Medicare in Tennessee

Medicare is the federal health insurance program that covers seniors over the age of 65 and adults with qualifying disabilities in America. There are almost 1.4 million  Tennessee residents enrolled in Medicare in 2022, up from just over 1 million in 2010. Medicare Advantage plans are becoming much more popular, and enrollment in these plans has doubled over the last decade. 

Original Medicare has several components. Part A is offered for free as long as enrollees contributed enough to Medicare through payroll taxes during their lifetimes. It covers emergency medical services and inpatient care, skilled nursing care, hospice care and home health services. Part B costs $170.10 in 2022 and covers preventative care, diagnostic testing, outpatient procedures, medical transportation and approved medical supplies and equipment. 

The Medicare Advantage program is also known widely as Medicare Part C. It offers enrollees the opportunity to select a private health insurance policy instead of traditional benefits. All Advantage plans provide the same coverage as Parts A and B, with the exception of hospice care (covered under Part A), but allow enrollees to customize their coverage with add-on services such as dental and vision coverage, prescription drug plans and savings programs. 

Medicare Part D covers prescription medications, and Medicare enrollees may choose a Part D plan if they’re enrolled in Original Medicare. Most Advantage plans include prescription drug coverage. Premiums vary based on coverage level. A Medicare Supplement plan helps retirees further reduce their medical expenses by covering out-of-pocket costs, such as deductibles and coinsurance.

This guide reviews Medicare in Tennessee and provides an overview of all the options available for residents over the age of 65 when it comes to obtaining health coverage. It also reviews the resources available to seniors who need help understanding their benefits and selecting a plan that works for them. 

Options for Medicare Coverage in Tennessee

Original Medicare provides basic coverage that’s not always suitable for seniors who need more comprehensive insurance. Tennessee residents have access to the Original Medicare program as well as many insurance plans administered by private insurance companies. Seniors can customize their coverage as they see fit using the original program or available private options. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage gives seniors an alternative to traditional Medicare coverage. Advantage plans are sold and administered through private insurance companies, and enrollees receive a federal subsidy to reduce their monthly premiums. Private insurers that sell Advantage plans are required to provide the same coverage offered through Parts A and B, aside from hospice care which remains covered under Medicare Part A. Medicare Advantage plans usually offer extra coverage options, such as dental and vision care, prescription drug coverage and discount programs for gyms and other wellness services. 

There are four types of Medicare Advantage plans available. These are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plans (SNP). Each plan may have different eligibility regulations, premiums, copayments, network providers and rules for seeing specialists. Medicare Advantage plans have annual out-of-pocket maximums, so seniors have a bit more control over their expenses. 

Who Should Consider Medicare Advantage

A Medicare Advantage plan is best for people who:

• Would like coverage for vision or dental care

• Are generally healthy and want lower premiums

• Need more control over out-of-pocket expenses

The Top 10 Medicare Advantage Plans in Tennessee

Seniors in Tennessee have a growing number of Advantage plans to choose from. The following table reviews the most popular insurers in the state by enrollment numbers, plan costs as of April 2022 and the types of plans available. More information is available on the Medicare Advantage plans in Tennessee page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later. Most Advantage Plans cover prescription drugs, and therefore seniors enrolled in these plans do not need enrolment in a separate Plan D. 

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Tennessee

Enrolling in Medicare can be confusing and frustrating, especially when seniors have so many insurance plans to choose from to meet their needs. Tennessee residents have access to several programs and resources to help them review insurance plans, understand their benefits, apply for financial aid, learn how to protect themselves against fraud and file complaints against abusive health care providers. The following resources can help seniors get started with the Medicare enrollment process.