Eligibility Requirements

Medicare Eligibility Requirements

To be entitled to Medicare, you must be a U.S. citizen or a permanent legal resident, and answer yes to at least one (1) of the following questions:

  • Are you age 65 years or older and eligible to receive Social Security benefits?
  • Are you under 65, permanently disabled and have been receiving Social Security disability insurance payments for at least two (2) years?
  • Do you receive continuing dialysis for permanent kidney failure or need a kidney transplant?
  • Do you have Amyotrophic Lateral Sclerosis (ALS — Lou Gehrig’s Disease)?

Medicare Advantage Eligibility Requirements

You can generally join a Medicare Advantage Plan if you meet these conditions:

  • You have Part A and Part B
  • You live in the service area of the plan
  • You don’t have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

If you have End-Stage Renal Disease (ESRD), you can only join a Medicare Advantage Plan in certain situations:

  • If you’re already in a Medicare Advantage Plan when you develop ESRD, you can stay in your plan or you may be able to join another Medicare Advantage Plan offered by the same company.
  • If you’re in a Medicare Advantage Plan, and the plan leaves Medicare or no longer provides coverage in your area, you have a one-time right to join another Medicare Advantage Plan.
  • If you have an employer or union health plan or other health coverage through a company that offers one or more Medicare Advantage Plan(s), you may be able to join one of that company’s Medicare Advantage Plans.
  • If you’ve had a successful kidney transplant, you may be able to join a Medicare Advantage Plan.
  • You may be able to join a Medicare Special Needs Plan (SNP) that covers people with ESRD if one is available in your area.

For more information about ESRD, download the booklet “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.”

Important Note: Federal Government rules require that if you join a Medicare Advantage Plan like Optima Medicare, and you want Medicare prescription drug coverage, you must get that drug coverage from your Medicare Advantage Plan.

In addition, Medicare has special rules that dictate when you can join, change or leave a Medicare Advantage Plan.

For more information, see our enrollment information page.