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Overview of Medicare in Tennessee

Did you know that in 2018, more than 1.3 million Tennesseans were enrolled in Medicare? That’s according to a 2018 report from the Center for Medicaid & Medicare Services (CMS). As a Medicare beneficiary, you may be able to choose from a variety of Medicare coverage options in your state. For many, however, Medicare coverage can seem like a complex maze. We’d like to help you understand the different “parts” of Medicare – from Original Medicare (Part A and Part B), to Medicare Advantage (Medicare Part C), to Medicare prescription drug coverage (Medicare Part D). This article gives you an overview of your Medicare plan options in Tennessee, as well as Medicare Supplement Insurance Plans (Medigap).

Let’s begin by looking at ORIGINAL MEDICARE. Original Medicare is a federal government program designed to help United States citizens and permanent legal residents (of at least five years) with health-care costs. You are generally eligible for Original Medicare if you are 65 years old or older. You may be eligible for Medicare when you are younger than 65 if you are permanently disabled and have received disability benefits for at least 24 months. Also, you may be eligible for Medicare at a younger age than 65 if you have been diagnosed with Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or you have permanent kidney failure that requires dialysis treatment or a kidney transplant (end -stage renal disease).

Original Medicare consists of two parts:

Medicare Part A provides basic coverage for inpatient hospital stays and hospice care, and limited coverage for post-hospital nursing facility services and home health care.

Medicare Part B provides basic coverage for doctor and laboratory services, and some outpatient medical services, including medical equipment and supplies, some home health-care services, and physical therapy.

Original Medicare does not cover everything. You may be responsible for paying the costs of:

  • Most prescription drugs (except for medications you receive while in the hospital or certain medications you receive in an outpatient treatment center)
  • Custodial long-term services (nursing home care)
  • Dentures and routine dental care
  • Routine vision care and eyeglasses or contact lenses

You can get Medicare Part A without a premium if you or your spouse worked at least 10 years (40 quarters) and paid Medicare taxes; otherwise, you may owe a premium for your Part A coverage. Most Medicare beneficiaries pay a premium for Part B coverage, along with any deductibles, copayments, and coinsurance costs that apply to Medicare Part A and Part B coverage.

Let’s turn to other Medicare coverage.

Medicare Part C refers to MEDICARE ADVANTAGE. Medicare Advantage is another way you can obtain Medicare coverage. Under this program, private insurance companies contracted with Medicare provide the benefits of Original Medicare (Part A and Part B) and often more. For example, Medicare Advantage plans must limit your annual out-of-pocket costs for most covered services. When this “cap” or limit is met, the Medicare Advantage plan begins paying 100% of many covered services. Also, many Medicare Advantage plans include additional benefits, such as routine dental and vision care, hearing, wellness programs, and prescription drug coverage. Hospice care is covered under Medicare Part A instead of directly through the Medicare Advantage plan.

There are various types of Medicare Advantage plans. Some specialize in providing coverage for the special needs of people who have specific health conditions, who live in nursing care facilities, or who receive benefits from both Medicare and Medicaid. Some Medicare Advantage plans provide prescription drug coverage; others do not. Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug (MA-PD) plans. MA-PD plans give you the convenience of having your Medicare medical and prescription drug benefits through one plan.

You may be able to enroll in a Medicare Advantage plan in Tennessee if you have Medicare Part A and Part B, and you live within the Medicare Advantage plan’s service area. You must continue to pay your Medicare Part B premium and may also pay an additional premium directly to your Medicare Advantage plan, along with any deductible, copayment, or coinsurance amount that may apply to the benefit plan you choose.

You can find out which Medicare Advantage plans are available where you live by typing your zip code into the eHealth plan finder on this page.

Now let’s look at prescription drug coverage.


As noted above, Original Medicare doesn’t cover prescription drugs in most situations.

