Eligibility and Enrollment

Eligibility for Generations Advantage Medicare Plans

A Medicare beneficiary must meet the following criteria in order to be eligible to enroll in Generations Advantage plans:

  • They are enrolled in Medicare Part A and Part B
  • They reside in the Generations Advantage service area, which includes all of Maine and New Hampshire.
  • They are not currently diagnosed with end-stage renal disease (or receiving regular kidney dialysis)
  • They are enrolling during an eligible Medicare enrollment period

Enrollment Periods for a Medicare Advantage Plan

When can a Medicare beneficiary join, switch, or drop a Medicare Advantage Plan?

  • When they first become eligible for Medicare, they can join during the 7-month period that begins 3 months before the month they turn 65, includes the month they turn 65, and ends 3 months after the month they turn 65.
  • If they get Medicare due to a disability, they can join during the 7-month period that begins 3 months before their 25th month of disability and ends 3 months after their 25th month of disability.
  • Between October 15 and December 7 (Annual Enrollment), they can join, switch, or drop a Medicare Advantage Plan. Their coverage will begin on January 1, as long as the plan gets the enrollment request by December 7.
  • During a Special Enrollment Period (see below)
  • During a Medicare 5-Star Special Enrollment Period

Can a Medicare beneficiary make changes to their coverage after December 7?
Between January 1 and March 31, if they are enrolled in a Medicare Advantage plan, they can leave their plan and switch to another Medicare Advantage plan or Original Medicare. If they switch to Original Medicare during this period, they will have until March 31 to also join a Medicare Prescription Drug Plan (Part D) to add drug coverage. Their coverage will begin the first day of the month after the plan gets their enrollment request.

NOTE: During this period, they cannot:

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Switch from one Medicare Prescription Drug Plan to another.
  • Join, switch, or drop a Medicare Medical Savings Account Plan.

Special Enrollment Periods
In most cases, Medicare beneficiaries must stay enrolled for the calendar year starting the date their coverage begins. However, in certain situations, they may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Please have them contact their plan for additional information if:

  • They move out of their plan’s service area.
  • They have Medicaid.
  • They qualify for Extra Help.
  • They live in an institution (like a nursing home).