- In 2019, there were 57 Medicare Advantage Plans available in Tennessee.
- 37% of the total Medicare population in Tennessee is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,194 per beneficiary in Tennessee, which is 1% higher than the national average.
- Available Medicare Advantage Plans range from 20 to 49 across Tennessee’s 95 counties.
Tennessee has a robust Medicare Advantage Plan market. If you want to move from Original Medicare to a Medicare Advantage Plan, you can only select a plan that’s available in your county even if you think the county next door has better options. The plans that are available to you depend on which health insurance provider you use and where you live.
Medicare Advantage Plans in Tennessee
Types of Medicare Advantage Plans
When you’re moving from Original Medicare to a Medicare Advantage Plan, you need to find a plan that fits both your medical needs and your budget. Tennessee’s Medicare Advantage program has four main types of plans to choose from.
Health Maintenance Organizations (HMO)
HMO plans are the most popular Medicare Advantage Plans and often the least expensive. However, these plans have restrictions. You must select your care from in-network health care providers, select a primary care physician, and obtain a referral to see a specialist. Some plans require you to continue paying your premium for Medicare Part B and occasionally for Part A. Many of these plans include prescription drug coverage, but not all do.
Preferred Provider Organizations (PPO)
While PPO plans offer more flexibility, these plans are more expensive. PPO plans let you select out-of-network health care and don’t require you to have a primary care physician or obtain a referral to see a specialist. However, you can still use a PPO’s in-network health care providers and leave the option of seeing an out-of-network physician open. Most PPOs offer prescription drug and vision coverage, dental care, and fitness and hearing programs.
Private Fee-For-Service Plans (PFFS)
PFFS plans offer the most flexibility of any Medicare Advantage Plan. With these plans, the insurance company decides how much it will pay for your health care coverage and how much you pay. You can use any doctor or institution that will accept your plan, but some health care providers won’t accept it; however, all health care providers must accept a PFFS plan in an emergency. Most of these plans include prescription drug coverage.
Special Needs Plans (SNP)
SNPs are tailored for individuals who live in a nursing home environment, are eligible for both Medicaid and Medicare, or have a serious illness, such as AIDS, cancer, or end-stage renal disease (ESRD). Except in emergency cases, you need to use in-network health care providers. You must select a primary care physician and obtain referrals to see specialists. All SNPs offer prescription drug coverage as a benefit.
Enrollment and eligibility for Medicare Advantage Plans in Michigan
- You must be aged 65 or older or have a disability.
- You must be a U.S. citizen or a permanent resident for at least five years.
- You must be enrolled in Original Medicare Part A and Part B but not in a Medicare Supplemental Insurance Plan (Medigap).
- The Initial Enrollment period runs for seven months, starts three months before you turn 65, includes your birth month, and continues for three months following your birthday.
- The Open Enrollment period runs from October 15 to December 7. You can switch from Original Medicare to a Medicare Advantage Plan, return to Original Medicare, or change Medicare Advantage Plans during this period.
- The Medicare Advantage Open Enrollment period runs from January 1 to March 31. You can change Medicare Advantage Plans or return to Original Medicare during this period; however, you can’t move from Original Medicare to a Medicare Advantage Plan. If you haven’t previously signed up for Medicare Part B, you can do so during this period, and then from April 1 to June 30, you can select a Medicare Advantage Plan. Your coverage will start on July 1.
- If you change locations, you can select a new Medicare Advantage Plan during a Special Enrollment period.
If you’re covered by your work or your spouse’s health care plan, you don’t need to select a plan when you turn 65. You have eight months after this coverage ends to enroll in Original Medicare or a Medicare Advantage Plan.
Prescription drug coverage
Under Original Medicare, you can sign up for a Medicare Part D plan. Many HMO and PPO plans include the cost of prescription drug coverage in your premiums or a separate premium. If you select an HMO or a PPO plan that doesn’t offer prescription drug coverage, you can’t add a Medicare Part D plan, or you’ll be expelled from your Medicare Advantage Plan and returned to Original Medicare. PFFS plans allow you to add a Medicare Part D plan if the coverage isn’t already included. All SNP plans are legally required to provide prescription drug coverage.
Medicare Advantage Resources in Tennessee
Deciding which Medicare Advantage Plan to choose can be a time-consuming process. Fortunately, Tennessee has numerous resources that can provide you with free counseling to help you determine your best option.
Tennessee Area Agencies on Aging
Created by an act of Congress in 1973, Tennessee’s Area Agency on Aging offices work to ensure services are available for seniors in the state’s communities. It can provide you with connections to local resources, such as nutritious meals for homebound or disabled seniors, transportation to medical appointments, and access to Medicare and Medicare Advantage counseling.
Contact Info: Website | 866-836-6678
State Health Insurance Assistance Program (SHIP) for Medicare Participants
Tennessee’s SHIP program can provide you, your family, or your caregiver with information about Medicare, Medicare Advantage, Medicare Supplement, and Medicare Part D programs. Its experienced counselors can assist you with selecting an appropriate health care plan and help you determine whether a Medicare Advantage Plan is your best option for prescription drug coverage. The SHIP program is part of a national network that provides free counseling and information for Medicare-eligible individuals. SHIP counselors are located throughout Tennessee, and you can call one to discuss your Medicare options.
Contact Info: Website | 877-801-0044
Tennessee Drug Card
A statewide program that provides free prescription assistance to all residents of Tennessee, the Tennessee Drug Card is designed to help uninsured and underinsured Tennesseans afford prescription drugs. You don’t need to fill out any applications or meet any qualifications. The drug card helps Tennessee residents, including seniors and disabled individuals, save up to 80% on brand-name and generic drugs.
Contact Info: Website | 888-987-0688
Learn More from Our Sources
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Part D | Last accessed June 2021
- Medicare | Health Maintenance Organizations (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organizations (PPO) | Last accessed June 2021
- Medicare | Private Fee-for-Service Plans (PFFS) | Last accessed June 2021
- Medicare |Special Needs Plans (SNP) | Last accessed June 2021
- Medicare |Who can join a Medicare Advantage Plan | Last accessed June 2021
- Medicare | Joining a health or drug plan | Last accessed June 2021
- Medicare | Special Circumstances (Special Enrollment Periods) | Last accessed June 2021