If you are younger than age 65 and on Medicare for a disability (except end-stage renal disease (ESRD), you have the right to join any Medicare Advantage (MA) plan that is accepting new members.
MA is also known as Medicare Part C. MA plans are alternatives to Original fee-for-service Medicare, and include:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private-Fee-For Service (PFFS) plans
- Special Needs Plans (SNPs)
- Medical Savings Accounts (MSAs)
These plans are sponsored by Medicare, which pays private insurance companies to provide health services to beneficiaries who enroll in these plans.
If you enroll in a managed care MA plan (such as an HMO or PPO), you must get your health services from network providers and make copayments when you receive care. PFFS and MSA plans don’t require you to use a network of providers, but be sure your doctors and other health care providers accept your plan’s rules before you receive services.
You receive all Medicare-covered benefits through the private MA plan you choose. Some MA plans offer Medicare prescription drug coverage (these are known as MA-PD plans), but other plans do not (these are known as MA-only plans). Most MA plans provide extra benefits (such as hearing, dental and eye exams) and charge lower copayments than Original Medicare. However, several MA plans charge the same or more than Original Medicare for certain services. For more information, see our Medicare Advantage section.
End-Stage Renal Disease & MA Plans
If you have end-stage renal disease (ESRD), you cannot enroll in an MA plan. You may only enroll in Original Medicare. However, MA plans are required to continue providing services to members who develop ESRD while enrolled. If an MA plan terminates its contract with Medicare, members of the MA plan who have ESRD may enroll in another MA plan, if one is available. If one is not available but becomes available later, a person with ESRD who previously lost their MA coverage can join that MA plan.
