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Not Sure If You're Eligible For Medicare Advantage? Find Out Here.

By Ashley Hinson, Lan Pham
Checking your Medicare Advantage eligibility can seem intimidating, but it doesn’t have to be.

If you’re considering enrolling in Medicare Advantage, it’s important to stay-up-to date about eligibility qualifications. So, who is eligible for Medicare Advantage? Read on to find out. 

Medicare Advantage Eligibility Requirements

Medicare Advantage, or Medicare Part C, is an alternative option to Original Medicare (Parts A and B). Many Medicare Advantage plans provide vision, dental and prescription benefits that Medicare Parts A and B do not cover. 

General Eligibility Requirements

The general eligibility qualifications for Medicare Advantage are similar to the qualifications for Medicare.

“First, you have to be eligible for Medicare parts A and B,” Adam Hyers, owner of Hyers and Associates insurance agency, tells WebMD Connect to Care. 

“You have to be entitled to Part A, which you’re entitled to through work credit, and then enrolled in Medicare Part B monthly premiums. For a vast majority, you have to be 65 or older,” Hyers explains.

The Centers for Medicare & Medicaid Services also specifies that you must live in the service area of the Medicare Advantage plan that you wish to join. If you live in a different state for a portion of the year, you’ll need to ask the plan’s provider if your coverage will remain uninterrupted. 

Eligibility for Those Under Age 65

Medicare Advantage plans are also available to those under age 65 with certain disabilities—as a part of general Medicare eligibility guidelines. 

According to the Social Security Administration, a person who has received Social Security Disability Insurance (SSDI) payments for 24 months becomes eligible for Medicareeven if they are under age 65

Additionally, the Centers for Medicare & Medicaid Services notes that those who receive certain disability benefits from the U.S. Railroad Retirement Board for 24 months are also eligible for Medicare. 

There are exceptions for people with Lou Gehrig’s disease (ALS) and end-stage renal disease (ESRD). The official U.S. government website for Medicare notes that those who have ALS automatically receive Medicare Parts A and B during the same month that their disability benefits start. When these individuals are choosing the specifics of their Medicare coverage, they can opt for a Medicare Advantage plan. 

Those with ESRD qualify for Medicare if they:

  • Have non-functioning kidneys
  • Need regular dialysis
  • Have received a kidney transplant
  • Have worked for the necessary amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
  • Are already receiving or eligible for Social Security or Railroad Retirement benefits
  • Are either the spouse or dependent of a person who meets the above two requirements

As of January 2021, those with ESRD can choose either Original Medicare or Medicare Advantage as a part of their eligibility. 

Dual Eligibility

In 2018, there were about 12.2 million people dually enrolled in Medicare and Medicaid, according to the Centers for Medicare & Medicaid Services. Many people don’t know they qualify for dual eligibility for Medicare Advantage and Medicaid through Dual Special Needs Plans, or D-SNPs, Alex Sampson, broker with Health Benefits Associates, tells WebMD Connect to Care. 

“The easiest way to see if you’re eligible is if you have a Medicaid card in your wallet and if you have a part A and B card from the federal government, then you are dually eligible,” Sampson says. According to Sampson, many free benefits are available to those who are dually eligible—depending on where they live. These benefits can include:

  • Food assistance
  • Transportation to and from the doctor’s office
  • Dental and vision benefits

Get started now. 

Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.