Around 1,409,142 Tennessee residents were enrolled in Medicare as of December 2021. This number includes both Original Medicare and Medicare Advantage enrollees. 84% of Medicare recipients in Tennessee qualify because of their age, while 16% qualify because of a disability.
In 2016, Tennessee had one of the highest enrollments for people qualifying due to a disability among all states in the country. This explains why Tennessee has a larger percentage of Medicare recipients who qualify due to a disability than the rest of the country. Considering how enrollment for seniors and those with disabilities is on the rise and the various Medicare plans on the market, it is important to compare your options carefully.
Keep reading to find out more about different Medicare plans in Tennessee and learn why you need the services of a licensed Medicare insurance agent.
Medicare Options in Tennessee
Once a person reaches the Medicare eligibility age of 65, they are automatically registered in the original Medicare program. Parts A and B of Original Medicare are the federally funded health insurance program for the elderly and disabled. It takes care of all your fundamental medical expenses.
Part A covers hospital care. All hospitalizations, rehabilitation stays, and certain home healthcare fall under this category. Part B includes preventative care like checkups and immunizations, diagnostic procedures like X-rays and blood tests, long-term care like hospitalizations and oxygen tanks, and emergency services like ambulance rides.
Medicare Supplement (Medigap) Plans in Tennessee
Medicare Supplement or Medigap plans in Tennessee are supplementary insurance that can be purchased by Medicare beneficiaries to pay for medical expenses not covered by Original Medicare. The federal government regulates the Medigap insurance market and provides a standard enrollment period of six months.
During this window, applicants are guaranteed coverage regardless of their health status, and their premiums cannot be based on their age or gender. However, if you are under 65 and qualify for Medicare due to a disability, you are not guaranteed access to a Medigap plan under federal guidelines.
Like many states in the US, Tennessee has enacted regulations to make Medigap policies available to those under the age of 65. According to a law passed in 2011, Medicare providers in Tennessee who sell Medigap policies to retirees aged 65+ are required to provide the same policies to those under the age of 65 who qualify for Medicare due to a disability.
Medicare Supplement Insurance (Medigap) enrollment for disabled Tennessee residents is open for the same six-month period as it is for the state’s senior citizens. A person is eligible for guaranteed issue coverage for the first six months after enrolling in Medicare Part B.
There are 12 Medigap plans to choose from in Tennessee. Each plan has a slightly different price and level of coverage. The following are the most popular options in Tennessee:
Outpatient prescription medicines are not covered under Original Medicare. Medicare recipients, however, have options for prescription drug coverage, including Medicare Advantage, employer-sponsored plans, and standalone Part D plans.
By the end of 2021, 481,309 Tennesseans receiving Medicare were enrolled in independent Part D plans. On the other hand, 611,660 Medicare beneficiaries chose Medicare Advantage plans that included prescription drug coverage.
Prior to 2018, more Tennesseans had enrolled in Medicare Part D standalone plans than in Medicare Advantage plans that included Part D coverage. Due to the rising popularity of Medicare Advantage, however, fewer people are signing up for separate standalone Part D plans, and more people are signing up for Advantage plans that incorporate Part D coverage.
In 2022, Tennesseans can choose from 26 different standalone Part D plans with monthly premiums anywhere between $6 to $150.
As soon as a person becomes eligible for Medicare, they can register for Medicare Part D. Beneficiaries can make adjustments to their Part D coverage every year between October 15th and December 7th. Any adjustments made during that time frame will apply the following January. It is important to consider that Medicare Part D plans evolve every year and that everyone’s drug needs fluctuate.
Medicare Advantage Plans in Tennessee
Medicare Supplements plans in Tennessee provide the most comprehensive coverage, but many beneficiaries can also opt for Medicare Advantage or Part C Plans. Medicare Advantage plans are provided by private companies that contract with Medicare and offer the same coverage as Original Medicare.
Different Advantage plans may have vastly different out-of-pocket costs since they determine their own coinsurance, copayment, and deductible amounts. Many Medicare Advantage plans also cover prescription medicines through Medicare Part D and may provide other benefits like dental and vision care.
Many Medicare plans don’t pay for medical like hospital stays, checkups, lab work, supplies, etc., so you have to bear these expenses yourself. To keep these costs low, make sure your doctor is in the plan’s network before enrolling.
Around 46% of Medicare beneficiaries in Tennessee were enrolled in Medicare Advantage plans by the end of 2021. This is consistent with the nationwide increase in the number of people enrolled in Medicare Advantage plans. Nearly 44% of Medicare recipients were enrolled in private plans during that time, with Medicare Advantage plans accounting for a majority of those enrollments.
There are four types of Medicare Advantage plans in Tennessee:
Health Maintenance Organization (HMO)
Most HMOs mandate that you use only in-network providers for all healthcare services:
- You must have a PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions.
- Plans typically provide drug coverage. You can’t purchase separate drug coverage.
- Staying within your network keeps costs low.
Preferred Provider Organization (PPO)
Medicare PPO plans have a recommended network of providers, but you can also choose doctors or hospitals outside the network for a higher price.
- You don’t need to have a PCP or referrals for specialists.
- Most plans provide drug coverage.
