Medicare Advantage

What it means

A Medicare Advantage plan replaces Original Medicare as the way benefits are received. The plan must cover what Parts A and B cover, and usually adds drug coverage and extras.

In exchange, care is generally delivered through the plan's own network, and services may need prior authorization.

It is not additional coverage on top of Original Medicare. Medigap, which is, cannot be used with it.

Why it matters

Which kind of Medicare somebody has changes who to call, which providers can be used, and what happens when care is needed away from home. After a death it also changes who has to be notified.

The choice is revisited each year during open enrollment, and moving back from Advantage to Original Medicare with a Medigap policy is not always straightforward later.

When you are likely to meet it

• When helping a parent review coverage.
• When a provider is out of network.
• When notifying insurers after a death.

Related terms

• Creditable coverageDrug coverage at least as good as Medicare's — losing it involuntarily opens a window to enroll.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• MedicareThe federal health insurance program for people aged sixty-five and over, and for some younger people with disabilities. It does not pay for long-term care.
• Medicare Part DMedicare's prescription drug coverage, bought as a separate plan from a private insurer.
• MedigapA private policy that pays some of what Original Medicare leaves the patient to pay. It cannot be combined with a Medicare Advantage plan.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Service areaThe geographic area a Medicare Advantage plan is sold for — and outside which a person may not stay enrolled.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.
• Special enrollment periodA window outside the annual one in which Medicare coverage can be changed, opened by a named life event.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — joining a plan (opens in a new tab)

Sahvelo guidance that uses this

• Medicare
• Health insurance after a death