Medicare in Tennessee

Medicare is typically the most popular health insurance program for folks aged 65 and above, as well as adults with specific disabilities. In Tennessee, a little less than half of all eligible residents were enrolled in Medicare in 2022, which is right on par with the national average. From 2022 to 2023, enrollment in Medicare increased. Now, more than half of the 1.2 million seniors in the population have chosen a plan.

Most in this age group know Original Medicare has a few parts. Part A comes at no cost for those who have paid sufficient payroll taxes during their working years—typically a minimum of 10 years. It covers essentials such as emergency care, inpatient treatment, hospice care and even home health services. Part B may come with a monthly premium of $170.10 in 2022, but it covers most outpatient procedures and medical equipment.

There is a trending pattern shifting away from the traditional options and heading for Medicare Advantage (Part C), which allows the selection of customizable options from a private insurance plan to better suit personal preferences. All Advantage Plans match the provisions of Part A and Part B—minus hospice care being exclusive to Part A—but additions such as dental, vision, prescription drug coverage and a medical savings program are also available. For prescription drugs, Medicare Part D will handle the medications, but most Advantage Plans have drug coverage in their bundles. Costs differ depending on what’s chosen, and if a reduction in costs is needed, a Medicare Supplement (Medigap) plan will help limit those out-of-pocket expenses such as deductibles.

This guide presents all the Medicare options for those aged 65 and up, so seniors can select the health coverage to suit their needs. There are also several resources provided to help answer any questions about all the customizable aspects of the varying healthcare plans. The end goal is to ensure seniors have what they need when it comes to their health.

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 provides a foundational level of coverage, but it may not encompass all the needs of seniors seeking more comprehensive insurance solutions. In the state of Tennessee, residents are presented with the choice of enrolling in the Original Medicare program or exploring a range of insurance plans administered by private insurance companies (Medicare Advantage). This empowers seniors to tailor their coverage according to their unique or specific needs, whether they choose the standard benefits of the original program or wish to leverage the flexibility and additional features offered by the private options.

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 offers seniors an alternative to standard Medicare. Administered by private insurers, these plans receive a federal subsidy, lowering monthly premiums. They are required to duplicate Part A and Part B coverage, but they also offer extra benefits to make their plans more appealing. Five types of Medicare Advantage Plans exist: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNP) and Medicare Savings Account (MSA), each with distinct rules, regulations and eligibility. Plus, the out-of-pocket limitations allow seniors to predict expenses and have a bit more control over their medical budget.

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 August 2023 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 2023 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.