  • If you’re enrolled in Original Medicare (Part A and/or Part B), you may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan.
  • If you are enrolled in a Medicare Advantage Private Fee-for-Service (PFFS) or Medical Savings Account (MSA) plan that doesn’t include prescription drug coverage, you may be able to get this coverage from any stand-alone Medicare Part D Prescription Drug Plan that’s available where you live.

Medicare Prescription Drug Plans are offered by private insurers contracted with Medicare. These plans may cover many of the prescription drugs frequently used by Medicare beneficiaries. However, there can be differences in coverage between plans. Medicare Prescription Drug Plans publish a list of prescription drugs they cover, often referred to as a formulary. The formulary can change at any time. You will receive notice from your plan when necessary.

You must have Medicare Part A and/or Part B and live in the Medicare Prescription Drug Plan’s service area to be eligible for Medicare prescription drug coverage.

You’re welcome to use the eHealth plan finder on this page to identify the Medicare Prescription Drug Plans available where you live.

Medicare Part D Prescription Drug Plans typically charge a fixed monthly premium. Depending upon your income, you may qualify for “extra help” to offset some or all of your premium cost. If you aren’t eligible for cost assistance, your Medicare Prescription Drug Plan costs are based on the plan you choose. Different plans will have different pharmacy networks, benefits, and premiums. Remember, if you are enrolled in Medicare Part B you must continue to pay your Part B premium.

You may also have the option of purchasing a Medigap (MEDICARE SUPPLEMENT) insurance plan if you have Original Medicare, Part A and Part B. A Medigap insurance plan can help pay your out-of-pocket costs for services covered under Original Medicare.

As you can see, you might have choices in your Medicare coverage that may let you tailor your coverage to meet your health needs and lifestyle.

Medicare resources in Tennessee

Tennessee Commission on Aging and Disability – Formed in 1963, this agency provides programs and services to help seniors and those with disabilities. The website includes information about the nine Area Agencies on Aging and Disability located throughout the state. In addition, the website for the commission offers facts about prescription drug coverage and other benefits for Medicare beneficiaries in Tennessee.

Tennessee Department of Human Services – This office provides information about financial assistance available to qualifying Medicare beneficiaries in Tennessee. Seniors and disabled residents who are unable to pay their Medicare premiums or deductibles may qualify for benefits through the state’s Medicaid program. There are many programs through which Medicaid assistance is offered, which include the Qualified Medicare Beneficiary and Special Low-Income Medicare Beneficiary Programs. The website offers information about eligibility requirements and forms to download. In addition, the Department of Human Services provides information on other programs available through the state to low-income families and seniors.

The State Health Insurance Assistance Program (SHIP) receives funding from the Centers for Medicare & Medicaid Services and is overseen by the Commission on Aging and Disability. SHIP provides free counseling and education to Tennessee Medicare beneficiaries.

Medicare statistical trends in Tennessee

Some facts of interest about Medicare in Tennessee as reported by CMS appear below for your information*:

In 2018-

  • 798,072 Tennessee residents had enrolled in Original Medicare Part A and/or Part B. 508,739 Medicare beneficiaries had enrolled in Medicare Advantage plans and other health plans.
  • 989,646 Medicare beneficiaries residing in Tennessee received Medicare prescription drug coverage. Nearly half (470,643) of these people got their Medicare prescription drug coverage by enrolling in a Medicare Advantage plan that included prescription drug coverage in its benefit package.
  • All Medicare beneficiaries in Tennessee have access to Medicare Advantage plans.
  • 59 Medicare Advantage plans are available throughout Tennessee.
  • 25 Medicare Prescription Drug Plans are available in the state.
  • 82% of people enrolled in Medicare Prescription Drug Plans have access to a plan with a lower premium than they paid in 2017.
  • 33% of people with Medicare Prescription Drug Plans receive Extra Help (also called the Low-Income Subsidy, or LIS).
  • $17.70 is the lowest monthly premium for a Medicare Prescription Drug Plan.

*Sources Used:
Statistical data from the Centers for Medicare & Medicaid Services, “Medicare Enrollment Dashboard ” and “2018 MA Part D Landscape State-by-State Fact Sheet”.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

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