Eligibility | - CHPW Medicare Advantage


To be eligible for Medicare, an individual must be a U.S. citizen or legal resident. Legal residents must have lived in the U.S. for at least 5 years before applying for Medicare. Most people are eligible to receive Medicare benefits if they meet one of the following requirements:

  • are at least 65 years old
  • are under 65 years old and living with a disability
  • are any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Anyone who qualifies to receive Original Medicare, is eligible to enroll in a Medicare Advantage plan. If you are not sure that you qualify, contact the Social Security Administration or talk to one of our Medicare experts at 1-800-944-1247 (TTY Relay: 7-1-1).

If you already know you qualify, enroll in one of our plans. A Medicare Advantage plan offers complete coverage under one card and many extra benefits at little to no extra cost per month.

Medicare Enrollment Periods

Initial Enrollment Period (IEP)

For most people, this is when they enroll in Medicare after turning 65 or becoming eligible due to disability. If you do not sign up for Medicare when you first become eligible, you may be subject to a Part B late enrollment penalty once you do sign up for coverage.

  • If you are turning 65, you are able to enroll in the seven months surrounding your birthday. This includes your birthday month plus the three months before and three months after your birthday.
  • If you become eligible for Medicare due to disability, you can enroll in the seven months surrounding your 25th disability visit.

General Election Period (GEP)

If you did not sign up for Medicare during the Initial Enrollment Period, you can enroll during the GEPThis happens every year from January 1 to March 31. You may be charged a higher premium or late enrollment penalties if you wait until the GEP to enroll in Original Medicare.

After you enroll in Medicare Parts A and/or B, you may choose to apply for additional coverage. If you enroll in both Part A and Part B, you may choose to join a Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan between April 1 and June 30 of the same year. You can also enroll in a Part D plan if you only enroll in Medicare Part B during the General Election Period.

Annual Enrollment Period (AEP)

If you already have a Medicare plan, every year you have the option to switch coverage with no restrictions. You can add or remove prescription drug coverage or join a different plan. You may only change coverage between October 15 and December 7.

Special Enrollment Period (SEP)

Certain life changing circumstances could create the need to change coverage. For example, if you retire, no longer have coverage through an employer, move out of the service area or qualify for state medical assistance.  If you qualify to change coverage, you can return to Original Medicare, add Medicare Prescription Drug (Part D) coverage, or join a Medicare Advantage plan.

If you have recently qualified for Medicare coverage by turning 65 or experience a circumstance that would allow you to enroll outside of the Annual Election Period, you can enroll in one of our CHPW Medicare Advantage plans.

Find Coverage in Your County

Some Advantage plans are only available in select areas. To see which plans are in your area, simply click the button below and locate your county on the map. It will show you which plans are available near you. Each colored shape on the map represents one of our Medicare Advantage plans. On the service map, you can compare all plans available in your county in one easy place.

MA Special Needs Plan 014

You qualify to join our Special Needs Plan if you reside in the geographic service area and:

  • are entitled to Medicaid
  • receive Medicare Part A benefits
  • receive Medicare Part B benefits. You or Medicaid must continue to pay your Medicare Part B premium.
  • qualify for “extra help” paying for your health care premiums on the Qualified Medicare Beneficiary (QMB) program
  • do not have End Stage Renal Disease (ESRD) with limited exceptions (if you develop ESRD when you are already a member of one of our plans or you were a member of a different plan that was terminated)

Have Questions?

We know that every person and every situation is different. We want you to be healthy. If you are not sure that you qualify for a Medicare Advantage plan, talk to one of our experts. They can you help find coverage that best fits your health care needs. Our experts are available at 1-800-944-1247 (TTY Relay: Dial 7-1-1) from 8:00 a.m. to 8:00 p.m., seven days a week. You can also request an expert to contact you using this online form.


Keep an Eye on Your Health

Woman getting an eye examRegular eye exams are important, even if you have good vision. Doctors can detect a variety of health issues just by examining your eye. Catching problems like tumors, diabetes or high blood pressure can help you get treatment before more serious symptoms show up.

Eye exams are covered in-network for CHPW Medicare Advantage members. Vision coverage is included in all plans.



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