A doctor who accepts Medicare Advantage plans checking the heartbeat of a senior woman

Who Is Eligible for Medicare Advantage?

Navigating the Medicare system doesn’t need to be complicated. It is important that you have the information you need to get the right kind of care. We all want the best medical care possible and many of us have doctors who are already an important part of our care team. If you are one of the millions of people in the United States who qualifies for Medicare there are some facts you should know about Medicare Advantage eligibility rules. 

Medicare Advantage is one of the four parts of Medicare. The parts of Medicare are Part A, Part B, Part C, and Part D. Here is a quick breakdown of what each Medicare Part covers:

  1. Part A – provides inpatient/hospital coverage (also called Original Medicare)
  2. Part B – provides outpatient/medical coverage (also called Original Medicare)
  3. Part C – offers an alternate way to receive your Medicare benefits (Medicare Advantage)
  4. Part D – provides prescription drug coverage

The different parts of Medicare help cover specific services. Most people will be covered under Original Medicare and receive the benefits of Part A and Part B. With Original Medicare the government pays the providers directly for the health services you receive. This means you can see any doctor or go to any hospital in the country that takes Medicare. You will find that most hospitals and doctors take Medicare.

Whereas Medicare Original is government-funded, Medicare Advantage is when private plans provide benefits. They provide the same benefits as Original Medicare, but there are different rules, costs, and restrictions. With Medicare Advantage there are also certain benefits available to you that are not covered by Medicare Original. Medicare Advantage is called Part C or Medicare private health plan. Medicare Advantage eligibility rules are different from Medicare Original eligibility rules. 

According to Medicare Advantage eligibility rules you need to be enrolled in Original Medicare (Medicare Part A and Part B). There are Medicare insurance providers in many parts of the country. If you want to enroll in Medicare Advantage you need to live in an area with a Medicare Advantage insurance provider. 

That insurance provider needs to be accepting new patients at the time you are enrolling. There are different enrolling periods throughout the year so if you are ready to enroll you will need to be sure you live in an area with a provider. If you suffer from End Stage Renal Disease (ESRD) you will not be able to enroll under Medicare Advantage eligibility rules. If you do have ESRD you may be able to enroll in a Medicare Special Needs Plan. 

Why Choose Medicare Advantage Plans?

Choosing the right plan for your health needs is important. It will impact your out-of-pocket costs which is important for many seniors who are living on a fixed income. The Medicare option you choose will also impact where you get your care and what benefits you are eligible for. 

With Original Medicare you can receive care at almost any doctor’s office or hospital in the country. Since Medicare Advantage is a private insurance plan you will need to get your care from providers that accept Medicare Advantage or in-network providers. One reason many people choose Medicare Advantage plans is that they provide many benefits that aren’t provided through Original Medicare. 

Medicare Advantage offers the same benefits of Original Medicare which are inpatient/hospital coverage as well as outpatient/medical coverage. Medicare Advantage also offers prescription drug benefits which is an important part of healthcare for many seniors, especially since the costs of prescription drugs can be very high and it would not be possible to pay the high costs out of pocket. Here are some of the benefits included in Medicare Advantage:

  • Routine vision and dental care
  • Hearing care and money for hearing aids
  • Memberships to gyms and wellness programs
  • Some home health care services
  • Modifications to your home for aging in place
  • Non-emergency medical transportation

These benefits are crucial to so many seniors. For example, dental and vision care at an advanced age is such an important part of your overall health. And as many seniors are experiencing increased difficulty with hearing, hearing aids can be a helpful tool when it comes to staying social and being able to communicate with friends, family, and medical providers. 

Home health care services can also be extremely helpful or even absolutely necessary for seniors who are aging in place. Many seniors are independent and do not want to live in assisted living facilities. For those who need healthcare services at home this benefit can be a wonderful option. Emerging technologies such as home health monitoring products and telehealth services also contribute to a well-balanced and patient-centered health care routine. 

Many will also need modifications made to their home as they age. Whether you need areas of your house retrofitted for wheelchair accessibility or you need grab bars installed in your bathroom, these changes to your home are important ways for you to stay safe and comfortable and to continue to enjoy your life at home. 

Another important benefit, non-emergency medical transportation, will make a major difference for a lot of seniors. For example, if you no longer drive yourself to doctor’s appointments it may be difficult to find transportation, or even impossible depending on where you live. Having access to transportation to get to and from your regular appointments will help you stay on top of your healthcare and avoid missing important appointments when you need them.

These are just some of the reasons why many choose Medicare Advantage plans. If these benefits sound helpful to you, you will want to review these Medicare Advantage eligibility rules again and check your periods of enrollment.

>> Questions about your Medicare Advantage eligibility? Contact Cano Health now at 855.CANOMED (855.226.6633) to speak with a Benefit Coordinator.