Many plans offer these added benefits at no additional cost, because Medicare pays insurers directly to manage your care.
Here's everything you need to know about eligibility, enrollment, benefits, and costs.
Medicare Advantage Eligibility Requirements
| Requirement | Details |
|---|---|
| Medicare Enrollment | Must be enrolled in both Part A and Part B. |
| Citizenship | Must be a U.S. citizen or permanent resident (5+ years). |
| Residency | Must live in the plan's service area at least 6 months per year. |
| End-Stage Renal Disease (ESRD) | Eligible since 2021. |
| Part B Premium | Must continue paying the Part B premium. |
Medicare Advantage Enrollment Periods
| Enrollment Period | When It Happens | What You Can Do |
|---|---|---|
| Initial Enrollment Period (IEP) | 3 months before and after your 65th birthday month | Enroll in Medicare Advantage for the first time. |
| Annual Enrollment Period (AEP) | October 15 – December 7 | Add, change, or drop a Medicare Advantage plan. |
| Medicare Advantage Open Enrollment (MA-OEP) | January 1 – March 31 | Switch to another Advantage plan or return to Original Medicare. |
| Special Enrollment Period (SEP) | Triggered by life events (e.g. moving, qualifying for Extra Help) | Make changes outside of standard enrollment windows. |
What Medicare Advantage Covers
Medicare Advantage plans must cover everything Original Medicare does — and often more:
- Hospital stays (inpatient care)
- Doctor visits and outpatient care
- Emergency services and mental health care
- Home health services (non-hospice)
- Prescription drugs (in most plans)
- Dental, vision and hearing benefits
- Fitness memberships (SilverSneakers)
- Worldwide emergency travel coverage
- Over-the-counter product allowances
Note: Extra benefits vary by plan. Always check the Summary of Benefits.
How Much Medicare Advantage Costs
Your total costs depend on factors like plan type, premiums, copays, and where you live. Key points:
- $0 Premium Plans: Available in most areas, but you must still pay your Part B premium.
- Deductibles: Some plans have $0 deductibles; others have separate drug and medical deductibles.
- Copayments/Coinsurance: Pay small fixed amounts or percentages for services.
- Out-of-Pocket Maximum: Limits your annual spending — a major advantage over Original Medicare.
- Income Impact: Higher-income individuals may pay more for Medicare Parts B and D, affecting total cost.
How Everstone Insurance Services Can Help
Advantage plans differ enormously from one ZIP code to the next. We compare the plans actually available where you live — checking your doctors, your prescriptions and your budget — so you can choose with confidence.