The Basic Requirements for Medicare Advantage

To enroll in a Medicare Advantage plan, you must first be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). You also need to be a U.S. citizen or a lawful permanent resident, and you must live in the service area where the plan operates. Most people become may be able to access for Medicare at age 65, though some younger people with disabilities or end-stage renal disease can join earlier.

Unlike Original Medicare, which is available everywhere in the country, each Medicare Advantage plan serves a specific geographic area. This means your address determines which plans you can choose from. If you move to a different county or state, you may lose your current plan and need to select a new one.

You do not need to have worked a certain number of years or paid Medicare taxes to join a Medicare Advantage plan, as long as you meet the age and citizenship requirements. If you are already receiving Social Security benefits, you are likely already enrolled in Medicare Part A and Part B automatically.

Key Takeaways

  • You must be enrolled in both Medicare Part A and Part B before you can join a Medicare Advantage plan.
  • Medicare Advantage plans only serve specific geographic areas, so your address determines which plans are available to you.
  • You must be a U.S. citizen or lawful permanent resident and live in the plan's service area.
  • Most people become may be able to access at age 65, but some younger people with disabilities or certain kidney conditions can join earlier.
  • You cannot be enrolled in both a Medicare Advantage plan and a Medigap supplemental insurance policy at the same time.

When You Can Enroll in Medicare Advantage

There are specific windows of time when you can join a Medicare Advantage plan. The main enrollment period runs from October 15 through December 7 each year, and coverage begins on January 1. If you are turning 65 soon, you have a seven-month window that includes the three months before your birthday, the month of your birthday, and three months after.

If you miss these windows, you may still be able to join during the Medicare Advantage Open Enrollment Period, which runs from January 1 through March 31 each year. During this time, you can switch from one Medicare Advantage plan to another, or from Original Medicare to a Medicare Advantage plan, without penalty. However, this window does not explore if you are newly may be able to access for Medicare.

Special enrollment periods also exist for people who experience certain life events, such as moving out of their plan's service area, losing employer coverage, or having a change in income. If you think a life event may have opened a special enrollment window for you, contact Medicare at 1-800-MEDICARE to ask about your specific situation.

Income and Financial Limits

Medicare Advantage plans do not have income limits. You can earn any amount and still join. However, your income may affect how much you pay in premiums and out-of-pocket costs if you also receive help from programs like the Low-Income Subsidy (LIS) or Extra Help.

Some Medicare Advantage plans are specifically designed for people with limited income and resources. These plans, sometimes called Special Needs Plans (SNPs), may have different rules and may offer additional benefits. To join one of these plans, you must meet the plan's specific criteria — for example, having a particular chronic condition, living in an institution, or having both Medicare and Medicaid.

If you receive Medicaid (state health insurance for people with low income), you may be restricted in which Medicare Advantage plans you can join. Some plans are designed for people with both Medicare and Medicaid, while others are not. Your state Medicaid office can tell you which plans accept people in your situation.

Health Status and Pre-Existing Conditions

Medicare Advantage plans cannot deny you coverage or charge you more based on your health status or pre-existing conditions. This protection is federal law. Even if you have heart disease, diabetes, cancer, or any other condition, you have the same right to join as anyone else, and you will pay the same premium as other people your age in the same plan.

You do not need to pass a medical exam or answer health questions to join a Medicare Advantage plan during the enrollment periods listed above. Some plans may ask about your health after you enroll, but only to help them understand what services might help you — not to decide whether to accept you.

The one exception is for Special Needs Plans designed for people with specific conditions. These plans may require that you have the condition they serve in order to join, but once you meet that requirement, they cannot deny you or charge you more.

Restrictions if You Have Other Coverage

If you are still working and have health insurance through your employer or union, you can still join a Medicare Advantage plan. Your employer plan and your Medicare Advantage plan will coordinate benefits, meaning each one pays its share of your medical bills. However, you should contact both plans before enrolling to understand how they will work together.

You cannot be enrolled in both a Medicare Advantage plan and a Medigap supplemental insurance policy at the same time. If you have a Medigap policy and want to switch to Medicare Advantage, you will need to drop the Medigap policy first. If you later want to return to Original Medicare with a Medigap policy, you may have limited options depending on your age and health status.

