Medicare Advantage Plans in Tennessee

Medicare Advantage plans provide seniors and other Tennessee residents with affordable and comprehensive health insurance. Also known as Medicare Part C, these plans include the same coverage as Original Medicare Parts A and B, and often include additional coverage for health care services that aren’t covered by Original Medicare, such as vision and dental care. Some Medicare Part C plans also include prescription drug coverage. 

Private insurance companies throughout Tennessee administer Medicare Advantage Plans. These companies collect premiums from plan participants and are paid by Medicare for services that fall under Medicare Parts A and B. Seniors who receive Social Security benefits may have part of their premiums deducted from their benefit payments.

According to the Kaiser Family Foundation, 34% of U.S. Medicare beneficiaries are participating in a Medicare Advantage plan. In Tennessee, this enrollment rate is even higher at 37%. In surrounding states, enrollment rates are fairly similar. While Kentucky’s rate is slightly lower at 31%, the enrollment rate in Alabama is a little higher at 39%.

In Tennessee, there are several options when it comes to Medicare Advantage plans. Seniors in the state can choose from HMOs, PFFSs, PPOs and SNPs. Additionally, while some of these plans may include limited prescription drug coverage, seniors may want to include Medicare Part D in their Medicare Advantage plan, which exclusively covers the cost of prescription medications. In the information that follows, we’ve included information about each of the Medicare Advantage plans that are available in Tennessee, as well as several resources in the state that can help seniors navigate the ins and outs of these complicated policies.

About Medicare Advantage Plans in Tennessee

Types of Medicare Advantage Plans

In Tennessee, there are several types of Medicare Advantage plans available to seniors. These include Health Maintenance Organizations (HMOs), Private Fee-For-Service plans (PFFS), Preferred Provider Organizations (PPOs) and Special Needs Plans (SNPs). Plans may vary in terms, price and coverage inclusions depending on the provider. Additionally, all plans from all providers may not be available throughout the state.

Health Maintenance Organizations (HMOs)

HMOs generally cost less than other types of Medicare Advantage plans, but they’re also far more restrictive. When participating in an HMO plan, seniors are required to elect a primary care physician from within their insurance company’s network. This physician is responsible for overseeing all patient care and must provide referrals in the event that a specialist is required. Treatment must be provided by in-network or referred practitioners. Patients who seek care outside of this network may be responsible for paying the full cost out of pocket.

Private Fee-for-Service Plans (PFFS)

PFFS plans offer the most flexibility compared to other Medicare Advantage plans. When enrolled in a PFFS, patients may seek care from any health care practitioner they wish. Their insurance company will pay a predetermined fee for the service or treatment provided, leaving the patient to pay any remaining charge. The fee for each service varies depending on the insurance provider. It’s important for enrollees to ensure the health care practitioner they receive care from will accept their coverage, as some providers may not accept PFFS plans.

Preferred Provider Organizations (PPOs)

Just as with an HMO, PPOs have specific provider networks that insurance companies prefer to work with. However, these plans combine this policy with the flexibility of PFFPs, allowing patients to seek care from any health care provider they wish. By seeking care within the network, plan participants pay lower co-pays. If a plan member wishes to receive care from an outside provider, their coverage amounts are reduced and they will have a higher co-pay amount. The monthly premiums charged by PPOs are usually higher than those of HMOs.

Special Needs Plans (SNPs)

SNPs are designed to meet the health care needs of certain groups of people, such as those who are eligible for both Medicare and Medicaid or have chronic diseases or illnesses like end-stage renal failure, cancer or autoimmune disorders. These plans tailor the services they cover and the providers they work with to deliver care targeted to their group’s condition or situation.  SNPs are required to include prescription drug coverage, and enrollment is restricted to individuals who qualify to be part of the group the plan serves.

Enrollment and Eligibility for Medicare Advantage in Tennessee

Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.

Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:

• Initial Coverage Election Period: This is the 7-month period during which everyone is eligible to enroll in a Medicare Advantage plan. The period spans from 3 months before the month of one’s 65th birthday to 3 months after one’s birthday month.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, the AEP runs from October 15-December 7 each year. During this period, anyone can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: From January 1-March 31 each year, anyone who is already enrolled in Medicare Advantage can switch to a different plan, or disenroll and switch back to Original Medicare. This period is not open to anyone who is not currently enrolled in Medicare Advantage.
• General Enrollment Period: In some circumstances, one can join Medicare Advantage between April 1-June 30. This enrollment period only applies to those who enrolled in Medicare Part B for the first time during Medicare’s Open Enrollment Period (January 1-March 31).

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

Prescription Drug Coverage

Depending on the plan and the insurance provider, some Medicare Advantage plans may cover the cost of prescription medications. When shopping for a plan, it’s important that seniors understand whether or not this coverage is included. In some cases, those who don’t have prescription drug coverage may want to enroll in Medicare Part D, which covers the cost of prescription medications. Medicare Part D premiums vary depending on the provider and the level of coverage obtained.

In Tennessee, Part D can be combined with Medicare Advantage in cases where the beneficiary’s plan does not include drug coverage. However, most Medicare Advantage plans that do include drug coverage cannot be combined with Part D. Beneficiaries who have a Medicare Advantage plan with prescription drug benefits risk being disenrolled from their MA plan if they obtain Medicare Part D benefits, as well.

Getting Help with Medicare Advantage in Tennessee

Medicare Advantage plans can be confusing for many enrollees. There is often a plethora of different providers available, each offering different plans at different prices. For many seniors, it can be helpful to have someone who understands the ins and outs of Medicare to provide assistance in choosing a plan. Below, we’ve listed several state and local resources throughout Tennessee that offer such assistance, as well as help with insurance claims, appeals and complaints.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources