How Do I Qualify For a Medicare Advantage Plan?

Medicare Advantage Plans, also known as Medicare Part C coverage, is an alternative way for Medicare beneficiaries to get their Original Medicare benefits. These services are provided by a private health insurance company. Those that qualify for Medicare Part C may find the coverage an attractive option because it provides additional benefits such as Medicare Part D prescription drug coverage, dental, vision, and hearing care.

Qualifying for Medicare Part C plans is not that different from being eligible for Original Medicare. Let’s take a look at how to qualify for a Medicare Advantage plan.

You Must Qualify for Original Medicare Coverage

To qualify for a Medicare Advantage plan, you must be eligible or already enrolled in Original Medicare. Generally, you can qualify for Original Medicare if you meet one of these requirements:

  • You are age 65 and older
  • You are under age 65 and disabled, and you are already receiving Social Security Disability Insurance or Railroad Retirement disability benefits.
  • You have Lou Gehrig’s disease 
  • You have End-Stage Renal Disease (ESRD) – a permanent kidney problem which usually means you need a transplant or on dialysis.
  • You must be a citizen of the United States or a permanent resident and have worked long enough to be eligible for Social Security or Railroad Retirement Board benefits.

You Must Live Within the Medicare Advantage Service Area

Medicare Advantage plans have selected regions or service areas where they are permitted by a state to operate and are approved by Medicare to offer coverage. Within these service areas, Medicare Advantage plans have networks of healthcare professionals and facilities who provide covered services to the Medicare Advantages plan’s members. So, you must enroll for Medicare Advantage coverage that is available in your location.

Special Needs Plan (SNP)

SNP is a special type of Medicare Advantage plan. However, unlike the Original Medicare plan, Special Needs Plans are tailored to meet the social and medical needs of the poor and those with chronic medical conditions. Your eligibility depends on the type of Medicare Special Needs Plan you choose, which include:

Institutional SNPs (I-SNPs): to qualify, you must stay for at least 90 days in a long-term care facility that is in the SNP network, such as an inpatient psychiatric facility, nursing home, long-term care nursing facility, or intermediate care facility.

Chronic Condition SNPs (C-SNPs): this is designed for those who have specific medical conditions. CMS only recognizes 15 chronic disease and illnesses categories, and you must be suffering from at least one of them to be eligible for C-SNPs.

Dual Eligible SNPs (D-SNPs): to qualify for this type of Special Needs Plan, you must be eligible for Medicaid and Medicare.

If you want to find out more about how you can qualify for a Medicare Advantage plan, don’t hesitate to contact Medicare Sharks.

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