If you have Veterans Affairs (VA) benefits, you can use them alongside Medicare Advantage. The VA and Medicare Advantage are separate systems, and using one does not affect your right to use the other. However, you should understand how your specific VA benefits coordinate with your Medicare Advantage coverage.

Enrollment for People New to Medicare

If you are turning 65 and becoming may be able to access for Medicare for the first time, you have a seven-month Initial Enrollment Period. This window includes the three months before the month you turn 65, the month you turn 65, and the three months after. During this time, you can join a Medicare Advantage plan without waiting for the annual enrollment period.

If you miss your Initial Enrollment Period, you may face a late enrollment penalty if you later join a Medicare Advantage plan. The penalty is typically 1% of the national average Medicare Advantage premium for each month you were may be able to access but not enrolled. This penalty stays with you as long as you have Medicare Advantage coverage.

To avoid penalties and gaps in coverage, it is important to make a choice during your Initial Enrollment Period, even if you are unsure. You can always switch to a different plan during the next annual enrollment period if you change your mind.

Special Situations and Exceptions

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you become may be able to access for Medicare. You can then join a Medicare Advantage plan during the annual enrollment period or during a special enrollment period if you experience a may have access to life event.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you may be able to join a Medicare Advantage plan, but the rules are complex. Some plans do not accept people with ESRD, and your enrollment options may be limited. Contact Medicare directly to learn which plans in your area serve people with ESRD.

If you are incarcerated, you cannot be enrolled in a Medicare Advantage plan. Your coverage will be suspended while you are in prison or jail. Once you are released, you can re-enroll during the next available enrollment period.

What to Ask Your Doctor and When to Seek Guidance

Before you choose a Medicare Advantage plan, ask your doctor which plans in your area include them as a provider. Ask whether the plan's network includes the specialists you see regularly and the hospitals or clinics where you prefer to receive care. Your doctor can also tell you whether the plan covers the medications you take and whether you will need prior authorization for any treatments.

If you have a chronic condition or see multiple specialists, ask your doctor about plans that specialize in your condition, such as a Special Needs Plan. These plans often have extra benefits and care coordination that may help you manage your health more effectively.

If you are unsure whether you meet the requirements for a specific plan or enrollment period, contact Medicare at 1-800-MEDICARE. You can also reach out to your State Health Insurance information Program (SHIP), which offers free counseling about Medicare choices. To find your local SHIP, visit shiptalk.org or call 1-877-839-2675.

Frequently Asked Questions

Can I join a Medicare Advantage plan if I have a pre-existing condition?

Yes. Medicare Advantage plans cannot deny you coverage or charge you more because of any health condition you have. Pre-existing conditions are fully covered from the moment you enroll, with no waiting periods or exclusions.

What happens to my Medicare Advantage plan if I move to a different state?

Most Medicare Advantage plans only serve specific counties or regions. If you move outside your plan's service area, your coverage will end, usually at the end of the month in which you move. You will have a special enrollment period to join a new plan in your new location. Contact your current plan and Medicare to understand your options before you move.

Can I have both Medicare Advantage and a Medigap policy?

No. You cannot be enrolled in both at the same time. If you want to switch from Medicare Advantage to Original Medicare with a Medigap policy, you must first drop your Medicare Advantage plan. Depending on your age and how long you had Medicare Advantage, you may have limited options when buying a Medigap policy.

Do I lose my Medicare Advantage plan if I go on Medicaid?

Not automatically, but it depends on your state and the specific plan. Some Medicare Advantage plans are designed for people with both Medicare and Medicaid. If your plan does not serve people on Medicaid, you may need to switch to a different plan. Contact your state Medicaid office and your current plan to understand your options.

What if I miss the enrollment important date?

If you miss your Initial Enrollment Period when you first become may be able to access for Medicare, you may face a late enrollment penalty of 1% of the national average premium for each month you were may be able to access but not enrolled. This penalty continues as long as you have Medicare Advantage. You can still join during the annual enrollment period (October 15 to December 7) or during a special enrollment period if you have a may have access to life event.