To be eligible for a Medicare Part C (Medicare Advantage) plan:
- You must be enrolled in Original Medicare (Medicare parts A and B).
- You must live in the service area of a Medicare Advantage insurance provider that’s offering the coverage/price you want and that’s accepting new users during your enrollment period.
To enroll in Original Medicare (to be eligible for Part C), in general, you must either:
If you’ve received monthly Social Security or Railroad Retirement Board (RRB) disability benefits for 24 months, you’re eligible for Original Medicare.
If you’re a disabled federal, state, or local government employee who’s not eligible for monthly Social Security or RRB benefits, you may be deemed entitled to disability benefits and automatically entitled to Part A after being disabled for 29 months.
- ESRD (end stage renal disease). If you have ESRD, you’re eligible for Medicare with coverage that could start as soon as your first month of dialysis treatment.
- ALS (amyotrophic lateral sclerosis). If you’ve received a diagnosis of amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), you become eligible for Medicare immediately upon collecting Social Security disability insurance (SSDI) benefits (5 months following the classification of “disabled”).
Many Medicare Advantage plans don’t accept people with ESRD. There is, however, an alternative Medicare Special Needs Plan (SNP) designed for people with specific circumstances or healthcare conditions.
To confirm your eligibility, consider using the eligibility calculator on the official Medicare website: Medicare.gov.
You can also use the calculator to calculate your premium.
A Medicare Advantage plan (Medicare Part C) is provided by a private insurance company that’s been approved by Medicare.
Often, they also include Medicare Part D (prescription drug coverage) and other benefits, such as vision and dental coverage.
There are many different companies offering Medicare Advantage plans. Each offers different levels of coverage and monthly premiums. Many are PPOs (preferred provider organizations) or HMOs (health maintenance organizations).
At a minimum, these plans will replace Medicare parts A and B, while offering a minimum of all of the benefits provided by parts A and B as required by law.
You don’t need Medicare Part C. It’s an optional alternative to Original Medicare that offers voluntary coverage.
Review the details of all your Medicare alternatives, including coverage and costs, to make a decision that’s best for you, your health, and your financial situation.