Medicare eligibility requirements

Am I Eligible?

To be eligible for a Medicare Advantage plan, you must fall under the following criteria:

You’re entitled to Part A and enrolled in Part B

Includes people under 65 years of age who are entitled to Social Security disability.

You permanently live in the plan’s service area

Do you live in one of our eligible counties?

Special Note

End Stage Renal Disease (ESRD) patients WILL be able to enroll in Medicare Advantage plans as of 2021, under the terms of the 21st Century Cures Act.

Special Enrollment Period

If you’ve recently become unemployed or lost your health coverage, you may qualify for special enrollment in an Experience Health plan to cover your medical and prescription needs.

Call 1-833-905-1311 (TTY: 711)^* to learn more.

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When can I enroll?

You can enroll in Medicare as early as three months before your 65th birthday, and up to three months after. This Initial Enrollment Period gives you a 7-month window to sign up.

Keep in mind, you don’t have to be retired to sign up. If you’re one of the millions of people working past 65, you can still enroll. Be sure to check with your benefits department to see if you could save money on your health benefits by enrolling in Medicare.

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Are There Other Times I Can Enroll?

Once you’re enrolled in Medicare, your enrollment options may be different depending on the time of the year.

Annual Enrollment Period (AEP) (From October 15 – December 7)
AEP takes place at the same time each year. During this period, you can enroll, disenroll — or change your Medicare plans (Medicare Advantage, Medicare Supplement, or prescription drug plan). You also have the option to return to Original Medicare. Elections made during AEP are effective on January 1 of the following year.
Open Enrollment Period (OEP)
When you enroll in a Medicare plan, your new coverage starts on January 1 of the year following your enrollment. However, you have 3 months to change your coverage if you’re not happy with your plan. It’s called the Open Enrollment Period, and it lasts from January through March. You can choose a new plan and switch without any penalty during the Open Enrollment period. Good to know!
“Lock-in Period” (From April 1 – October 14)
Between April 1 and October 14, you cannot change coverage, unless you qualify for a Special Enrollment Period (SEP). If you do not qualify for an SEP, you’ll have to wait until AEP to elect new coverage.
Special Enrollment Period (SEP) (Timing is dependent)
During an SEP, you can enroll, disenroll or change your coverage because of personal circumstances. Reasons for qualifying for an SEP may include: you’ve moved, you became eligible for Medicare and Medicaid, you’re leaving your employer group health plan.
Enrolling After 65?
Learn what your options are.