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Medicare Advantage eligibility and how plans work




Not everyone is eligible to join a Medicare Advantage Plan. This video addresses what qualifications are required to enroll in an Advantage Plan. Why some plans include Medicare Part D drug coverage while others do not is also discussed. Also, learn why your doctor visits may not be covered by choosing the wrong plan.




Do you meet the qualifications to enroll in a Medicare Advantage Plan?

In order to enroll in a Medicare Advantage Plan you must meet certain eligibility guidelines. First, you must be enrolled in Medicare Parts A and B and continue to pay your Part B premium which is normally deducted from your Social Security. You will also need to live in a plan’s service area. A service area is typically defined as a specific County. And you must not have end-stage renal disease.

Medicare Advantage Plans that include Part D benefits are referred to as MAPD plans and those without Part D are referred to as MA plans. Unless you have other creditable drug coverage you should enroll in a MAPD plan to avoid the Part D Late Enrollment Penalty. You cannot enroll in a PPO, HMO or HMO-POS plans without Part D coverage and enroll in a stand-alone Part D plan.

Medicare Advantage Plans require that you share in the cost of your care. You may pay a plan premium, deductible, copays or coinsurance when you use your plan. One popular feature of Medicare Advantage Plans is the annual Maximum Out-Of-Pocket (MOOP) amount that can limit your annual costs. This amount can vary year to year.