- Drug coverage cannot be purchased separately.
- Out-of-network charges and higher premiums.
Private Fee-For-Service (PFFS)
PCPs and specialist referrals aren’t necessary under PFFS programs:
- You can consult any Medicare-approved doctor or healthcare facility, provided that they agree to the plan’s terms.
- Drug coverage may be included, or you can purchase a separate drug plan.
- You’ll pay more if you go with a provider who doesn’t agree with the rules of your insurance plan.
Special Needs Plan (SNP)
SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:
- You require a PCP and recommendations for specialists.
- Plans always include prescription coverage.
- SNPs are open to everyone who meets the eligibility criteria at any point in time.
Comparing Medicare Advantage Plans in Tennessee
Medicare Advantage plan availability in Tennessee varies by county, but the market is healthy statewide. To get coverage in 2022, you can choose from 33 different Medicare Part C plans in Lake County or 59 options in Davidson County.
With all the options on the market, you need to make sure you’re picking a plan that fits your individual requirements and budget. Here are some factors to consider while weighing your options:
Since each Medicare Advantage plan has its own set of providers, you might have to stick to a much smaller geographic area. If the size of the provider network is a problem, or if you plan to travel a lot within the US during retirement, consider getting Original Medicare with a Medigap plan and Part D coverage.
However, if you already have a provider in mind, it is important to research all of your options before deciding on coverage. Some doctors are contracted with Medicare Advantage plans but aren’t part of the Original Medicare network.
Amount of Coverage Required
Are you looking for plans with perks like health care, retirement plans, and gym memberships? Medicare Advantage plans often include these, but Medigap plans don’t. Your Medicare insurance agent will help you find and compare plans based on the benefits you want.
Check Plan Ratings
Make sure you compare Part c and Part plans before open the enrollment period begins on the CMS website. The plans are rated on a scale of 1 to 5 (5 being the highest).
Out-of-pocket expenses include deductibles, copayments, and coinsurance that you pay yourself. You can keep these costs at a minimum by sticking to a provider network. Enrollees can use our plan finder tool to learn more about the expenses they’ll incur on different plans.
Since you’re already paying Part B deductibles, your Medicare Advantage or Supplement plan premiums add to your monthly cash flow. You’re responsible for these expenses whether you use your benefits or not. To keep your costs low, it is important to have at least one zero-premium plan with affordable drug coverage in your area.
If you’re interested in prescription coverage, consider Part C plans. Medicare Advantage plans often include integrated Part D coverage, which pays for your prescription drugs. If you choose Original Medicare and a Medigap policy, you’ll also need to enroll in a Medicare Part D plan to cover your prescription drug costs.
Deductibles, Coinsurance & Copays
You will be paying these expenses when you start using your Medicare insurance benefits. So, you need to be aware of your plan’s hospital and medical coverage. This includes hospital stays, medication, and other medical expenses.
Freedom to Travel
Unlike the limited coverage for international travel provided by Original Medicare, most Medigap policies do include some coverage for international travel. Medicare Advantage programs may extend coverage for travel abroad beyond what is available under Original Medicare, but unlike Medigap policies, Medicare Advantage plans vary across providers. Before signing up, make sure you understand the plan’s terms on international travel.
Medicare Eligibility in Tennessee
Medicare enrollment is open to Tennessee residents over the age of 65. Patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), can also enroll for Medicare at any point in their lives.
Medicare Enrollment in Tennessee
Once you have received at least four Social Security or Railroad Retirement Board payments before your 65th birthday, Medicare will enroll you automatically. Otherwise, you can reach out to your local Social Security Office or apply online. We recommend you avoid mailing your application since that could take a few days to reach the office and even more time to process.
Enrollment in Medicare is open during the following time frames:
The initial enrollment period begins three months prior to your 65th birthday to the third month after it. People who have never had Medicare before should sign up during this period. If you started receiving Medicare benefits at a younger age, you could also adjust or upgrade your current plan.
Enrollment is open again from January 1st to March 31st for individuals who missed the initial period. During this timeframe, you can sign up for Original Medicare (Parts A and B), Medicare Advantage (Part C), a Medigap policy, or Medicare Part D.
You get a 3-month window from October 15th to December 7th each year, during which you can make changes to your Part C plan.
You might be granted a special enrollment window in case your coverage or eligibility changes due to unforeseen circumstances, like losing a job or relocating to an out-of-coverage area.
Why Choose Medicare Hope Insurance at Integrity Now Insurance Brokers?
The Medicare insurance agents at Integrity Now Insurance Brokers are required to renew their accreditation with AHIP every year. We are qualified to handle all of your Medicare Insurance concerns. We help people of all ages who are struggling to pay for necessary medical treatment, including the elderly and disabled youth.
Medicare insurance options continue to expand each year with the introduction of new companies and plans. Existing plans may also undergo modifications and updates. You don’t need to worry about keeping track of these changes – that’s what we’re here for.
You can discuss your healthcare and financial requirements with one of our licensed Medicare insurance agents in Tennessee, and they will help you compare your options. They’ll help you compare quotes and decide whether you would be better off with a Medicare Advantage Plan or a Medicare Supplement Plan. We offer all the knowledge you require to begin living debt- and stress-free.
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