Can You Be Denied a Medicare Advantage Plan?

Question

Lori Marion` · Accepted Answer

As long as you apply for a plan during a valid election period and you meet the eligibility requirements, you can't be denied. 
To qualify for a Medicare Advantage plan,  you must have both part A and part B of Medicare. Some plans have additional requirements such as plans designed for people who have a chronic condition such as diabetes or heart conditions. There are also plans designed specifically for people who also have Medicaid and may contain additional requirements that look into the level of Medicaid or state wavers. It's always best to work with an experienced agent to help guide you through the process of choosing and enrolling into a plan.

Michael Andrews · Answer

So the question is, can you be denied a Medicare Advantage plan? I'm assuming this question is asking, can you be denied from enrolling into a Medicare Advantage plan? The short answer to that is no. However, you do need to qualify.

Most Medicare Advantage plans are available to anybody that is eligible for Medicare. However, there are certain plans, such as Dual Special Needs Plans, that are typically for people that have a lower income and are on Medicare. There are also plans known as Chronic Special Needs Plans for individuals that have specific chronic health conditions.

All those plans vary depending on where you live, depending on the state you live in, and even down to the zip code of the house.

Kathie Rossow · Answer

If this person has both Medicare Parts A & B, that is one qualification.  
Then they need to be living in the service area of the plan they want to join.
Must be a U.S. citizen,  or lawfully present in a way that qualifies them for Medicare.
They also need a valid enrollment period, unless they qualify for a Special Enrollment Period.
They don't need to be concerned about qualifying  medically, as there are no medical questions

Daniel Olofsson · Answer

Generally, if you're eligible for and have Original Medicare (Part A and Part B), you can't be denied enrollment into a Medicare Advantage plan, as long as you live in your chosen plan's service area.

Before deciding upon a plan, make sure your Doctors and Hospitals are in Network and your prescriptions are in the formulary.

Medicare Advantage plans can be full of extra benefits like prescription drug coverage, dental, hearing, and vision coverage. Another advantage of a Medicare Advantage plan is a mandatory out-of-pocket maximum---They basically come in two flavors---a PPO and an HMO.

Again, You are eligible for a Medicare Advantage plan if you have Original Medicare (Part A and Part B). Even those on Medicare under 65 due to disability may enroll. You may sign up for a Medicare Advantage policy if you live in your chosen plan's service area.

Pauline Weiland · Answer

Assuming you have Medicare Part A and Part B, an Advantage plan cannot discriminate for any reason. You are not automatically eligible for all Advantage plans. Some plans require you have your state Medicaid or a Doctor verification form of certain kinds of chronic conditions. Also if you have a State drug plan or VA, you can get the Advantage coverage with no Rx included. It's helpful to speak to a local agent representing multiple companies to best know your situation.

Answered by Pauline Weiland on April 13, 2026

Agent Licensed in AZ, CA, MS, NV & TX

Answered by Pauline Weiland Medicare Insurance Agent

Ashley King · Answer

Enrollment in a Medicare Advantage Plan may be denied if the beneficiary does not live in the plan service area, don't have both Parts A and B, or don't meet Medicaid level requirements for certain plans.

Answered by Ashley King on April 13, 2026

Broker Licensed in MD, AL, AR & 9 other states

Answered by Ashley King Medicare Insurance Agent

Charles Calvin · Answer

You cannot be denied a Medicare Advantage plan based on your health. However, you do have to have a valid enrollment/election period to be able to enroll, as well as having both Parts A & B of Medicare.

Answered by Charles Calvin on April 13, 2026

Broker Licensed in MO, FL, IA & IL, KY, NE & SC

Answered by Charles Calvin Medicare Insurance Agent

Kelsey Hentzen · Answer

You cannot be denied for health to enroll in a Medicare Advantage plan. However, the insurance companies may require prior authorizations from the doctor before approving certain services. Additionally, certain advantage plans require chronic conditions to be enrolled such as CSNP (Chronic Special Needs Plans) or DSNP (Dual Special Needs Plans) that combine Medicare and Medicaid.

Answered by Kelsey Hentzen on July 28, 2026

Broker Licensed in KS & MO

Answered by Kelsey Hentzen Medicare Insurance Agent

Brooke Smith · Answer

Medicare Advantage Plans do not deny applicants due to pre-existing conditions. As long as you live within the plan's service area and you are enrolled in Orginal Medicare Parts A and B, you shouldn't run into any problems.

Answered by Brooke Smith on April 13, 2026

Agent Licensed in UT, CA, ID, NV, OR & WY

Answered by Brooke Smith Medicare Insurance Agent

Edward MacConnell · Answer

Yes you can be denied a Medicare Advantage plan if you do not have a valid election period or you do not live in the advantage plans geographic area.

Destin Marks · Answer

As long as you qualify or currently receive medicare part a and b as well as have a special enrollment period you can not be denied for any any health conditions to be approved for coverage.

Carly Cusack · Answer

If you have effective Part A and Part B coverage and you pay all your premiums, you can't be denied a Medicare Advantage Plan.

Rodolfo Rojas · Answer

You can't be denied Medicare Advantage as long as you have part A and Part B, which is original Medicare.

Michael Eiseman · Answer

Yes. If a client falsified information on an application. If they are outside of eligibility standards.

JP Richardson · Answer

The question is can you be denied coverage in a Medicare Advantage plan?

Medicare Advantage plans are funded in part by CMS, or Centers for Medicare and Medicaid Services. So because of that, as long as you have your Part

Daniel Brechin · Answer

There are times you cannot change plans, if you have an enrollment period, you should be able to do that..

Daniel Brechin 
Contact me.

Voss Speros · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/can-you-be-denied-a-medicare-advantage-plan#voss-speros