months before your 65th birthday month
- Annual Enrollment Period (AEP) - October 15 – December 7 each year
- Special Enrollment Periods (SEPs) - Triggered by qualifying events like moving, losing employer coverage, or gaining/losing Medicaid eligibility
Frequently Asked Questions
Can I enroll in Medicare Advantage if I'm under 65?
Yes, if you are eligible for Medicare due to a disability or ESRD. You must be enrolled in both Medicare Part A and Part B, and the plan must be available in your area.
Do I need to live in the plan's service area year-round?
You must primarily reside in the plan's service area. If you spend significant time in another area (snowbirds, for example), look for a PPO plan that offers out-of-network coverage, or consider Original Medicare with a Medigap plan for more flexibility.
Can I Enroll in Medicare Advantage if I Have Medicaid?
Yes. If you have both Medicare and Medicaid (dual-eligible), you may qualify for a Dual Eligible Special Needs Plan (D-SNP), which coordinates benefits from both programs and often has very low or $0 costs.