Are you looking at options for Medicare coverage? Original Medicare, or Part A (hospital insurance) and Part B (outpatient insurance), provides basic coverage but won’t cover prescription drugs or limit your out-of-pocket costs each year.
One solution is a Medicare Advantage (MA) plan, or Medicare Part C. MA plans provide the same basic coverage as Original Medicare, though the plans are run by private insurers. Many MA plans include coverage for prescription drugs and limit your out-of-pocket expenses.
What You Need to Know
A Medicare Advantage plan must provide the same coverage as Original Medicare.
Many MA plans cover prescription drugs.
You can enroll in an MA plan at the same time you enroll in Medicare.
What Types of Medicare Advantage Plans Are Available?
Most Medicare Advantage plans in Tennessee use a network of doctors and medical facilities to reduce the cost of medical care. Common types of plans include:
- Health Maintenance Organization (HMO): You’ll generally use an in-network facility for care. If you visit an out-of-network provider, you’ll pay more out-of-pocket, except in emergencies. You’ll also need to choose a primary care physician (PCP) and get a referral to see a specialist.1
- Preferred Provider Organization (PPO): You’ll be able to visit any healthcare provider you want, but you’ll likely pay less out-of-pocket if you use an in-network doctor. You won’t need to pick a PCP or get a referral for a specialist.
- Special Needs Plans (SNP): You’re eligible for these plans if you have certain health conditions.2
- Chronic Condition SNP (C-SNP): These plans are available if you have a chronic condition such as cancer or diabetes.
- Institutional SNP (I-SNP): You’ll qualify if you live in a nursing home or require in-home care.
- Dual-Eligible SNP (D-SNP): You’ll qualify if you’re eligible for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): You won’t need to choose a PCP. Your insurance provider will decide how much the plan will pay for each medical service, and how much you’ll need to pay for care.3
- Medicare Medical Savings Accounts (MSA): These plans use a high-deductible insurance plan for coverage. You’ll use the MSA to pay out-of-pocket medical expenses.4
You can save money in a Medicare Advantage plan by going to in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
Coverage for prescription drugs is known as Medicare Part D. It’s not part of Original Medicare, but many MA plans in Tennessee include prescription drug coverage.
Before you sign up for an MA plan, check its drug formulary, or list of covered medications, to make sure your prescriptions are included.
How Do You Choose Medicare Advantage Plans in Tennessee?
Check your plan’s benefits and costs before you sign up. Costs include:
- Premiums: The monthly cost of your MA plan. You also must pay the Medicare Part B premium ($148.50 for most people in 2021). You may be able to get a zero-premium plan, but your deductible or other costs might be higher as a result.
- Other Costs
- Deductible: The annual amount you’ll need to pay out-of-pocket for care before your plan starts paying.
- Coinsurance: This is your portion of the cost of care, usually shown as a percentage of the total.
- Copay: This is the fixed price for specific medical services.
- Out-of-Pocket Maximum: The yearly limit on the amount you pay out-of-pocket for care. This usually doesn’t include copays or premiums.
- Plan Benefits
- Vision: Covers services like eye exams and frames.
- Dental: Covers services including teeth cleaning and checkups.
- Telehealth: Covers remote health services such as phone consultations or video office visits.
- Additional Perks: Many MA plans provide additional benefits, such as transportation services or fitness classes.
Many Medicare Advantage plans also offer vision and dental coverage.
When and How to Enroll in Medicare Advantage?
You can sign up for a Medicare Advantage plan in Tennessee when you’re enrolled in Medicare Part A and B. The easiest time to enroll in Medicare is during your Initial Enrollment Period, which includes the three months before and three months after you turn 65.
Did you miss your Initial Enrollment Period? You can still sign up for Original Medicare during the General Enrollment Period from January 1 to March 31 each year. If you miss your Initial Enrollment Period, however, you may face penalties on your Medicare premiums.
Enrollment in Medicare goes through the Social Security Administration. You can sign up for Original Medicare online, over the phone or at your local Social Security office.
The best time to join an MA plan is during an enrollment period, including:
- Initial Enrollment Period: Join a Medicare Advantage plan in Tennessee when you sign up for Original Medicare.
- Medicare Annual Election Period: Join an MA plan during the yearly Medicare enrollment period from October 15 to December 7.
- Medicare Advantage Open Enrollment Period: Switch back to Original Medicare or change your MA plan each year from January 1 to March 31.
- Special Enrollment Period: You might be able to make changes to your MA plan outside of an open enrollment period under certain circumstances, such as:
- You’re moving outside of the service area of your plan.
- You’re joining a healthcare plan from a union or employer.
- You’ve become ineligible for Medicaid or are otherwise losing your current coverage.
- Medicare is terminating your plan or your provider is leaving the Medicare program.
- You’ve been diagnosed with a health condition that requires an SNP.
How Much Do Medicare Advantage Plans Cost in Tennessee?
The cost of a Medicare Advantage plan in Tennessee varies depending on a number of factors, such as your location or whether you choose a zero-premium plan. The average cost of a Medicare Advantage plan in Tennessee is $20.82 per month.5
Your costs can change depending on the plans available in your area as well. For example, in Nashville and Memphis you might pay between $0 and $201 per month in premiums.6 Don’t forget to consider other costs, like your deductible or copays, when comparing plan prices.
What If You Want to Change Your Medicare Advantage Plan?
You can change your plan in Tennessee during any of the open enrollment periods each year. To sign up for a new plan, simply fill out the plan’s application. Your old plan is automatically terminated when your new coverage takes effect.
What Are Alternatives to Medicare Advantage?
Medicare Advantage plans aren’t your only coverage option in Tennessee. You can also consider:
- Program for All-Inclusive Care for the Elderly (PACE): This program provides comprehensive medical care at local facilities for seniors who meet location and income eligibility criteria.7
- Original Medicare: Stick with Medicare Part A and B if it provides the right amount of coverage for you.
- Medicare Supplement: Also known as Medigap, these policies help fill gaps in coverage left by Original Medicare.
- Medicare Supplement with Part D: Your Medigap policy won’t include Medicare Part D, so you’ll need to purchase a separate prescription drug plan.
What Are Medicare Resources in Tennessee?
- State Health Insurance Assistance Program (SHIP): This free program provides unbiased counseling and resources to help you get enrolled in Medicare and sign up for an MA plan.8
- Tennessee Department of Commerce and Insurance: This state department provides resources and information on health insurance, including Medicare coverage options.9
- Tennessee Division of TennCare: This is Tennessee’s Medicaid program, which provides affordable health insurance options for those with low income or disability.10
Is a Medicare Advantage plan right for you? If so, start looking at plan options in your area, so you’re ready to sign up when you enroll in Medicare.