To qualify for a Medicare Advantage plan (Part C), you must be enrolled in both Medicare Part A and Part B, live in the plan's service area, and be a U.S. citizen or legal resident. It is generally available to those 65 or older, or under 65 with certain disabilities.
Medicare Eligibility: Age, qualifications & requirements. Medicare is our country's federal health insurance program for people age 65 and older, some younger people with disabilities, and people of any age with end-stage renal disease (ESRD).
You might need a Medicare Advantage (Part C) plan for an all-in-one solution that bundles hospital (Part A), medical (Part B), and often prescription drug (Part D) coverage, plus extras like vision, dental, hearing, and fitness benefits, all with a yearly out-of-pocket spending limit for financial protection, though it requires using provider networks. It's a popular choice for those wanting convenience, lower upfront costs (some $0 premiums), and comprehensive benefits beyond Original Medicare.
Medicare Advantage Plans can be a great choice for seniors who:
Technically, there are no income limits to Medicare or Medicare Advantage plans. You are eligible for Medicare coverage regardless of your annual income. However, higher premium costs do exist for beneficiaries with higher income.
The government pays Medicare Advantage plans a set rate per person, per year (around $12,000 in 2019, not including Part D–related expenses) under what's known as a risk-based contract. That means that each plan agrees to assume the full risk of providing all care for that inclusive amount.
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
When you turn 65, you become eligible for Medicare if you: Either receive or qualify for Social Security retirement cash benefits and are: A U.S. citizen. A lawful permanent resident (green card holder)
If you join a Medicare Advantage Plan you'll still have Medicare, but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
Generally, if you're eligible for Original Medicare (Part A and Part B), you can't be denied enrollment into a Medicare Advantage plan. If a Medicare Advantage plan gave you prior approval for a medical service, it can't deny you coverage later due to lack of medical necessity.
Your Medicare Approval During the General Enrollment Period
You can complete the application online when you enroll in Medicare during the General Enrollment Period. It can also take roughly 4-6 weeks to get your approval during this enrollment window.
You cannot have original Medicare and a Medicare advantage plan at the same time. It's one or the other. You also cannot have a Medicare supplement and Medicare advantage plan at the same time. It's either original Medicare (with or without a supplement) OR Medicare advantage.
Of course, no Medicare Advantage plan is really $0 cost. You may still pay deductibles and copays for covered services, and you'll still have to pay the Part B premium. But depending on your own personal healthcare needs, a Medicare Advantage plan may be worth it for the added benefits.
Across the country, health systems report that Medicare Advantage's growing administrative burden — from denied authorizations to delayed reimbursements — has become unsustainable. Some hospitals have already ended their contracts; others are limiting participation to only a few select plans.
If you file your taxes as "married, filing jointly" and your MAGI is greater than $218,000, you'll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $109,000, you'll pay higher premiums.
People leave Medicare Advantage (MA) plans due to difficulty accessing needed care (especially with worsening health), restrictive provider networks, complex prior authorization rules, and dissatisfaction with care quality, often feeling trapped as their health needs grow despite initial low costs and extra perks that become limiting. Issues with provider availability, network changes, and sometimes misleading marketing also drive disenrollment, pushing people back to Traditional Medicare for greater freedom, notes KFF.
If you qualify for Medicare, it's not a stretch to qualify for a Medicare Advantage plan. You need to have Medicare Part A and Part B. There are certain signup periods to be aware of, though. Compare 2026 Medicare Advantage Plans.
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