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Who Qualifies for Medicare Advantage Plans?

If you’ve been browsing through Medicare plans, you’ve probably heard about Medicare Advantage plans. You might be wondering who qualifies for Medicare Advantage plans and whether these increasingly popular plans would suit your health care needs.

In this guide, we’ll help you understand if you’re eligible for a Medicare Advantage plan. We’ll also give you tips on how you can find a Medicare Advantage plan that fits your health, budget, and lifestyle.

Who qualifies for Medicare Advantage?

To qualify for a Medicare Advantage plan, you need to meet the Medicare eligibility requirements, which could include age or health condition requirements. You also need to be an American citizen or a permanent resident who has lived in the U.S. for at least five consecutive years. 

Once you meet these requirements, you’ll need to meet a few additional conditions in order to get a Medicare Advantage plan. You must be enrolled in Medicare Parts A and B, and you can’t be enrolled in a Medicare Supplement (Medigap) plan. You will also need to live in an area that offers the particular Medicare Advantage plan you want to purchase.

Can I switch to a Medicare Advantage plan?

If you have a different Medicare plan, you can switch to a Medicare Advantage plan during the Open Enrollment Period. This period, also called the Annual Enrollment or Annual Election Period, runs from Oct. 15 through Dec. 7. If you switch to an Advantage plan during this time, your Medicare Advantage coverage will begin on Jan. 1 of the following year.

If you miss Open Enrollment, you may be able to switch to a Medicare Advantage plan during a Special Enrollment Period if you have a qualifying life event.

How could a Medicare Advantage plan benefit me?

With a Medicare Advantage plan, you’ll be covered for everything that’s included in Medicare Parts A and B. Unlike other Medicare plans, some Medicare Advantage plans may cover services not included in Original Medicare including prescriptions, routine dental, vision, or hearing care. 

However, it’s important to note that while prescription drug coverage is common in Medicare Advantage plans, the specifics vary from plan to plan. Therefore, it’s crucial to review each plan’s details to understand what is covered and what isn’t.

Depending on the Medicare Advantage plan you choose, you might also be able to get free fitness classes, meal delivery, and transportation to and from medical appointments. 

In general, Medicare Advantage plans have lower monthly premiums than other Medicare plans. For 2023, for example, the average monthly premium for Medicare Advantage members was $18, according to the Centers for Medicare & Medicaid Services (CMS). Some Advantage plans may offer $0 monthly premiums.

LEARN MORE: What To Know About $0 Medicare Advantage Plans

What should I know before I purchase a Medicare Advantage plan?

Medicare Advantage plans have a few key differences that you’ll want to understand before you switch from another Medicare plan.

Medicare Advantage plans use provider networks, and some plans may require you to see certain doctors or use certain hospitals that are in your plan’s network in order for those services  be covered. While many plans allow you to use “out-of-network” providers, you may pay a higher copay for doing so.

Some types of Medicare Advantage plans may require you to choose a primary care provider. If you need to see a specialist, you might need to get a referral from your primary care provider.

If you’re traveling outside of the United States, be aware that Medicare Advantage won’t cover any care that you might need while you’re away.

How can I choose a Medicare Advantage plan that suits my needs?

As you consider purchasing a Medicare Advantage plan, it helps to think about your health needs, budget, and lifestyle.

Considering your health priorities

First, you’ll want to decide how much coverage you need. To do this, it can help to write down how many times you go to the doctor each year. You should also make a list of your medications and the names of any specialists you see.

Since many Medicare Advantage plans offer dental, vision, and hearing care, you may want to write down any expenses you’ve had for these services in the past year.

This information will help you understand what to prioritize when selecting a plan. For example, if you have regular appointments with specialists, you may want to choose a plan that doesn’t require referrals. You will also want to choose a plan with a network that includes your primary care doctors and specialists.

If you don’t use hearing or vision services very much, you may not need a plan that includes lots of coverage for these services. For prescriptions, always check to make sure that your plan covers your medications. You may want to compare the prices of your prescriptions with different plans.

Thinking about your budget

In terms of your budget, it’s important to understand the total cost of each plan. While some plans may offer $0 premiums, they might have higher deductibles. In some cases, plans with higher premiums could have lower deductibles or copays.

Would you be happier with a lower premium, or would lower deductibles and copays be better for you? As you consider your finances, you may want to make a list of the copays and deductibles for your current plan. Do you usually meet your deductible? Do you have to pay a copay that’s more than you’d like for a certain specialist?

By answering these questions, you’ll be able to sort through the financial aspects of Medicare Advantage plans more easily. For example, if you determine that a low deductible suits you best, you can focus on plans with deductibles that are affordable for you.

Considering your lifestyle

As you sort through Medicare Advantage plans, think about the features that might improve your life. Would free fitness classes make it easier for you to exercise? Would transportation to medical appointments be helpful?

If you can, make sure that the plan you choose covers the services that would make a positive difference in your life.

Where can I get more information about Medicare Advantage plans?

When you shop for Medicare Advantage plans in your area, you can go to the official Medicare website to find the plans that are available in your city or you can contact Medicare directly.

If you’d like, you can talk on the phone with a SmartMatch™ Licensed Insurance Agent, too. All phone consultations are free with no obligation to enroll. Give SmartMatch a call today to learn more about Medicare Advantage options that may be right for you.

Key Takeaway

To qualify for a Medicare Advantage plan, you need to be Medicare-eligible, enrolled in Original Medicare (Parts A & B), and live in an area that provides your desired Medicare Advantage plan. In addition, even if you’re eligible, there are other considerations to determine if a Medicare Advantage plan is best for you, such as plan coverage, costs and premiums, as well as certain lifestyle factors such as travel.

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Please contact Medicare.gov, 1-800-Medicare or your local State Health Insurance Program (SHIP) to get information on all of your options. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Not all plans offer all benefits. Availability of benefits and plans varies by carrier and location. Limitations and exclusions may apply. No obligation to enroll. SmartMatch Insurance Agency represents Medicare Advantage [HMO, HMO SNP, PPO, PPO SNP, and PDP] organizations that have a Medicare contract. Enrollment in any plan depends on contract renewal. PLEASE NOTE: Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.

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