Medicare Advantage (Medicare Part C) Eligibility Requirements

• by Christian Worstell
• November 30, 2023
• Reviewed by John Krahnert

Medicare Part C Eligibility - Quick Look

How does Medicare Part C work?

Medicare Part C plans are sold by private insurance companies as an alternative to Original Medicare. Medicare Part C plans are also called Medicare Advantage plans and are required by law to offer at least the same benefits as Medicare Part A and Part B. 

There are several different types of Medicare Advantage plans, such as HMO plans and PPO plans. Medicare Advantage plans can feature its own network of participating providers.

Who is eligible for Medicare Part C?

If you’re enrolled in Original Medicare (Part A and Part B), you may be eligible to sign up for a Medicare Advantage (Part C) plan during a qualifying enrollment period. This includes people under the age of 65 who qualify for Medicare because of a disability or health condition.

What is covered under Medicare Part C?

Medicare Part C plans provide all of the same benefits as Original Medicare. Most Medicare Advantage plans also offer prescription drug benefits, which Original Medicare doesn't cover.

Some Medicare Advantage plans may also offer a number of additional benefits that can include coverage for things like:

• Routine dental care
• Routine vision care
• Routine hearing care
• Memberships to fitness and wellness programs like SilverSneakers

Keep in mind that Medicare Advantage plans with one or more of these benefits may not be available where you live. Compare local plan options to find out what benefits are available.

How much does Medicare Part C cost?

​ In 2024, the average Medicare Advantage plan premium is $13.24 per month.¹

In 2024, 89 percent of Part C plans cover prescription drugs, and 66 percent of those plans feature a $0 premium, according to the Kaiser Family Foundation.² $0 premium plans aren’t available in all locations and may not be available where you live, so be sure to compare your local plan options.

Medicare Advantage plans are required to include an annual out-of-pocket spending limit, which limits how much you will have to pay in Medicare deductibles, coinsurance and other out-of-pocket costs in a single year.

Medicare Part A and Part B don't include an out-of-pocket spending limit.

When can I enroll in a Part C plan?

If you are eligible for a Medicare Advantage plan and there is a plan available in your service area, you still need to wait for an enrollment period to join.

This Medicare enrollment guide can help you navigate the various Medicare enrollment periods.

Initial Enrollment Period (IEP)

When you first become eligible for Medicare, you will be given an Initial Enrollment Period (IEP).

Your IEP lasts for seven months. It begins three months before you turn 65 years old, includes the month of your birthday and continues on for three more months.

Fall Medicare Open Enrollment Period

The fall Medicare Open Enrollment Period (also called the Medicare Advantage Annual Enrollment Period) is a yearly period during which current Medicare beneficiaries can sign up for or drop a Medicare Advantage plan and/or Medicare Part D prescription drug plan. Beneficiaries can also drop either type of coverage and keep their Original Medicare during this time.

Fall Medicare open enrollment lasts from October 15 to December 7 each year. During this time, you may be able to sign up for, change or disenroll from a Medicare Advantage plan.

Special Enrollment Period (SEP)

You could potentially qualify for a Medicare Special Enrollment Period (SEP) if you experience a qualifying life event.

These qualifying events can include situations such as moving to a new plan service area, moving into or out of a skilled nursing facility and more.

A licensed insurance agent can help determine if you are eligible for a Special Enrollment Period.

You can also call to speak with a licensed agent to find out more about Medicare Advantage plans in your area and learn when you may be able to enroll. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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