Medicare Advantage Plans in Tennessee

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, telehealth, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, though some may qualify earlier due to disability or conditions such as ALS or ESRD. Understanding the different enrollment periods can help you avoid penalties or gaps in coverage:

• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Periods

What Types of Medicare Advantage Plans Are Available in Tennessee?

Tennessee residents have access to several types of Medicare Advantage (MA) plans:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and obtain referrals for specialist care. These plans typically require choosing a primary care physician (PCP).
• Preferred Provider Organizations (PPOs): Allow out-of-network care at a higher cost and typically don’t require referrals or PCP selection.
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider who agrees to the plan’s payment terms. No PCP is needed.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, cancer, or heart disease.
  • I-SNPs: For individuals in nursing homes or requiring in-home nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid. These plans often include care coordination, drug coverage, and extra benefits at little to no cost.
• Medical Savings Accounts (MSAs): Pair a high-deductible Medicare Advantage plan with a medical savings account funded by your plan to help cover medical expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Tennessee include Part D drug coverage. MSAs and some PFFS plans are exceptions. If your plan doesn’t include drug coverage:

• You may be allowed to enroll in a standalone Part D plan (only available with certain plan types).
• Delaying coverage without having creditable prescription drug coverage may lead to late enrollment penalties.

Before enrolling, check the plan’s formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Reviewing Medicare Advantage costs and plan features is essential. Consider the following:

• Premiums: Many plans offer $0 premiums, but others may charge a monthly fee.
• Deductibles, Coinsurance & Copays: Out-of-pocket costs vary based on the plan structure.
• Out-of-Pocket Maximums: MA plans include a yearly spending limit to protect you financially.
• Extra Benefits: Tennessee plans often include dental, vision, telehealth, transportation, over-the-counter (OTC) allowances, and fitness programs.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: Starts 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop a Medicare Advantage plan.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Medicare Part B during this time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): For switching MA plans or returning to Original Medicare.
• Special Enrollment Periods: Triggered by events such as:
  • Moving out of your plan’s service area
  • Losing employer or Medicaid coverage
  • Medicare plan contract termination
  • Qualifying for an SNP due to a chronic health condition

What If You Want to Change Your Medicare Advantage Plan?

You can switch MA plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Once your new coverage starts, your previous plan will be automatically canceled.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system ranks plans from 1 to 5 stars based on quality and customer satisfaction:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These scores are updated annually and apply to both MA (Part C) and Part D prescription drug plans.

What Are Medicare Resources in Tennessee?

Tennessee residents can access several helpful resources for Medicare support:

• Tennessee SHIP Program: Offers free Medicare counseling and plan guidance.
• Tennessee SMP Program: Educates Medicare beneficiaries about fraud prevention.
• Tennessee Department of Commerce & Insurance: Oversees insurance complaints.
• TennCare: Tennessee’s Medicaid program, which may help low-income residents with healthcare costs. Call 1-855-259-0701 for assistance.

Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also known as Medigap, help pay costs that Original Medicare doesn’t cover, such as deductibles and copayments.

• You must be enrolled in Medicare Parts A and B.
• The best time to enroll is during your six-month Medigap Open Enrollment Period, which begins when you enroll in Part B.
• These plans don’t cover prescription drugs—you’ll need a separate Part D plan.
• There are 10 standardized plans; Plans F, G, and N are the most popular.
• Medicare Supplement Plan G had the highest enrollment in 2023 and is one of the fastest-growing options.
• Plan F is not available to those newly eligible for Medicare after 2020.

Learn more about Medicare Supplement plans in Tennessee.

Next Steps

If a Medicare Advantage plan in Tennessee fits your health and financial needs, compare plans available in your area. Evaluate premiums, provider networks, prescription coverage, and added benefits—then be ready to enroll when eligible.