If you're on Medicare because of a disability, Medicare Advantage is open to you the same way it is to someone who is 65. This page covers who can join, what it costs, when you can join or switch, what to check, and how North Carolina, South Carolina and Tennessee differ. For the full picture, including when Medicare starts and how to stay covered until then, see our guide to Medicare under 65 on disability.
Can I get a Medicare Advantage plan if I'm under 65?
Yes. If you have Medicare Part A and Part B, you can join a Medicare Advantage plan at any age. There is no minimum age.
A Medicare Advantage plan (also called Part C) is a Medicare-approved plan from a private company that you can choose instead of Original Medicare to get your Part A and Part B benefits. Under federal rules, you're eligible if you're entitled to Part A and enrolled in Part B. You also need to live in the plan's service area and meet Medicare's citizenship or lawful-presence rules.
People with End-Stage Renal Disease (ESRD) used to be shut out of most plans. That changed on January 1, 2021, and people with kidney failure can now join like anyone else.
Can a plan turn me down because of my disability?
No. A Medicare Advantage plan may not deny, limit or condition coverage based on health status, and federal rules name disability, medical condition and medical history specifically. Plans must accept eligible people who join during a valid enrollment period. There are no health questions.
Does Medicare Advantage cost more if you're under 65?
No. A plan has to charge the same premium and the same copays to everyone in that plan, whatever their age. A 45-year-old and a 75-year-old in the same plan pay the same amounts.
That rule comes from 42 CFR 422.262, which says premiums and cost sharing may not vary among people enrolled in the same plan. By contrast, Medicare Supplement (Medigap) insurers in North Carolina and Tennessee are allowed to charge separate rates for people under 65, and South Carolina's under-65 guarantee runs only through a state pool with its own rates.
What you pay with a Medicare Advantage plan:
- The Part B premium still applies. You pay the monthly Part B premium and may also pay the plan's premium. The 2026 standard Part B premium is $202.90 a month. Some plans have no plan premium, and some help pay part of the Part B premium. See how the Part B premium works.
- Copays and coinsurance for care you use, which differ from plan to plan.
- A yearly out-of-pocket limit. Every plan must set a yearly maximum out-of-pocket amount for in-network care, no higher than the ceiling Medicare sets each year. Once you reach your plan's limit, you pay nothing more for covered services for the rest of the year. Original Medicare has no yearly limit unless you add other coverage.
- Drug costs, if the plan includes drug coverage. Your out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026 and $2,400 in 2027. After that, you pay nothing for covered Part D drugs for the rest of the year.
When can I join a Medicare Advantage plan on disability?
Your first chance is the 7-month window around your 25th month of disability benefits, the month Medicare starts. After that, you can make changes in set windows each year.
| Window | What you can do |
|---|---|
| Your first 7-month window (3 months before your 25th month of benefits, that month, and 3 months after) | Join a Medicare Advantage plan or a drug plan. If you join before Medicare starts, the plan starts the same day your Medicare does. If you join later in the window, it starts the first of the next month. |
| Your first 3 months with Part A and Part B | One change. If you joined a plan in your first window, you can switch to another Medicare Advantage plan or go back to Original Medicare once. |
| October 15 to December 7 each year | Open Enrollment. Join, switch or drop a Medicare Advantage plan, or move between Original Medicare and Medicare Advantage. Changes start January 1. |
| January 1 to March 31 each year | Medicare Advantage Open Enrollment (only if you're already in a plan). One change: another Medicare Advantage plan, or Original Medicare with a drug plan. |
| When certain life events happen | Special Enrollment Periods, for example when you move, lose or change other coverage, or get Medicaid or Extra Help. See Medicare Special Enrollment Periods. |
| Around your 65th birthday | A new 7-month window to join, switch or drop a Medicare Advantage or drug plan, even though you've had Medicare for years. |
We explain the two yearly windows side by side in Open Enrollment vs. Medicare Advantage Open Enrollment.
