Unfortunately, despite the fact that Traditional Medicare was designed to be as comprehensive as possible, there are still coverage gaps associated with Parts A and B medical services which you must pay out of pocket. And if you don’t have a Medicare supplement in place to help you manage those expenses, it can cost you thousands in the long run. One type of supplement which seniors can choose from is called Medicare Advantage (or Medicare Part C). It is a comprehensive, private health insurance policy which replaces your Traditional Medicare benefits with an equal or greater amount of coverage from a private insurance company. For more details on how this policy works, keep reading.
Federal Regulations for Medicare Advantage
Because a Medicare Advantage policy effective replaces your federal medical benefits, some people call it “Medicare Replacement” instead of Advantage or Part C. When you file a Medicare-related claim, the company that you purchase your policy from becomes responsible for paying out – not Uncle Sam. But these plans are still regulated by the government, ensuring that your coverage is at least as good (and, in most cases, better) that what Traditional Medicare offers.
Medicare Advantage Enrollment In Tennessee
Medicare Advantage is fairly popular in Tennessee. Right around 36% of seniors who have enrolled in Medicare have also replaced those benefits with a Medicare Advantage policy. However, you should know that not all Medicare Advantage plans are the same. They can vary greatly from one plan to another, which is why some are more popular than others:
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
Tennessee seniors can expect to pay different rates than retired persons in Colorado or Washington State. In this chart, we have a sample of rates which seniors in your area could be paying right now. These are for comparison purposes, as they are only estimates and cannot be guaranteed.
Most Popular Medicare Advantage Plans in Tennessee
Most product and service reviews rate their goods on a five-star scale, with five stars being the best one can achieve. We have adopted this simple, easy to understand system for our Medicare Advantage plans. The more stars they get, the more you know that they can manage your care well, pay out your claims, and be there for you when you need them the most – all at a price you can afford.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
There is a trade-off when it comes to provider networks when you are dealing with a Medicare Advantage plan. The less expensive ones, like the HMO plans, give you very little choice when it comes to the doctors and facilities you are allowed to patronize. Plans with larger provider networks, such as PPOs or PFFS plans, cost more monthly but give you more flexibility. In some cases, you may be able to go outside of your network for a premium. In more extreme situations, you may be refused treatment (unless you are having a medical emergency) if you try to go outside of your network.
- HMO Plans – HMO plans can be somewhat restrictive, but you get affordability in exchange. You choose a primary care physician from a modest network of doctors that are hand-picked by your insurance provider. From there, your primary doctor will refer you to other healthcare specialists as necessary for additional care. Going out of network will not be covered by your insurance company unless it is an emergency.
- PPO Plans – PPO plans give you a wider variety of doctors to choose from, but they are also more expensive than an HMO plan. You can see virtually any healthcare provider you want with a PPO. But your medical costs will be the lowest if you choose from the network of preferred providers that your insurance company wants you to go to.
- PFFS Plans – In order to get care under a Private Fee-For-Service plan, your insurance company will have to negotiate with your chosen care provider. Once they agree to payment terms, you can get the care you need and your insurance provider will help cover the costs. But they don’t always agree. And they may not agree every single time you schedule an appointment with your care provider. So you will have to be vigilant and stay in touch with your care providers when making arrangements for your health care.
- Special Needs Plans – Special Needs Plans are usually only available to people with specific medical needs, such as frequent and expensive care for a chronic illness. They function similarly to an HMO; you select a primary care doctor, you must stay within the network in order to get your costs covered, but you will have exceptions for emergency care received outside of your network. You also may have the option to negotiate for out-of-network non-emergency care, but this is rare.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans – HMO networks are known for their affordability; this is even more true with a Medicare Advantage HMO Network. Another good thing about Medicare Advantage HMOs is that you have a better variety of doctors and facilities to choose from due to the prevalence of healthcare providers who accept Medicare.
- PPO Plans – PPO health care plans may be too expensive for most private citizens. But when you combine a PPO network with a Medicare Advantage plan, this can make these health insurance plans more affordable for many seniors. It’s a good idea to see if there are any available, local PPO plans which fit within your budget before you make a decision based solely on price.
- PFFS Plans – PFFS plans don’t necessarily hinge on provider networks, even under Medicare Advantage. You can choose any provider you wish, and get affordable care as long as they agree to the payment terms set by your insurance company. But a PFFS plan paired with Medicare Advantage might help you get more access to affordable care. There’s a chance your care providers will be more accepting of your insurance company’s payment terms if you’re getting Medicare assistance.
- Special Needs Plans – If you qualify for a Special Needs Plan, affordability is a very high priority. Thanks to financial assistance from Medicare, Medicare Advantage Special Needs Plans can make getting life-saving healthcare much more affordable for you. But you will still need to follow the same rules about staying in network that you would with any other Special Needs Plan.
Most seniors who are shopping around for Medicare Advantage plans already have a doctor or several healthcare providers that they want to stay loyal to. Before you switch plans, you should use the government’s Medicare Physician Search Tool in order to make sure your preferred healthcare providers will be available in your new plan’s network. Finding out this information is essential for choosing the right plan.
Drug, Vision and Dental Coverage
When it comes to vision coverage, Medicare Advantage is the only supplemental plan that directly offers this option. Unfortunately, there is no branch of Medicare which offers vision coverage – only hospital services, doctor visits, and prescription drugs. If you don’t purchase a Medicare Advantage plan, you can always purchase a private vision plan independently on your own. But adding it to a Medicare Advantage plan makes it that much easier to manage.
yYou also may have the option to purchase dental coverage with a Medicare Advantage plan. The same rules apply to dental coverage as well; if you don’t purchase a Medicare Advantage plan, you’ll have to purchase a private plan from a separate company if you get your Medicare benefits supplemented with a Medigap policy or if you decide to stick with Original Medicare without supplementing it. But Medicare Advantage gives you the option of managing your dental and all your other health care coverage under the same policy.
Enrollment Options & Best Time To Enroll
If you have the opportunity to enroll during your IEP (see below), you should take advantage of it. Enrolling during the IEP has the fewest barriers to entry when it comes to obtaining affordable coverage from a reputable insurance company. If your IEP has passed, and if you don’t qualify for an SEP, then you may have to take a medical survey or settle for a policy from a less desirable company. Seniors with certain medical conditions, such as End Stage Renal Disease, will have an especially hard time finding coverage outside of their IEP. But your state department of insurance can help you find affordable coverage options, as well as your local insurance agent. You can learn more on our Medicare Advantage Enrollment Options page.
- Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
- Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.
What Medicare Advantage Plan Is Best For Me?
It can be really hard to choose the right Medicare program as you plan for retirement and beyond. Your medical costs will make it more expensive as you get older, and your financial assets may not be enough to pay for it. But if you can find a stable company that offers you a solid plan at an affordable monthly premium, they can help you live to a ripe, old age.
Choosing the right plan is difficult, but we can help make it easier for you. And we can help you find the right plan within your narrow enrollment period window, too. Just reach out and contact us today. All we need is a few bits of personal information to get started, and we can help you find the most affordable Medicare Advantage quotes from providers near you – all in a matter of minutes!