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Medicare in Tennessee

GoHealth helps Tennessee residents stay in-tune with the intricacies of Medicare

Reviewed by: Ed McClane, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • You are eligible for Medicare in Tennessee when you turn 65 years old.

  • Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). features hospital (Part A) and medical (Part B) coverage and offers you the option to add drug (Part D) and supplemental (Medigap) coverage.

  • Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Tennessee bundles Part A, Part B, and usually Part D coverage while offering additional coverages like dental and vision care.

 

Music is a little bit like Medicare. Everything sounds good until someone misses an important note. Medicare in Tennessee is too complex to just play by ear. GoHealth is here to help.

Who is Eligible for Medicare in Tennessee?

The federal government created Medicare in 1965 to benefit U.S. citizens ages 65 and older. You also are eligible for Medicare in TN regardless of your age if:

Those who are eligible can enroll in Part A (also known as “hospital insurance”), Part B (“medical insurance”), or both. Once enrolled in Part A and B (known collectively as Original Medicare), you have the option of switching to Medicare Advantage in Tennessee (also known as Part C) to receive the benefits of Parts A and B from a private insurance company along with other benefits like dental and vision coverage.

If you decide to stay enrolled in Parts A and B, you have the option to add Part D to cover a portion of your prescription expenses. You may also choose to add Medigap, which is supplemental coverage that helps fill in the gaps in out-of-pocket costs like copays and coinsurance.

How do I Apply for Medicare in Tennessee?

Your choices for applying for Medicare in Tennessee include:

  • Enrolling online with the Social Security Administration. [1]
  • Visiting a local Social Security office. [2]
  • Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).

If you are receiving Social Security benefits before you turn 65, you may be automatically enrolled in Original Medicare. If not, you have to apply. Your first chance to sign up is during your Initial Enrollment Period, a seven-month window that includes the month of your 65th birthday and the three months before and the three months after your 65th birthday.

What is the Difference Between TennCare and Medicare?

TennCare is the name of the Medicaid program in Tennessee.

Each state has its plan for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those in need with their healthcare costs regardless of age. As of 2021, TennCare assists more than 1.4 million Tennesseans who are low-income or struggling with qualifying disabilities.

TennCare also administers Medicare Savings Programs for Medicare beneficiaries who don’t qualify for Medicaid but still have eligible needs. [3]

Is Every 65-Year-Old Eligible for Medicare?

Yes. As long as you’re a U.S. citizen, you become eligible for Medicare in Tennessee at age 65.

A GoHealth study found that 1 in 7 older Americans surveyed incorrectly thought the Medicare eligibility age was 62. That may be because Americans are eligible to start drawing Social Security benefits at age 62. The Social Security Administration oversees Medicare enrollment and deducts Medicare premiums from Social Security payments, if you choose.

While Medicare is an individual policy, a person on Medicare can benefit from their younger spouse turning 62. Any Medicare beneficiary who hasn’t worked 10 years must pay a Part A premium, but they no longer have to when a spouse who has worked at least 10 years turns 62. That spouse, however, like everyone else, still has to wait to turn 65 before joining Medicare. [4]

What are the Different Plans of Medicare?

If you’re on Original Medicare, perhaps you’re considering a switch to Medicare Advantage in Tennessee.

Here are some things to consider.

  • Medicare Advantage bundles the hospital and medical coverage offered by Parts A and B of Original Medicare in TN, as well as the drug coverage and supplemental coverage.
  • Medicare Advantage also offers additional coverage options not provided by Original Medicare like dental and vision coverage and a monthly stipend for purchasing over-the-counter supplies.
  • Medicare Advantage and Original Medicare have different coverage areas and various costs. Original Medicare is nationwide coverage anywhere that accepts Medicare. Medicare Advantage uses a network of providers in your area, but that distinction allows Medicare Advantage in Tennessee to often offer more affordable options.

What is the Highest Rated Medicare Advantage Plan?

The Centers for Medicare & Medicaid Services has a Medicare Star Ratings system that assigns a rating of up to five stars to individual Medicare Advantage plans, and Medicare Advantage beneficiaries even are offered the opportunity to switch once a year to a five-star plan. [5]

While the rating system can shed light on Medicare Advantage plans’ performance, it’s not as easy as just picking the highest-rated plan. A GoHealth licensed insurance agent, without obligation, can help you compare plans and find the one that’s the right fit for you.

Medicare in Tennessee by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,274,719 people are enrolled in Medicare in Tennessee. The total number of beneficiaries enrolled in Medicare Advantage in Tennessee is 538,411. The previous year, 503,626 enrolled in Medicare Advantage. Medicare Advantage participation in Tennessee went from 40.34% to 42.24% year over year. If you’d like to dive deeper into how Medicare in Tennessee breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Tennessee
1,274,719
Beneficiaries with Part A & Part B
538,411
Medicare Advantage Beneficiaries
42.24%
Medicare Advantage Participation Rate
55.05%
% Female
44.95%
% Male
1
Average HCC Score
$9,623.85
Actual Per Capita Costs
16.54%
% Eligible for Medicaid
31.52%
% of Beneficiaries with an Emergency Department Visit
17.97%
Hospital Readmission Rate
86.65%
% Non-Hispanic White
10.19%
% African American
0.89%
% Hispanic
2.26%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Tennessee Medicare Resources & Contacts

Beneficiaries spend an average of $9,623.85 each year on Medicare in Tennessee. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Tennessee-based resources, like these, may be able to help:

TN SHIP - Medicare Counseling

1-877-801-0044

https://www.tn.gov/aging/our-programs/state-health-insurance-assistance-program–ship-.html

What should I know about TN SHIP?

Free advice is available from the Commission on Aging & Disability, which runs Tennessee’s State Health Assistance Insurance Program.

Learn more

Tennessee Department of Commerce & Insurance

1-800-792-7573

https://www.tn.gov/commerce/resources-services/file-a-complaint.html

What should I know about the Tennessee Department of Commerce & Insurance?

The state agency responds to insurance-related complaints.

Learn more

TennCare

1-855-259-0701

https://www.tn.gov/tenncare/members-applicants/how-do-i-apply-for-tenncare.htmll

What should I know about TennCare?

It is the official state Medicaid program, with representatives available to answer questions and help Tennesseans apply.

Learn more

Tennessee Department of Veterans Services

615-741-2345

https://www.tn.gov/veteran/veteran-benefits/tn-state-benefits.html

What should I know about the Tennessee Department of Veterans Services?

It helps veterans and their families understand and optimize their health-related benefits.

Learn more

Nationwide Resources

Speak with an insurance agent that is licensed in Tennessee about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in TN, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

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Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.