Medicare Advantage or Original Medicare: what's different under 65?
The choice is the same one everyone on Medicare makes, but under 65 the fallback options are narrower. Neither Advantage nor a Supplement is automatically the right answer.
With Original Medicare, you can use any doctor or hospital in the country that takes Medicare, and in most cases you don't need approval in advance. But after the Part B deductible you usually pay 20% of the cost with no yearly limit. People 65 and older can fill that gap with a Medicare Supplement. Under 65, whether you can buy one depends on your state, as the table further down shows.
With Medicare Advantage, you get a yearly out-of-pocket limit and, in most plans, drug coverage in one plan. In exchange, you may need to use the plan's doctors for non-emergency care, get a referral to see a specialist, or get approval before certain services. You also can't buy a Medicare Supplement to cover a Medicare Advantage plan's costs.
A Medicare Advantage plan must cover everything Original Medicare covers, and some plans add extras such as some vision, hearing or dental care. We compare the two paths in more depth in Medicare Advantage vs. Medicare Supplement.
What should I check before choosing a plan?
Check the plan against the care you actually use: your doctors, your prescriptions, and the services that need approval. When you live with a disability, these details can matter more than the premium.
- Every doctor, specialist, hospital and therapist. Ask each one whether they work with the plan you're considering. Medicare suggests asking your doctors and pharmacies directly.
- Every prescription, by name and dose, and the pharmacy you use. If the plan has drug coverage, you get your drugs through it. You generally can't add a separate drug plan on top of a Medicare Advantage plan.
- Which services need approval in advance. Think about therapy, equipment such as wheelchairs or oxygen, home health care, and specialist visits.
- Care you're in the middle of. If you're in an active course of treatment when you join, the plan must give you at least 90 days before it can ask for a new approval, and that includes people who are new to Medicare. An approval for a course of treatment must last as long as it's medically necessary.
- The yearly out-of-pocket limit and the copays for the services you use most often.
- Time away from home. If you spend part of the year in another state, check whether the plan covers you there.
- Other coverage you already have. If you have coverage from an employer or union, talk to that benefits office before you join or change anything. If you have Medicaid, see having both Medicare and Medicaid.
Our checklist for comparing Medicare Advantage plans walks through these questions one at a time.
What is a Special Needs Plan, and could I qualify?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan for people with Medicaid, certain serious chronic conditions, or who live in a facility such as a nursing home. Some people under 65 on disability qualify for one.
There are three types:
- Dual Eligible SNPs (D-SNPs) for people who have both Medicare and Medicaid.
- Chronic Condition SNPs (C-SNPs) for people with certain severe or disabling chronic conditions. A plan can focus on one condition or a group of related conditions.
- Institutional SNPs (I-SNPs) for people who live in a nursing home or similar facility, or who live at home but need that level of care.
Every SNP includes Medicare drug coverage and offers care coordination. You need Part A and Part B and must live in the plan's area. You can stay in an SNP only while you still meet its condition. If you no longer do, you may get a Special Enrollment Period to choose another plan. SNPs aren't offered everywhere, and what's available changes from year to year.
Can I switch back to Original Medicare later?
Yes, during the windows above. Getting a Medicare Supplement afterward is the harder part, and it depends on your state and your timing.
You can leave a Medicare Advantage plan for Original Medicare during Open Enrollment, Medicare Advantage Open Enrollment, or a Special Enrollment Period, and add a stand-alone drug plan. Whether you can also buy a Medicare Supplement without health questions depends on state rules. In Tennessee, for example, people under 65 get a 6-month Medicare Supplement window when their Medicare Advantage coverage is ended for a reason unrelated to their own conduct or nonpayment. That window is tied to coverage being ended, so leaving a plan by choice may not count. Ask before you switch, not after. Our page on switching from Medicare Advantage to Original Medicare covers the steps.
