No. Medicare Part D prescription drug plans and Medicare Advantage plans are
“guaranteed issue” to all people living within the plan’s service area - with only very limited exceptions (such as Special Needs Plans).
And since 2021, guaranteed issue rights are extended to people with End-Stage Renal Disease (ESRD) who wish to join a Medicare Advantage plan. (However, Medicare Advantage Special Needs Plans for dual-eligible people (D-SNPs) may still be allowed to exclude people with ESRD).
The Exception to Guaranteed Issue Rights: Medicare Advantage Special Needs Plans (SNPs)
If you apply for a Medicare Advantage
Special Needs Plan (SNP), you must meet the "
need" addressed by the plan (specific chronic condition(s) or financial need or residence in a long-term care facility). For example, if you join a SNP designed for people with Diabetes - you must be diabetic. If you are currently enrolled in a Medicare Advantage Special Needs Plan and you no longer meet the "need" requirement, you will be granted a
Special Enrollment Period (SEP) to enroll in a different Medicare Advantage plan.
More about the exception to Dual- Eligible Medicare Advantage plan Special Needs Plan (D-SNP) guaranteed issue rights
As noted above, some Medicare Advantage SNPS are designed to work with the state Medicaid program and provide benefits for Dual-Eligible Medicaid/Medicare beneficiaries (D-SNPs) and these D-SNPs can deny enrollment to anyone suffering from ESRD - even though,
since 2021, a person can join any Medicare Advantage plan even though they have ESRD.
As the Centers for Medicare and Medicaid noted in the regulations dealing with ESRD Medicare Advantage plan enrollment: "States already have the ability in their state Medicaid agency contract with each D–SNP to restrict which dually-eligible individuals may enroll in the D–SNP. If the state’s contract with a D–SNP excludes those with ESRD, the D–SNP may retain that exclusion in order to comply with the state contract required under § 422.107." (https://www.govinfo.gov/content/pkg/FR-2020-06-02/pdf/2020-11342.pdf)
Related Question: Can a
Medicare Advantage plan deny me coverage because of my health or pre-existing
conditions?
No – with a few exceptions. In general, Medicare Advantage
plans
no longer ask any health-related questions.In order to join a Medicare Advantage plan, a
Medicare beneficiary must only reside in the Medicare Advantage plan’s service
area (county or ZIP code) and have both Medicare Part A and Part B coverage. The exceptions:Medicare
Advantage
Special Needs Plans are designed for people with a specific chronic
illness (C-SNPs). C-SNPs can ensure that
plan members suffer from the specific chronic condition for which the plan is
designed (such as, diabetes, chronic heart failure, kidney failure or End-Stage
Renal Disease (ESRD), HIV/AIDS, or dementia).
Historical note about ESRD and Medicare Advantage plan coverage:
From 2006 to 2020, a Medicare beneficiary was not allowed to enroll in a Medicare Advantage
plan (
MA or MAPD) if they suffered from kidney failure or End-Stage Renal Disease (or ESRD) - that
ESRD rule was changed in 2021.
As was true before 2021, if you are already a member of a Medicare
Advantage plan and then suffer End-Stage Renal Disease (ESRD), your Medicare
Advantage plan cannot end your plan coverage based on this medical condition.