Medicare in Tennessee
- Want to ensure you're getting the benefits you're eligible for? Start with this guide to Medicare in Tennessee to understand your options and when you have to enroll.
What Tennessee Medicare Plans Are Available?
Tennessee Medicare provides comprehensive healthcare benefits to state residents who meet federal eligibility requirements. In 2020, Medicare delivered coverage to 1,377,466 Tennessee beneficiaries, which included 803,720 Original Medicare enrollees and 573,746 Medicare Advantage enrollees.
Medicare beneficiaries may opt to receive coverage through Original Medicare or a Medicare Advantage plan. Each offers enrollees a different set of options so they can find the right policy for their individual needs.
When enrolling in Original Medicare, beneficiaries should consider the following three components of coverage:
Medicare Part A covers inpatient care and related expenses such as room and meal fees. Coverage includes, but is not limited to, the following services:
- Home health visits
- Inpatient hospital stays
- Short-term post-acute care
- Skilled nursing facility stays=
- Inpatient psychiatric care
Medicare Part B covers outpatient care and related expenses, including but not limited to:
- Diagnostic tests and imaging
- Routine physicals and other preventative services
- Medical transportation
- Treatment for illnesses or injuries
- Outpatient rehabilitation
- Certain mental health care services (including addiction-related treatment)
- Medications and vaccinations administered in a clinical setting
Part D may be added to Parts A or B to provide coverage for prescription drugs. This optional coverage may also be added to select Medicare Advantage plans that don’t bundle in drug coverage. Part D covers all or part of the enrollees’ prescription medication costs, depending on the policy.
Medicare enrollees may purchase either or both Part A and B. Beneficiaries must have either Part A or B to qualify for Part D enrollment.
Medicare Advantage, which is also known as Part C, offers beneficiaries an all-in-one alternative to Original Medicare. Plans are administered by private insurers, who must follow Medicare guidelines. Although plans may vary widely by insurer, Part C provides coverage for inpatient and outpatient services, and policies typically include prescription drug benefits. Enrollees may also receive additional benefits not available through Original Medicare, such as coverage for dental, vision and hearing services.
Beneficiaries who opt for a Medicare Advantage Plan may choose from the following types of plans:
- HMO: Beneficiaries who opt for an HMO plan must choose a primary care physician, who coordinates all of their care. Enrollees typically receive services exclusively from in-network providers and facilities.
- PPO: With a PPO plan, members may receive services from in-network physicians and facilities or opt for out-of-network care at a higher cost.
- PFFS: Enrollees in PFFS plans may receive care from any physician or facility that agrees to the plan’s terms.
- SNPs: Special Needs Plans limit membership to individuals who have specific conditions or medical needs. SNPs typically maintain networks that include specialists and drug formularies designed to meet enrollees’ unique healthcare requirements.
Medicare Supplement Insurance (Medigap)
Although Medigap plans aren’t offered through Medicare, they’re designed to work with a Medicare policy. This supplemental insurance may be purchased from private insurers to cover out-of-pocket costs associated with Medicare, including copays, coinsurance and deductibles. Some Medigap plans fully cover these expenses. Others pay only a percentage.
Who Is Eligible for Tennessee Medicare?
If you’re 65 or older, you can apply for healthcare benefits through Tennessee Medicare. Younger individuals who are disabled or who've been diagnosed with end-stage renal disease may also qualify for coverage through the program.
Automatic Enrollment Criteria
Individuals who’ve received retirement benefits from Social Security or the Railroad Retirement Board for at least 4 months prior to turning 65 are automatically enrolled in Medicare Parts A and B, with coverage beginning the first day of the month you turn 65. Beneficiaries who wish to enroll in a Medicare Advantage plan instead must do so during the relevant enrollment period.
Medicare has several enrollment periods, during which applicants and current beneficiaries may sign up for or change coverage:
- The Initial Enrollment Period: The 7-month IEP begins 3 months before the month you turn 65. It includes your birthday month and the three months that follow.
- The General Enrollment Period: Applicants who miss their IEP may sign up for Original Medicare during the General Enrollment Period, which runs from January 1 through March 31 annually.
- Special Enrollment Periods: An applicant who experiences a qualifying event such as a job loss that results in the loss of private insurance may be eligible for a Special Enrollment Period. SEPs run for 8 months, beginning the first day of the month after the qualifying event. Applicants who enroll in Medicare through an SEP usually won't have to pay a late-enrollment fee.
Enrolling in Medicare Advantage and Prescription Drug Plans
Applicants who want to enroll in a Medicare Advantage plan may do so during Medicare’s Initial Enrollment Period or during the Annual Enrollment Period, which runs between October 15 and December 7. Enrollees who want to switch between Original Medicare and Medicare Advantage may also do during this period, and beneficiaries who haven’t previously signed up for a Part D prescription drug plan may do so at this time.
Medicare Advantage also offers a second enrollment period which runs between January 1 and March 31. At this time, MA beneficiaries may select a different MA plan or they may switch back to Original Medicare.
How Do I Enroll in Medicare in Tennessee?
If you’re eligible for automatic enrollment, you don’t need to do anything. Otherwise, you can apply for Medicare through the Social Security Administration’s simple online form or by visiting your local Social Security office. You may also apply for benefits over the phone by calling (800) 772-1213.
Contact Information for Tennessee Medicare, Medicaid and Insurance Help
If you have questions about Tennessee Medicare or need help applying, assistance is available at the following agencies:
- HelpAdvisor: State Medicaid programs such as TennCare often have complex eligibility requirements. HelpAdvisor provides comprehensive information designed to help individuals understand what benefits are available to them through Medicare, Medicaid or other public programs.
- State Health Insurance Assistance Program (SHIP): TN SHIP offers no-cost healthcare counseling to Medicare beneficiaries and their caregivers. You can start the process by calling TN SHIP at (877) 801-0044.
- Tennessee Department of Commerce and Insurance: Tennessee residents can find information on health insurance options by visiting the state’s Department of Commerce and Insurance. If you need general information or assistance with healthcare-related matters, you can contact the agency by phone at (615) 741-2241.
CoverRx: Designed to help low-income individuals who don’t have prescription drug coverage, CoverRx provides affordable access to a variety of medications. For more information, call (800) 424-5815.