Medicare Advantage Plans in Tennessee

If you’re an older American living in Tennessee, there are several healthcare options to choose from. One of the more popular options is Medicare Advantage (Part C). If you or a loved one is shopping for Medicare Advantage plans in Tennessee, there are some main details you’ll want to know. We’ll help you learn what Medicare Advantage is, what it does, and how much you may need to pay.

Here’s GoHealth’s guide to Medicare Advantage (Part C) in Tennessee.

Medicare is broken into parts. These include Part A (hospital/inpatient coverage) and Part B (medical coverage). If you receive your Medicare through Parts A and B, this is known as Original Medicare. Original Medicare beneficiaries must add standalone Medicare Part D coverage if they need prescription drugs.

Medicare Advantage (Part C) plans are sold by private insurers and provide Medicare Part A and B coverages. Some plans also incorporate Part D coverage (more on Part D below). Medicare requires all Medicare Advantage plans to cover at least the same A and B benefits as Original Medicare — and many Part C policies also provide additional coverage options such as dental, hearing and vision coverage.

If you search for Medicare Advantage plans in Tennessee, you generally won’t be able to choose from any plan in the state. This is because Medicare Advantage plans offer coverage based on your location.

Medicare Advantage plans in Tennessee typically allow you to see doctors and providers within a provider network. These are a group of Medicare-approved medical professionals in an area that have signed a contract to treat an insurance company’s customers. Your provider network is generally based on where you live.

How you interact with your provider network depends on the type of plan you have. Two common types of Medicare Advantage plans in Tennessee are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

With an HMO you will have a primary care physician (PCP) to manage your care. If you need to see a specialist, your PCP will refer you to certain medical providers and medical facilities that have been designated as “in-network.” With an HMO, you will usually need to see in-network providers for your plan to cover the visits.

A PPO is another Medicare Advantage option in Tennessee. PPOs tend to be slightly different from HMOs in that they still use primary care physicians and provider networks, but PPOs typically allow more freedom to see out-of-network providers. However, you will experience the greatest cost savings when you see in-network providers.

What is the Medicare Star Ratings system?

Medicare assigns star ratings to its Medicare Advantage plans. These stars range from one to five stars, with five stars being the highest. These star ratings take multiple factors into account, including participants’ satisfaction with the plan.

If you are comparing plans, the Medicare star rating system is one method that can help you determine the best plan for you. However, you should take into account costs and coverage in addition to star ratings.

When you choose a Medicare Advantage plan in Tennessee, you will often still pay your monthly Part B premium. The Medicare Part B premium is income-based; in 2023, most people pay the standard monthly premium of $164.90. If you or your spouse worked and paid Medicare taxes for at least 10 years, you probably won’t have to pay a premium for Part A.

The average monthly premium in 2023 for Medicare Advantage in Tennessee is $17.08. However, there are several Medicare Advantage plans that have a $0 premium. This means you will not pay any additional premium beyond your Part B premium to have a Medicare Advantage plan. While this may seem like a great deal, it’s important to find a plan that meets your needs. If you choose a Part C plan with a $0 premium but still need to purchase other coverages to meet your needs, you may not be getting the value you had hoped for.

Also, much more than just the premium goes into the overall cost of a Medicare Advantage plan. You must also consider copayments, coinsurance, deductibles and out-of-pocket limits. Unlike Original Medicare, Medicare Advantage plans generally have an out-of-pocket maximum; once you pay the limit for Medicare expenses, your plan will pay 100 percent of the remaining costs for the rest of the plan year. Taking all of these costs into account when shopping for Medicare Advantage plans in Tennessee will help you find a plan that’s right for your budget.

Medicare eligibility starts with being a U.S. citizen or legal resident. From there, most people will first qualify for Medicare Advantage when they turn 65. To sign up, you must be enrolled in Original Medicare (Parts A and B). Your first chance to enroll due to age is during your Initial Enrollment Period (IEP) — this includes the month you turn 65, plus three months before and after. Once you’re enrolled in Parts A and B, you can switch to Medicare Advantage.

However, some people qualify for Medicare Advantage based on medical conditions. These may include:

• End-stage renal disease (ESRD)
• Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
• Being eligible for disability-based Social Security benefits (as certified by a physician) for more than 24 months

A person does not have to be age 65 to qualify for Medicare under these medical conditions. However, a person may have a waiting period to qualify for Medicare if they have ESRD or a disability.

In addition to the Initial Enrollment Period, Medicare outlines very specific times when you can sign up for, or switch, your Medicare Advantage plan. Every fall, there is a Medicare Open Enrollment Period — also known as Annual Enrollment Period — from October 15 to December 7. If you’re already enrolled in Medicare, you can sign up for a Medicare Advantage plan or switch plans during this time. If you are happy with your current plan, you do not have to change anything.

There is also the Medicare Advantage Open Enrollment Period. Held from January 1 to March 31, you can switch your current Medicare Advantage plan or go back to Original Medicare. However, if you have Original Medicare, you cannot sign up for Medicare Advantage at this time.

You may be able to enroll in a Medicare Advantage plan outside of these periods if you experience certain life events. If you move or lose your existing coverage, for example, you may qualify for a Special Enrollment Period. If so, a new enrollment window will open during which you can shop, and enroll in, for Medicare Advantage plans in Tennessee.

If you’d like a “bundled” plan that offers Parts A, B and D coverage all in one policy, you can enroll in a Medicare Advantage plan in Tennessee. Medicare Part D is the portion of Medicare Advantage that covers prescription drugs. You’re not required to enroll in Part D coverage, but beware — If you don’t enroll in a Part D plan when you are first eligible, you may have to pay a long-lasting enrollment penalty when you do sign up.

When you are searching for a Medicare Advantage plan with Part D coverage, you have the option to view the plan’s formulary. The formulary is a listing of all the medications the plan covers. Medicare Part D plans will separate these medications by “tiers” or levels. Tier I medications are usually generic or low-cost medications. Tier V medications are usually the most expensive ones.