Introduction to Medicare Advantage in Tennessee (Part C)

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 32% 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
HMO Plans 59%
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

The most dramatic difference between Advantage plans is their provider network. The provider network determines which doctors and facilities you can get medical care from. The plans with the least expensive provider networks, as you can see, tend to be the most popular. However, there are certain downsides to the less costly plans.

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.

Doctor/Providers List

Drug, Vision and Dental Coverage

Unlike Traditional Medicare or most Medicare supplements, you have the option to add extra coverage to your Advantage policy. MAPD plans are Advantage plans which incorporate Medicare Part D prescription drug coverage; in most other scenarios, you would have to manage Part D separately. You can also add vision or dental coverage (or both) to the same Advantage plan. This provides a lot of convenience for seniors – although usually for a higher monthly rate.

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?

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