Medicare in Tennessee

Medicare Advantage is available as an alternative to Original Medicare. Medicare Advantage includes all of the benefits of Original Medicare (hospital and outpatient/physician coverage), although the out-of-pocket medical costs can be very different, as Advantage plans can set their own coinsurance, copays, and deductible levels (within parameters set by CMS). Most Advantage plans also include Part D coverage for prescription drugs, as well as extra programs like dental and vision coverage.

But Advantage plans tend to have localized provider networks, as opposed to Original Medicare’s nationwide access to medical providers. There are pros and cons to either option.

Thirty-six percent of Tennessee Medicare beneficiaries selected private Medicare Advantage plans in 2018, which was comparable to the 33% of all Medicare beneficiaries nationwide who were enrolled in Medicare Advantage plans. The remaining 64% of Tennessee’s Medicare beneficiaries had opted instead for coverage under Original Medicare.

By late 2022, however, nearly 49% of the people enrolled in Medicare in Tennessee had Medicare Advantage plans. This aligns with the overall growth in Medicare Advantage enrollment nationwide; at that point, about 46% of all Medicare beneficiaries nationwide were enrolled in private plans, nearly all of which were Medicare Advantage plans (there are still Medicare Cost plans available in some areas, and those are included in the private plan enrollment total as well).

The availability of Medicare Advantage plans in Tennessee varies from one county to another, but the market is fairly robust throughout the state. For 2023 coverage, availability ranges from 36 Medicare Advantage plans in Dyer County to 66 plans in Davidson County.

Medicare beneficiaries can switch from Original Medicare to Medicare Advantage or vice versa during the annual election period in the fall (October 15 to December 7, with coverage effective January 1). And there’s also a Medicare Advantage open enrollment period (January 1 to March 31) during which Medicare beneficiaries who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

• Learn about Medicare’s annual open enrollment period.
• Questions to ask when you’re deciding between Medicare Advantage and Original Medicare.
• Learn how Tennessee Medicare beneficiaries with limited financial means can be helped by Tennessee’s Medicaid program.

Medigap plans are optional coverage used to supplement Original Medicare, covering some or all of the out-of-pocket medical costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

Medigap plans are standardized under federal rules, and people are granted a six-month enrollment window (which starts when they’re at least 65 years old and enrolled in Medicare Part A and Part B), during which coverage is guaranteed issue for Medigap plans and premiums cannot vary according to the applicant’s health. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

But Tennessee is among the majority of the states that have adopted rules to ensure that people under age 65 have at least some access to Medigap plans. Since 2011, under state law,  Tennessee Medigap insurers that offer plans to people age 65 and older are required to offer all of the same plans to people under 65 who become eligible for Medicare as a result of a disability. Disabled Tennessee residents have the same six-month open enrollment window for Medigap as those who gain eligibility for Medicare due to their age. The six-month window starts when the person is enrolled in Medicare Part B, and coverage is guaranteed issue during the enrollment window.

Tennessee residents under age 65 can be charged higher premiums for their Medigap coverage. Under the terms of the state law regarding Medigap access for people under age 65, Tennessee was to conduct a study after five years (which would have been in 2016) to determine whether the state should continue to allow Medigap insurers to place under-65 enrollees in a separate risk pool for rating purposes. But as of 2023, a quick look at Medicare’s Medigap plan finder tool indicates that the state has not changed anything about the rating requirements: A non-smoking female who is 65 years old will pay between $55 and $300 per month for Medigap Plan A in Tennessee, whereas a non-smoking female under the age of 65 will pay between $334 and $960 per month for the same policies.

People who are enrolled in Medicare and a Medigap plan prior to age 65 are granted another Medigap open enrollment period when they turn 65, allowing them to switch to a lower-priced Medigap plan at that point.

And Medicare beneficiaries under age 65 also have the option to enroll in Medicare Advantage if that’s their preference. The premiums for Advantage plans do not depend on medical history, but there are pros and cons to Medicare Advantage coverage.

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription drug plan.

As of November 2022, there were 465,125 Medicare beneficiaries enrolled in stand-alone Part D prescription drug plans in Tennessee, and another 656,065 beneficiaries who had Part D coverage integrated with their Medicare Advantage plans. A few years earlier, in 2018, the number of people enrolled in stand-alone Medicare Part D plans in Tennessee had been higher than the number of beneficiaries with Part D coverage integrated with Medicare Advantage. But the growth in Medicare Advantage enrollment has resulted in declining enrollment in stand-alone Part D coverage and increasing enrollment in Advantage plans that include Part D coverage (overall enrollment in Medicare has been growing, as has overall enrollment in Part D coverage).

For 2023 coverage, there are 24 stand-alone Part D plans available in Tennessee, with premiums ranging from about $7 to $106 per month.

Medicare Part D enrollment is available when a person is first eligible for Medicare, and beneficiaries can make changes to their Part D coverage each fall, from October 15 to December 7. Changes made during that time will take effect the following January. Beneficiaries can use Medicare’s plan finder tool to see how each plan would cover the drugs they need, keeping in mind that Part D plans change from one year to another, and each person’s prescription needs change as well.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Tennessee includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

The Tennessee State Health Insurance Assistance Program for Medicare Participants can provide a variety of assistance and information, including answering your questions about Medicare eligibility in Tennessee and Medicare enrollment in Tennessee.

The Tennessee Commission on Aging and Disability is also an excellent resource for Medicare beneficiaries in Tennessee, or people who will soon be eligible for Medicare in Tennessee.

The Tennessee Department of Commerce and Insurance licenses and oversees the health insurers that offer coverage in the state, as well as the brokers and agents who sell the policies. Their office can provide assistance and guidance for consumers with various insurance-related questions. Medicare Advantage and Part D plans are regulated at the federal level by CMS (states oversee financial solvency and licensing), but the state is responsible for much of the regulations that apply to Medigap plans, other than the federal standardization described above.

The Medicare Rights Center is a nationwide service that can provide assistance and information about Medicare enrollment, eligibility, and benefits.

This resource explains how Tennessee Medicaid can provide assistance to Medicare beneficiaries who have limited income and assets.