Medicare Advantage Plans in Tennessee
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: February 24, 2021
Medicare Advantage, also called Medicare Part C, covers all the things that Original Medicare (Medicare Part A and Medicare Part B) does and sometimes added perks. These plans can include dental and vision insurance, and may even provide preventative health coverage, such as gym memberships or even coverage while traveling.
Medicare Advantage plans are intended to give enrollees flexible coverage according to their unique needs, with opportunities to change or enhance their coverage as their needs change. These plans are sold by private insurance companies, although applicants aren't eligible unless they're already enrolled in Original Medicare.
- 1 In 2019, there were 57 Medicare Advantage plans available in Tennessee.
- 2 37% of the total Medicare population in Tennessee is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $10,194 per beneficiary in Tennessee, which is 1% higher than the national average.
- 4 Available Medicare Advantage plans range from 20 to 49 across Tennessee’s 95 counties.
Medicare Part C plans are optional, and the types of plans vary between states and even within the state of Tennessee itself. Companies may offer different types of coverage in different regions of the state. Some of the Medicare Advantage plans may look familiar to you if you previously had private insurance or coverage through your employer. When you enroll in a Medicare Part C plan, the premium is your responsibility. Medicare Advantage coverage also changes from year to year, so it’s important to check with your policyholder to avoid gaps or loss of coverage.
Medicare Advantage Plans in Tennessee
Types of Medicare Advantage Plans
Medicare Advantage plans vary, and Tennessee has several different types, including Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-For-Service Plans (PFFS), and Special Needs Plans (SNP). Several major insurance companies provide these plans, and there are many similarities between the different types of coverages. However, each insurance company has its own eligibility guidelines and exclusions. Tennessee offers several state and local resources for seniors to help understand the differences between each plan and find appropriate coverage in their geographical location. For those who are “snowbirds” or spend part of their time in another location, assistance is also available to find plans within Tennessee’s Medicare Advantage program that have coverage for travelers.
Health Maintenance Organizations (HMO)
HMO insurance programs have a network of general and specialist physicians that enrollees must select from. This network submits its billing to the providing insurance agency, and the agency itself has negotiated contracts with physicians in your area. HMO coverage is among the most restrictive and may not cover enrollees when they travel or receive care from out-of-network providers except in cases of an emergency.
Preferred Provider Organizations (PPO)
PPOs contract with local healthcare providers in your area, including doctors offices and hospitals. These providers have rates lower for policyholders, and the PPO network is similar in setup to an HMO. However, PPO insurance holders can choose services from out-of-network providers and still be covered under their PPO, although they may have to pay more. This is different from HMO out-of-network coverage, as HMO policyholders will often have to pay out-of-pocket costs fully.
Private Fee-For-Service Plans (PFFS)
PFFS plans also have a network of healthcare service providers, and these providers agree to treat any PFFS member. Policyholders may seek treatment from non-network providers and pay more, although the insurance plan will cover part of the costs. Prescription drugs may be covered by some PFFS plans, but it’s not a guarantee. These plans have higher premiums than HMOs and PPOs, and the plan may charge more for certain services.
Special Needs Plans (SNP)
SNP plans have some of the highest premiums of all Medicare Part C plans, but they will cover medical care for subscribers in long-term care facilities, such as assisted living facilities and nursing homes. Seniors who live in these long term care homes and who are enrolled in either Medicaid, Medicare, or both, may be eligible for these plans. SNP plans can also provide a complete spectrum of care for those with qualifying chronic conditions. Those enrolled in SNP plans must receive all coverage from the network of providers, and the premiums for these plans are high. SNP plans are limited in coverage and may not be available in all Tennessee counties.
Enrollment & Eligibility for Medicare Advantage Plans in Tennessee
Tennessee residents aged 65 and older are eligible to apply for Medicare Advantage plans. Applicants must be enrolled in Original Medicare Part A and Part B and not be enrolled in Medigap insurance to qualify for a Medicare Part C plan. Other qualifications in Tennessee include:
- Applicants must be 65 or older
- Be enrolled in Social Security or have worked long enough to be eligible for Social Security
- Must not have end-stage renal disease (ESRD), although those with that condition may opt for SNP plans.
