Seniors age 65 and over in Tennessee should already be enrolled in the federal Medicare program, if they have not done so already. Medicare, also referred to as “Traditional Medicare” or “Original Medicare, refers to Medicare Parts A and B. These two parts cover most of your medical needs, from hospital treatment to basic doctor visits.
Coverage and Benefits
Because most senior citizens are, in theory, retired and living on a fixed income, Original Medicare is designed to be as affordable as possible. Part B is usually the most expensive. It requires monthly premiums and a yearly deductible, both of which can be calculated on this page. Part A, however, but be free if you have a long enough employment history. But in order to have access to free Part A benefits, you have to have been employed for at least 10 years (or 40 quarters) over the course of your lifetime. If not, they you may be required to pay additional fees.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Supplemental Medicare Plans in Tennessee
There are over one million people living in Tennessee right now that are currently receiving Medicare benefits (1,109,791 to be exact). The more popular form of supplemental coverage is a Medicare Advantage policy, which 32% of all beneficiaries have (355,133 total). 15% of Medicare recipients are protecting themselves from Medicare coverage gaps with a Medigap supplement policy (or 166,518 recipients). Still, however, more than half – 53% of Medicare enrollees, or 588,189 people – have some other alternate supplement, perhaps through a work program, or no supplementation whatsoever.
Keep in mind that getting a supplemental Medicare plan requires that you be enrolled in Medicare first. To enroll, check important dates, or to learn more about Medicare enrollment, click that link.
Is Purchasing Additional Medicare Coverage Absolutely Necessary?
The answer to that question is different for every individual, and depends largely on your own personal circumstances. But for many individuals, supplemental coverage can be essential for mitigating huge medical bills. In the table below are examples of some of the “gaps” in Original Medicare that you would be expected to pay 100% out-of-pocket for a hospital visit or outpatient care.
|Medicare Part A Costs||Medicare Part B Costs|
If you are closer to age 65 and feel as though you are in relatively good health, you may not think you need to compare Medicare plans in Tennessee. Unfortunately, unexpected health complications go up with age, when retirement incomes usually dwindle. But there are affordable ways to protect yourself, even on a fixed income. We’ll explore some of those options now.
Option #1: What is Medigap?
The term “Medigap” is a nickname of sorts. The first part – “medi” – references the policy’s connection to Medicare. The latter, “gap”, refers to the gaps in coverage that are problematic with Traditional Medicare, and the fact that Your Medigap policy is designed to protect you from them. There are ten plans total: A-D, F, G, and also K-N. Plans E, H, I and J were eliminated from the program due to the Medicare Modernization Act of 2010. By federal law, all 10 plans offer identical benefits in each state. Someone with a Medigap Plan D policy in Wyoming will have the exact same benefits as someone with a Plan D supplement in Tennessee – the only difference is the price they will pay, and the company which provides the coverage.
Below are the benefits you can expect from each supplement plan:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$102||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$101||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$85||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$91||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$73||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$98||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$68||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$76||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$46||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$86||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
How Is Medicare Advantage Different from Medicare?
Medicare Advantage both is, and is not, a part of traditional Medicare. That may sound confusing, so let’s try to clear the air: Medicare Advantage is sometimes referred to as Medicare Part C, which technically makes it a part of the Medicare Program. At the same time, however, it is its own separate form of coverage. So separate, in fact, that your medical claims will not be paid out by any government entity. Instead, they will be paid out by whatever private insurance company you purchase your Medicare Advantage plan from.
The good news is that no matter what Advantage plan you buy, you will at the very least still receive the same benefits you would be getting from Original Medicare. Your private insurer cannot take those away from you, because they are protected by federal law. Additionally, you may receive other benefits such as vision or dental if your insurer offers them at a price you can afford. Unfortunately, the low costs of such plans come from your insurance company working with a small number of doctors within a limited network. So you may be getting additional coverage at a potentially lower cost, but many Medicare Advantage beneficiaries end up losing their preferred doctors as a result.
Another unique feature of Medicare Advantage includes the Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) networks through which members receive their medical care.
The Major Differences between Medicare Advantage and Medigap
At the end of the day, your overall healthcare costs will probably be the strongest determining factor in which plan you decide to purchase. In the table below, we outline some of the costs you can expect to pay with each plan, including premiums and out-of-pocket expenses, as well as many other determining factors:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
More Useful Information
You can use the directory search tool below to directly contact Medicare experts who will have more information. This article is only a primer to get your started on your journey for affordable health care. With a little digging, you can find out which options are best for you.
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Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.