There are 2 general eligibility requirements to qualify for a Medicare Advantage plan (Medicare Part C).
There are 2 general eligibility requirements to qualify for a Medicare Advantage plan (Medicare Part C):
1. You must be enrolled in Original Medicare (Medicare Part A and Part B).
2. You must live in the service area of a Medicare Advantage insurance provider that is accepting new users during your application period.
Who is eligible for Medicare Part C?
Anyone who is enrolled in Original Medicare (Part A and Part B) may be eligible to sign up for a Medicare Advantage (Part C) plan. This includes people under the age of 65 who have qualified for Medicare because of a disability.
People who have End-Stage Renal Disease (ESRD) are able to enroll in a Medicare Advantage plan. If you have ESRD, you may also be able to enroll in a Medicare Special Needs Plan (SNP).
A Special Needs Plan is a certain type of Medicare Advantage plan that is designed for people with specific health care conditions or circumstances.
In some cases, you may be able to have a Medicare Advantage plan and a Medicare Part D prescription drug plan at the same time, as long as your Medicare Advantage plan does not include prescription drug coverage.
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How does Medicare Part C work?
Medicare Part C plans are sold by private insurance companies as an alternative to Original Medicare. Medicare Part C plans are required by law to offer at least the same benefits as Medicare Part A and Part B.
There are several different types of Medicare Advantage plans, such as HMO plans and PPO plans. Each type of plan may feature its own network of participating providers.
What is covered under Medicare Part C?
Medicare Part C plans provide all of the same benefits as Original Medicare. Most Medicare Advantage plans also offer prescription drug benefits, which Original Medicare doesn't cover.
Some Medicare Advantage plans may also offer a number of additional benefits that can include coverage for things like:
Some Medicare Advantage plans may require you to pay a monthly premium. In 2023, the average premium for a Medicare Advantage plan with prescription drug coverage is $17.60 per month.1
89 percent of Part C plans available throughout the country cover prescription drugs, and 66 percent of those plans feature a $0 premium.2
7 out of 10 Medicare Advantage Prescription Drug plan beneficiaries are enrolled in a $0 premium plan.2
The average medical deductible for a Medicare Advantage plan in 2023 is $25.44 per year.1
Medicare Advantage plans are required to include an annual out-of-pocket spending limit, which limits how much you will have to pay in Medicare deductibles, coinsurance and other out-of-pocket costs in a single year.
Medicare Part A and Part B don't include an out-of-pocket spending limit. Medicare out-of-pocket costs can add up quickly if you're faced with a long-term inpatient hospital stay or undergo extensive medical care that requires high coinsurance or copay costs.
When can I enroll in a Part C plan?
If you are eligible for a Medicare Advantage plan and there is a plan available in your service area, you still need to wait for an enrollment period to join.
When you first become eligible for Medicare, you will be given an Initial Enrollment Period (IEP).
Your IEP lasts for seven months. It begins three months before you turn 65 years old, includes the month of your birthday and continues on for three more months.
Fall Open Enrollment Period
The fall Medicare Open Enrollment Period is an annual period during which current Medicare beneficiaries can sign up for or drop a Medicare Advantage plan and/or Medicare Part D prescription drug plan. Beneficiaries can also drop either type of coverage and return to Original Medicare during this time.
Fall Medicare open enrollment lasts from October 15 to December 7 each year. During this time, you may be able to sign up for, change or disenroll from a Medicare Advantage plan.
Special Enrollment Period (SEP)
You could potentially qualify for a Medicare Special Enrollment Period (SEP) at any time throughout the year if you experience a qualifying life event.
These qualifying events can include situations such as moving to a new plan service area, being released from jail, moving into or out of a skilled nursing facility and more.
A licensed insurance agent can help determine if you are eligible for a Special Enrollment Period.
You can also call to speak with a licensed agent to find out more about Medicare Advantage plans in your area and learn when you may be able to enroll.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
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