Turning 65 opens another door. Your Medigap Open Enrollment Period is the 6 months starting the first month you're 65 and enrolled in Part B. During it, an insurer can't turn you down or charge you more because of your health, even if you've had Part B for years. If you're in a Medicare Advantage plan at 65, your new 7-month window lets you move to Original Medicare.
How are the rules different in North Carolina, South Carolina and Tennessee?
Who can join Medicare Advantage is set by federal law, so it's the same in all three states. Federal Medicare Advantage standards override state law, apart from state licensing and solvency rules. What differs is the backup option, a Medicare Supplement, and how Medicare and Medicaid plans line up for people who have both.
| State | What differs |
|---|---|
| North Carolina | Medicare Supplement under 65: Plan A guaranteed, plus Plan D or G if the insurer sells them at 65, within 6 months of first enrolling in Part B. Integrated D-SNPs on CMS's 2026 list: none. |
| South Carolina | Medicare Supplement under 65: guaranteed only through the South Carolina Health Insurance Pool (SCHIP). Integrated D-SNPs on CMS's 2026 list: four. |
| Tennessee | Medicare Supplement under 65: the same plans sold at 65, including for ESRD, within 6 months of Part B and after certain coverage losses. Integrated D-SNPs on CMS's 2026 list: six, all fully integrated with TennCare. |
Mistakes we see people make
- Choosing on premium alone. A low premium doesn't help if your specialist doesn't work with the plan or your medication isn't covered.
- Not checking which services need approval before joining, especially therapy, equipment and home health care.
- Leaving a Medicare Supplement for Medicare Advantage without checking whether you could get the Supplement back under your state's rules.
- Letting the first 3 months pass without confirming the plan works for you.
- Skipping the review at 65, when the new enrollment window and Medigap Open Enrollment give you the most choices you'll have.
What to have ready before you talk to us
- Your Medicare card, or your Social Security award letter if the card hasn't arrived
- Every doctor, specialist, therapist and hospital you use, by name
- Every prescription, with the dose, and your pharmacy
- Any equipment, therapy or home health services you use or expect to need
- Any other coverage you have, such as Medicaid, Extra Help, or employer or union coverage
- Anyone who is helping you, so they can join the call
How The Jordan Insurance Agency helps
A licensed agent from The Jordan Insurance Agency will check your doctors, prescriptions and the services you rely on against your options, explain how Medicare Advantage and Original Medicare compare for your situation, and map the windows that apply to you, including at 65. We work by phone, by video, or in person at our office at 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, Monday through Friday, 9 to 5 Eastern, at no cost to you. Call (704) 926-7565 or use the button below to schedule a Medicare review. You can also read more on our Medicare page or browse our Medicare questions answered.
Frequently asked questions
Can a Medicare Advantage plan charge me more because I'm on disability?
No. A plan must charge the same premium and the same cost sharing to everyone enrolled in it, and it can't deny or limit coverage because of a disability or health condition.
Do I still pay the Part B premium if I join a Medicare Advantage plan?
Yes. You keep paying the Part B premium (the 2026 standard amount is $202.90 a month), plus the plan's premium if it has one. Some plans help pay part of the Part B premium.
Can I join a Medicare Advantage plan if I have kidney failure?
Yes. Since January 1, 2021, people with End-Stage Renal Disease can join a Medicare Advantage plan once they have Part A and Part B, like anyone else.
What happens to my treatment if I switch to a Medicare Advantage plan?
If you're in an active course of treatment when you join, the plan must give you at least 90 days before it can require a new approval for that treatment. That includes people who are new to Medicare.
What happens to my Medicare Advantage plan when I turn 65?
You can keep it. Turning 65 also gives you a new 7-month window to switch or drop it, and a 6-month Medigap Open Enrollment Period if you want to move to Original Medicare with a Supplement.
Reviewed and approved by Billy Jordan, Jr., licensed agent and President of The Jordan Insurance Agency.
Last reviewed: October 2026
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