Medicare Part C programs have several different enrollment periods, and it’s important to pay attention to the deadlines and requirements for each:
- The Initial Coverage Election Period (IEP) is the same as the IEP for Original Medicare. Most seniors are urged to subscribe to Original Medicare and select their Medicare part C plans within three months of their 65th birthday. (Technically, the IEP begins three months before the 65th birthday, includes the birth month, and continues for three subsequent months.) The coverage starts the first of the month following enrollment, so it’s important to select your coverage beforehand and enroll at the beginning of the month to avoid any insurance gaps.
- Medicare Advantage Open Enrollment Period: January 1 – March 31. This enrollment period allows subscribers to change Medicare Advantage plans or enroll in an initial one. Or, seniors may choose to end Medicare C coverage entirely. Another option during this time is to end a Medicare C plan and enroll in a Medicare stand alone prescription drug plan (Medicare Part D).
- Medicare Annual Enrollment Period (AEP): October 15 – December 7. This enrollment period allows applicants to enroll in a Medicare Part C plan or change from one plan to another. Other options include dropping their Medicare C plan and returning to just Original Medicare. For seniors who already have Medicare D coverage, they can make changes to these plans at this time, as well.
- General enrollment period: April 1 and June 30. This enrollment is only for seniors who are already enrolled in Medicare Part A or those who opted for Medicare part B for the first time during the open enrollment period and are switching to Medicare Advantage.
- Medicare Special Enrollment Period. Some seniors may qualify for a special enrollment period, although these circumstances are limited. A local insurance agent can help determine eligibility and answer questions about the type of documentation necessary.
Prescription Drug Coverage
While some Original Medicare plans may cover prescription medications, coverage is limited, and some medicines ineligible. Medicare Part D is complementary insurance coverage for Original Medicare, specifically intended to cover medicine.
Some, but not all, Medicare Part C plans in Tennessee cover prescription drugs, but each plan is different. Furthermore, the types of coverage change each year, so the drugs some recipients use may not be covered by the same plan from year to year. The only Medicare Advantage plans that are legally required to cover prescription drugs are the SNP insurance programs.
Medicare Advantage Resources in Tennessee
Comprehensive healthcare for seniors is important, and Medicare Advantage plans are intended to give seniors options as their health needs change. For first-time enrollees, or those who have a limited understanding of insurance language and medical jargon, the details of many plans can be hard to understand, and the specifics of what is and isn’t covered are confusing.
To help seniors and first-time Medicare applicants find a plan that covers their needs, Tennessee offers many resources at both the local and state levels, including counseling services to help with the policy review and application process.
State Health Insurance Assistance Program (SHIP)
SHIP works through Tennessee’s Area Agencies on Aging, helping seniors understand the Medicare process. Counselors don’t endorse any specific plan, insurance issuer, or type of coverage, but rather provide information to those who seek services in a simple to understand manner. In Tennessee, the service is divided geographically, with counselors available for East, Middle, and West Tennessee. Counselors work with those already receiving Medicare, people considering enrolling in Medicare programs and those looking into programs on behalf of another. Appointments must be made and are available virtually.
Contact Information: Website | 877-801-0044
Tennessee Department of Commerce & Insurance
This state body licenses and regulates insurance providers and offers counseling services for Medicare applicants and policyholders. Seniors may also contact this department to verify a policy or insurer or to access consumer education resources.
Contact Information: Website | 615-741-2241
Get Covered Tennessee
This organization is funded by several non-profit and government agencies throughout the state. Its Health Assist program offers advice from specialists on choosing Medicare Part D plans and comparing various Advantage plans to each other and Original Medicare. Phone numbers for assistance in Spanish, Arabic, or English are posted on the organization’s website.
Contact Information: Website | 866-475-7879
- Sources [-]
https://www.healthcare.gov/glossary/health-maintenance-organization-hmo/ Last accessed April 2021
https://www.healthcare.gov/glossary/preferred-provider-organization-ppo/ Last accessed April 2021
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/C-SNPs Last accessed April 2021
https://www.tn.gov/aging/resource-maps/tennessee-area-agencies-on-aging-and-disability.html Last accessed April 2021
https://www.tn.gov/aging/our-programs/state-health-insurance-assistance-program–ship-.html Last accessed April 2021
https://www.tn.gov/commerce/insurance/consumer-resources/health-insurance-information.html Last accessed April 2021
http://www.getcoveredtenn.org/health-assist.html Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.