Tennessee Medicare Guide

Have questions about Medicare? Get free advice from our licensed Tennessee Medicare Advisors. Schedule a free consultation or give us a call at (888) 604-0055 to get started.

This guide will help you get to know the basics about Medicare in Tennessee, so you can feel confident making important decisions about your health insurance.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Tennessee

• Medicare Eligibility and Enrollment Steps

• Tennessee Medicare Advantage Plans

• Tennessee Medicare Supplement Plans

• Tennessee Medicare Part D Plans

• Get help paying for Medicare in Tennessee

A Snapshot of Medicare in Tennessee

There are 1.4 million Tennessee Medicare beneficiaries, making up 20% of the state’s population. The majority of beneficiaries are on Medicare due to age, but about 16% are on Medicare due to disability. 19% of Tennessee Medicare enrollees are also receiving Medicaid benefits. 

Medicare beneficiaries have a choice between Original Medicare and Medicare Advantage. 55% of Tennessee Medicare beneficiaries stay on Original Medicare and 45% enroll in Medicare Advantage plans.

Tennessee Medicare Eligibility and Enrollment Steps

All US citizens who meet one of the following requirements are eligible for Medicare:

• You’re 65 or older

• You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

Medicare beneficiaries must first enroll in Parts A & B before enrolling in additional Medicare plans. Most beneficiaries age into Medicare and enroll during their Initial Enrollment Period (IEP). Your IEP is unique to your birth month. It starts three months before the month you turn 65 and extends until three months after. Some people choose to delay Part B enrollment because they’re still working. If you do this, just be sure you’ll be eligible for a Special Enrollment Period when you stop working. 

2. Compare additional coverage options

After enrolling in Original Medicare, there are different types of plans you can choose to build your Medicare insurance package. Medicare Advantage plans replace Original Medicare while Medicare Supplement (also called Medigap) plans sit on top of your Original Medicare coverage. There are also prescription drug (Part D) plans. Choosing which plans to enroll in is a personal decision that you should make based on your unique health and financial needs. We’ll explain the details of each of these plan types below, but we’re also here to help! Give us a call at (888) 604-0055 if you have any questions about your Medicare options.

3. Get the best value from Medicare

One of the ways to continue to ensure you get the best value from Medicare is by reviewing your coverage each year during the Medicare Open Enrollment Period. Medicare Advantage and prescription drug plans change every year, and your healthcare needs will change over time too! During the Open Enrollment Period, which occurs every year from October 15 - December 7, you can change from one Medicare Advantage plan to another or from one drug plan to another—without consequence. We often find that it’s best for Medicare recipients to stay on their same plan, but in some cases, shopping around saves people thousands!

Tennessee Medicare Advantage Plans

There are 101 Medicare Advantage plans in Tennessee. Your specific pricing and availability will depend on the county you live in. For example, Davidson County has 48 Medicare Advantage plans from 13 insurance carriers and Shelby County has 38 plans from 10 insurance companies (in 2023).

Medicare Advantage plans offer a bundled approach to Medicare. With one plan, you get Part A & Part B coverage. Most Medicare Advantage plans also provide Part D (prescription drug) coverage and various added benefits, which may include:

• Dental, vision, and hearing

• Meals

• Transportation to doctor appointments

• Telehealth services

• Flex cards

Many people are surprised that a lot of Medicare Advantage plans offer all of these extra benefits with a low or no additional premium (Medicare Advantage enrollees still need to pay the Part B premium). 

Medicare Advantage plans have downsides too. To provide more benefits at a low cost, insurance companies implement:

• Provider networks that limit the doctors you can see

• Prior authorization requirements

• Cost structures that result in high out-of-pocket costs (costs outside of your premiums)

Tennessee Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement (also called Medigap) plans stack on top of your Original Medicare coverage. Medigap plans are best for helping to cover the 20% of costs that Original Medicare doesn’t. These plans can significantly reduce your out-of-pocket costs. Medicare Supplement Plan G, for example, practically eliminates out-of-pocket costs. After you meet your Part B deductible ($226 in 2023), you don’t owe anything else for Medicare-covered services for the year! 

In addition to significantly limiting your out-of-pocket costs, Medigap plans have a couple key benefits that improve your access to care. First, like Original Medicare, they don’t have provider networks and allow you to see any doctor who accepts Medicare. In case you’re wondering, about 90% of doctors nationwide accept Medicare, and you won’t be limited to doctors in your state, which is great for travelers! Second, they don’t require prior authorization, which allows you to get the care you need faster.

There are ten types of Medigap plans in Tennessee, labeled by letters A-N. Each letter plan, (e.g., all Plan Ns) are required to provide identical coverage, but pricing may vary based on the insurance carrier as well as personal factors like your location, age, gender, and smoking status. 

The best time to enroll in a Medigap plan is during the first six weeks that you have Part B coverage. This six months is your Medigap Open Enrollment Period, and during it, you are guaranteed acceptance into any Medigap plan, regardless of your health status. Outside of this time (and a few other special guaranteed issue periods), insurance companies can ask you questions about your health history and may deny you coverage.

Tennessee Part D Plans

Original Medicare does not provide prescription drug coverage, which is why we have Medicare Part D. Tennessee Medicare beneficiaries can get prescription drug coverage through either a Medicare Advantage plan that includes them (MAPD plan) or through a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Tennessee, but plan pricing and availability varies by county.

If you don’t have any prescriptions when you first enroll in Medicare, we still recommend enrolling in one of the cheaper plans to avoid paying a Part D penalty later.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Tennessee Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Tennessee

These three government programs can help individuals with low income and resources with their medical expenses.

Tennessee Medicaid

Medicaid is a joint federal and state program that’s managed by each state. Tennessee’s Medicaid agency is called TennCare. TennCare Medicaid helps a variety of people, including people who are elderly or have a disability. 

Like most state Medicare agencies, TennCare also has the following Medicare Savings programs with varying benefits:

• Qualified Medicare Beneficiaries (QMB) Program

• Specified Low-Income Medicare Beneficiary (SLMB or SLIB) Program

• Qualified Individuals-1 (QI-1) program

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance. Extra Help may also be referred to as the Part D Low Income Subsidy. 

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Tennessee

• Tennessee pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, get help determining if you qualify and submitting your application from one of our licensed Tennessee Medicare Advisors.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.