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Basic Eligibility Requirements – Effective January 1, 2009

Medicare Advantage plans are available to anyone who is eligible for Medicare in the United States, regardless of age, income, or health conditions. You must live in the service area of the plan you join. Participation is voluntary.

In order to be eligible, you must:

  1. Be entitled to Medicare Part A and enrolled in Medicare Part B.
  2. Continue to pay your Medicare Part B premiums (and Part A, if applicable) unless they are otherwise paid for by Medicaid or by another third-party.
  3. Be a resident of Bucks, Chester, Delaware, Montgomery, or Philadelphia counties in Pennsylvania.
  4. If you elect a Medicare Advantage plan that includes Part D prescription drug coverage, you must obtain your Part D benefits through that plan.
  5. The federal government will not allow us to accept people with End-Stage Renal Disease, unless they are converting from Keystone Health Plan East or Personal Choice® Employer Group Coverage, or if their current Medicare Advantage plan stops providing coverage in their area.
  6. For Keystone 65 Complete plans only: Keystone 65 Complete is an HMO Special Needs Plan designed for people who have full Medicare and Medicaid benefits. You must be enrolled with the state Medical Assistance program (including Healthy Horizons) and have a Medicaid ACCESS card to join this plan.

If you have limited income and resources, you may qualify for a low-income subsidy. When you join, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.

You can see if you qualify for a low-income subsidy by calling:

  • 1-800-MEDICARE (1-800-633-4227) (TTY/TDD: 1-877-486-2048), 24 hours a day/7 days a week
  • Pennsylvania Office of Medical Assistance Programs (Medicaid) at 1-717-787-1870
  • The Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday

Please note: In some cases, Medical Assistance copays will apply.

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For additional information, read our Frequently Asked Questions about Medicare Part D.