Choosing the Medicare Coverage That Best Suits Your Needs - PIH Health

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Published on October 17, 2016

Choosing the Medicare Coverage That Best Suits Your Needs

Medicare recipient

As fall approaches, many of us have the opportunity to review our health insurance needs. For those eligible for Medicare, the annual election period, (AEP), begins October 15, 2016 and ends December 7, 2016. During this time, all Medicare recipients have the option to review their current Medicare coverage, make updates, or choose a new plan.

Staying with your current Medicare plan may be sufficient, however it may not be the best choice since Medicare alone does not cover all healthcare needs; and out-of-pocket costs can be expensive. You may also want to select a new type of Medicare coverage. There are two types of Medicare plans available: Medicare Advantage Plans and Medicare Supplement Plan.

Medicare Advantage Plans

These plans can save you money over time, and provide extra benefits such as transportation, chiropractic and discounts on medications. You will choose a primary care physician (PCP) to manage your care, and will pay a small, set amount of copayments for most doctors’ visits. All specialists and hospitals are contracted by the health plans, and your care is provided within a network of providers. Visits to specialists must be referred by your PCP.

A Medicare Supplement Plan

This plan is also known as Medigap, meaning it covers the benefit gaps left by Medicare. The plan may assist in paying Medicare deductibles and co-insurance costs, and provide benefits not covered by Medicare. You can purchase a supplemental plan by paying an additional monthly premium. There is no network of providers and you can visit any doctor who accepts Medicare.

Below is a side-by-side comparison between Medicare Advantage and a Medicare Supplemental Plan (Medigap):


Medicare Advantage Plan

Medicare Supplemental Plan

Monthly Premium

Low monthly premium, as low as $0

Monthly premiums that typically range from $95-$185


Closed network of contracted specialists and hospitals

Open to all doctors and hospitals that accept Medicare

Office Visits

Set copayments, as low as $0 with max out-of-pocket expenses ranging from $3K-$7K

Some plans cover balance of fees not paid by Medicare

Issuing Process

Guaranteed to all Medicare recipients, with the exclusion of those who have end stage renal disease (kidney failure)

Underwriting process (some exclusion, including when first turning 65)

Enrollment Period

Annual election period (AEP): 10/15-12/7

Open enrollment periods: 1/1-2/14

Lock-in periods: 2/15-12/31

Open enrollment throughout the year without restrictions


Same within the service area (usually by county)

Based on age, sex and tobacco usage

At PIH Health, we value our Medicare patients and are here to ensure that you have access to PIH Health hospitals and physicians. We encourage you to contact us by phone at 1.866.365.4450 or visit us online at

The information in Healthy Living Online is for educational purposes only.  It is not intended nor implied to be a substitute for professional medical advice.  The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan.

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