Medicare Advantage Plans in Tennessee
Key Takeaways
- Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). substitutes for Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). , offering the same Part A and B benefits.
- Medicare Part C plans often bundle additional services like dental, hearing, vision, and prescription drug (Part D) coverage.
- There are opportunities every year to sign up for Medicare Advantage, starting when you’ve first enrolled in Medicare.
- Some Medicare Advantage plans feature $0 monthly premiums, but make sure to choose a plan that provides the benefits you need.
If you’re a Medicare-eligible resident in Tennessee, you have access to at least one Medicare Advantage (Part C) plan. If you or a loved one is considering some of the 123 plans that are available in the state as of 2024, there are some crucial details you’ll want to know. We’ll help you learn what Medicare Advantage is, what it does, and how much you may need to pay.
Here’s GoHealth’s guide to Medicare Advantage (Part C) in Tennessee.
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Tennessee Medicare Advantage Plan Coverage
Original Medicare consists of Part A (hospital/inpatient coverage) and Part B (medical coverage). Original Medicare beneficiaries must add standalone Medicare Part D coverage to cover prescription drugs.
Medicare Advantage (Part C) plans are sold by private insurers and provide Medicare Part A and B coverage. Most also incorporate Part D coverage. Many Part C policies also provide additional coverage options such as dental, hearing, and vision benefits.
The availability of specific Medicare Advantage plans depends on your ZIP code, but every eligible person in Tennessee has access to at least one plan.
Medicare Advantage plans typically require you to see doctors and providers within a provider network to take full advantage of your benefits. These are a group of Medicare-approved medical professionals in an area that have signed a contract to treat an insurance company’s customers. Your provider network is generally based on where you live.
How you interact with your provider network depends on the type of plan you have. Two common types of Medicare Advantage plans in Tennessee are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
With an HMO you will have a primary care physician (PCP) to manage your care. If you need to see a specialist, your PCP will refer you to certain medical providers and medical facilities that have been designated as “in-network.” With an HMO, you will usually need to see in-network providers for your plan to cover the visits.
A PPO is another Medicare Advantage option in Tennessee. PPOs tend to be slightly different from HMOs in that they still use primary care physicians and provider networks, but PPOs typically allow more freedom to see out-of-network providers. However, you will experience the greatest cost savings when you see in-network providers.
What is the Medicare Star Ratings system?
Medicare assigns star ratings to its Medicare Advantage plans. These stars range from one to five stars, with five stars being the highest. These star ratings take multiple factors into account, including participants’ satisfaction with the plan.
If you are comparing plans, the Medicare star rating system is one method that can help you determine the best plan for you. However, you should take into account costs and coverage in addition to star ratings.
TN Medicare Advantage Plan Costs
When you choose a Medicare Advantage plan in Tennessee, you will often still pay your monthly Part B premium. The Medicare Part B premium is income-based; in 2024, most people pay the standard monthly premium of $174.70. If you or your spouse worked and paid Medicare taxes for at least 10 years, you probably won’t have to pay a premium for Part A.
The average monthly premium that Tennesseans pay in 2024 for Medicare Advantage in is $18.29. However, everyone in the state has access to $0 premium plans. This means you will not pay any additional premium beyond your Part B premium to have a Medicare Advantage plan. While this may seem like a great deal, it’s important to find a plan that meets your needs. If you choose a Part C plan with a $0 premium but still need to purchase other coverages to meet your needs, you may not be getting the value you had hoped for.
You must also consider copayments, coinsurance, deductibles, and out-of-pocket limits. Unlike Original Medicare, Medicare Advantage plans generally have an out-of-pocket maximum; once you pay the limit for Medicare expenses, your plan will pay 100 percent of the remaining costs for the rest of the plan year. Taking all of these costs into account when shopping for Medicare Advantage plans in Tennessee will help you find a plan that’s right for your budget.
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Medicare Advantage Plan Eligibility and Enrollment in Tennessee
Medicare eligibility starts with being a U.S. citizen or legal resident. From there, most people will first qualify for Medicare Advantage when they turn 65. To sign up, you must be enrolled in Original Medicare (Parts A and B). Your first chance to enroll due to age is during your Initial Enrollment Period (IEP) — this includes the month you turn 65, plus three months before and after. Once you’re enrolled in Parts A and B, you can switch to Medicare Advantage.
However, some people qualify for Medicare Advantage based on medical conditions. These may include:
- End-stage renal disease (ESRD)
- Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
- Being eligible for disability-based Social Security benefits (as certified by a physician) for more than 24 months
In addition to the Initial Enrollment Period, Medicare outlines very specific times when you can sign up for, or switch, your Medicare Advantage plan. Every fall, there is a Medicare Open Enrollment Period — also known as Annual Enrollment Period — from October 15 to December 7. If you’re already enrolled in Medicare, you can sign up for a Medicare Advantage plan or switch plans during this time. If you are happy with your current plan, you do not have to change anything.
There is also the Medicare Advantage Open Enrollment Period. Held from January 1 to March 31, you can switch your current Medicare Advantage plan or go back to Original Medicare. However, if you have Original Medicare, you cannot sign up for Medicare Advantage at this time.
You may be able to enroll in a Medicare Advantage plan outside of these periods if you experience certain life events. If you move or lose your existing coverage, for example, you may qualify for a Special Enrollment Period. If so, a new enrollment window will open during which you can shop, and enroll in, for Medicare Advantage plans in Tennessee.
Are There Tennessee Medicare Advantage Plans With Prescription Drug Coverage?
If you’d like a “bundled” plan that offers Parts A, B and D coverage all in one policy, you can enroll in a Medicare Advantage plan in Tennessee. Medicare Part D is the portion of Medicare Advantage that covers prescription drugs. You’re not required to enroll in Part D coverage, but beware: If you don’t enroll in a Part D plan when you are first eligible, you may have to pay a long-lasting enrollment penalty when you do sign up.
When you are searching for a Medicare Advantage plan with Part D coverage, you have the option to view the plan’s formulary. The formulary is a listing of all the medications the plan covers. Medicare Part D plans will separate these medications by “tiers” or levels. Tier I medications are usually generic or low-cost medications. Tier V medications are usually the most expensive ones.
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Find the Medicare Plan that works for you.
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Sources
- FACT SHEET. CMS.gov.
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