Medicare Advantage Plans (Medicare Part C) offer an alternative to Original Medicare. They provide coverage through private insurance companies, often including no-cost extras such as vision, hearing, and dental care.
The prerequisite to an Advantage Plan is enrollment in both Medicare Part A and Part B. Without them, a beneficiary cannot join any Advantage Plan.
Many seniors are unaware that enrollment periods are strict, and missing them means waiting months or even years before applying again. Understanding eligibility rules and sign-up windows is essential for getting the right plan at the right time.
Who Is Eligible for a Medicare Advantage Plan?
Take a quick look at the eligibility criteria to know whether you qualify for Medicare.
- Must Be Enrolled in Medicare Part A and Part B
A person must first sign up for Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). Without both, Medicare Advantage enrollment is impossible. This is a federal requirement, not optional.
- Must Live in the Plan’s Service Area
Medicare Advantage plans are sold by private insurance companies, and every plan operates in a specific state. If a person moves outside that area, they must select a new plan that covers their new location. ZIP codes determine coverage availability, and some states have more options than others.
- Special Rules for Those with ESRD (End-Stage Renal Disease)
Previously, people with End-Stage Renal Disease (ESRD) could not enroll in most Medicare Advantage Plans. However, since January 1, 2021, those with ESRD have been allowed to join any Medicare Advantage Plan.
- Cannot Have Medigap Coverage
Medigap (Medicare Supplement Insurance) and Medicare Advantage cannot be used together. If someone has Medigap and wants to switch to a Medicare Advantage Plan, they must cancel their Medigap policy.
When Should You Enroll in a Medicare Advantage Plan?
Medicare has certain enrollment periods during which you can sign up for a Medicare plan or switch your existing plans. Here are different enrollment periods for Medicare Advantage Plans.
Initial Enrollment Period (IEP)
The initial enrollment period is 7 months, starting 3 months before your 65th birthday and ending 3 months after you turn 65. You can enroll during this period if you haven’t had Medicare before. However, waiting until the last 3 months delays coverage.
General Enrolment Period (GEP)
If you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) between January 1 and March 31 every year.
You can also make changes to your current Medicare plans. For example, if you have Original Medicare and you want to switch to a Medicare Advantage Plan, you can do so during this period.
Annual Election Period (AEP)
This is for those who already have Medicare and want to make changes to their coverage plans.
AEP runs from October 15 to December 7 each year, during which you can join, switch plans, or drop your coverage plans. Changes take effect on January 1.
Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period occurs annually from January 1 to March 31 and applies only to individuals who are already enrolled in a Medicare Advantage Plan.
During this time, beneficiaries can switch to a different Medicare Advantage Plan or return to Original Medicare, with or without a Part D prescription drug plan. However, those enrolled in Original Medicare cannot use this period to join a Medicare Advantage Plan.
Unlike the Annual Enrollment Period (AEP), which allows anyone with Medicare to make broader plan changes, OEP is strictly for those already in a Medicare Advantage Plan and does not permit first-time enrollment in Medicare Advantage.
Special Enrollment Periods (SEP)
Once enrolled in a Medicare plan, coverage typically lasts for the entire calendar year. However, certain life events may allow individuals to change their Medicare Advantage Plan outside of standard enrollment periods.
The qualifying events include moving to a new service area, losing employer health coverage, becoming eligible for Medicaid, or being diagnosed with specific conditions. The SEP window varies, but it extends for two months following the qualifying event, allowing those affected to transition to an appropriate plan without significant coverage gaps.
Take a quick glance here.
| Enrollment Period | Who It’s For | What Can Be Done | When |
| Initial Enrollment Period (IEP) | New Medicare-eligible individuals | Sign up for Part A, Part B, Part C, and Part D | 7-month window around 65th birthday |
| General Enrollment Period (GEP) | Those who missed their IEP | Sign up for Part A and Part B (late penalties apply) | Jan 1 – Mar 31 |
| Annual Enrollment Period (AEP) | Anyone with Medicare | Join/switch Medicare Advantage or Part D | Oct 15 – Dec 7 |
| Medicare Advantage Open Enrollment Period (OEP) | Only Medicare Advantage members | Switch Advantage plans or return to Original Medicare | Jan 1 – Mar 31 |
| Special Enrollment Periods (SEP) | Those with qualifying life events | Enroll or change Medicare plans | Varies by event |
What Information Is Required To Enroll?
The following information is required when enrolling into a Medicare Advantage plan.
- Medicare Number: Found on the red, white, and blue Medicare card. This is needed to verify your Part A and Part B enrollment.
- Personal Information: Includes your full legal name, date of birth, address, and phone number. Sometimes, your Social Security Number (SSN) is required for identity verification.
- Plan Selection: You must provide the plan name and ID number when enrolling. If switching plans, a person must confirm the new plan cancels the old one automatically.
How To Enroll in a Medicare Advantage Plan?
- Online Enrollment: Visit Medicare.gov to compare plans and apply directly.
- Phone Enrollment: Call 1-800-MEDICARE (1-800-633-4227). You can also call the insurance company directly.
- Paper Application: Some plans allow applying via mail. Forms must be completed and sent before enrollment deadlines.
- Assistance Through Insurance Agents: Licensed Medicare agents provide plan comparisons and help with enrollment. This service is free, but agents represent specific insurance companies.
What Happens After Enrollment?
Here’s what happens after your enrollment.
- Medicare sends a letter confirming successful enrollment. If denied, the letter explains why and possible next steps.
- The new insurance card arrives within 10-14 business days. A welcome package includes a benefits summary and provider directory.
- Your coverage begins January 1 if enrolled during AEP. It starts the first of the following month if enrolled during IEP or SEP.
What if Enrollment Is Denied?
Common reasons for denial include:
- Not enrolled in Part A and Part B
- Living outside the plan’s service area
- Trying to enroll outside valid enrollment periods
What can you do?
- Confirm eligibility rules were met.
- Contact Medicare or the insurance company to clarify the reason.
- Wait for the next enrollment period to see if all rules have been followed.
Making Medicare Enrollment Simple With Silveredge
Knowing when and how to enroll in a Medicare Advantage plan prevents coverage gaps. Missing deadlines means waiting months or longer before signing up again. Using the right method to enroll — whether online, by phone, or through an agent helps avoid delays.
In-time enrollment requires knowledge of enrollment periods, eligibility rules, and available options. At Silveredge, we simplify this process by helping you find and compare Medicare plans that fit your healthcare needs and budget.
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