Medicare is a national health insurance program designed especially for U.S. citizens and legal permanent residents of 65 years of age and older and is also for people with certain disabilities or end stage kidney failure. Just like rest of the country, residents of Tennessee cal also qualify for Medicare plans based upon their age or disabilities. In Tennessee more than 1.3 million residents are enrolled in Medicare and around 20% of these are eligible due to a disability. More than one third of Medicare beneficiaries in Tennessee have chosen Medicare Advantage plans, who have the option to choose between 15 to 37 Medicare Advantage plans in 2019 depending upon the county in which they live. In addition to this, around 39% of Medicare beneficiaries in Tennessee have opted for stand alone Medicare Part D plan.
Types of Medicare Coverage in Tennessee
Like in any other state, residents in Tennessee too can enroll in Original Medicare, which is a federal government plan designed to help U.S. Citizens and permanent legal residents with health care costs. Individuals become eligible for Original Medicare if they are 65 years or older or if they are permanently disabled and have received disabled benefits for at least 24 months. Individuals also become eligible for Original Medicare at a younger age than 65 if they have been either diagnosed with Lou Gehrig’s disease or if they have permanent kidney failure that requires dialysis treatment or a kidney transplant. Original Medicare comprises of two parts, Medicare Part A that provides basic coverage for inpatient hospital stays along with hospice care and include some limited coverage for post-hospital nursing facility and some home health care. Medicare Part B provides coverage for doctor and laboratory services along with some out-patient medicals services like medical equipment and supplies, some home health-care services and physical therapy. Individuals enrolled in Original Medicare will require to pay cost of most of the prescription drugs which they take in their home, nursing home care, dentures and routine dental care along with routine vision care and eyeglasses or contact lenses. Medicare Part A comes without a premium for individuals if they or their spouse has worked at least ten years and have paid Medicare taxes. However Medicare beneficiaries need to pay a premium for Part B coverage along with any deductibles, copayments, and coinsurance costs that are associated with Medicare Part A and Part B coverage.
Medicare Part C or Advantage Plan
Medicare Part C or Medicare Advantage plan is an alternative way of obtaining Medicare coverage. This plan is offered by private health insurance companies contracted with Medicare to provide the benefits of Original Medicare and often more. For most of the covered services, Medicare Advantage plans limit annual out-of-pocket costs for members and when they met this limit then the Medicare Advantage plans start paying 100% of the covered services. Besides Original Medicare benefits, Medicare Part C also include additional benefits like routine dental and vision care, hearing, wellness programs, and prescription drug coverage. There are different types of Medicare Advantage plans, ranging from plan offering coverage for the special needs of the people having specific health conditions to people living in nursing care facilities or people receiving both Medicare and Medicaid benefits. In order to enroll in this plan, individuals in Tennessee need to have Medicare Part A and Part B and they must be living within the plan;s service area. In 2020, the average Medicare Advantage monthly premium in Tennessee changed from $25.11 in 2019 to $22.62 in 2020. In the state 100% medicare beneficiaries have access to a Medicare Advantage plan and there are around 99 Advantage plan available in the state. Some of the Medicare Advantage Plans available in Tennessee include:
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Private Fee-for-Service (PFFS) Plans
- Medical Savings Account (MSA) Plans
- Special Needs Plans (SNP)
From 2020 Tennessee insurance companies providing Medicare Advantage plans are allowed to add some additional non-health related benefits to certain beneficiaries like providing financial help in making structural changes to the home if required. This change has been implemented to help individuals who might need help to modify their home such as widening doorways or installing ramps for their homes.
Medicare Advantage Prescription Drug Plans
As beneficiaries with only Medicare Part A and Part B don’t get prescription drug coverage under Original Medicare, so they look for prescription drug plans. Hence, to provide such individuals with prescription coverage from the same plan giving them health benefits, Medicare Advantage Prescription Drug Plans were launched. Medicare Advantage Prescription Drug plans in Tennessee just like any other states provide prescription drug coverage in addition to Medicare Part A and Part B benefits. With these plans, beneficiaries will not require to enroll in a separate Medicare Prescription Drug Plan along with their health insurance. However, Medicare beneficiaries should review a plan’s prescription drug formulary before enrolling in the plan to ensure that it includes the medications they need. It is important for individuals shopping for this plan to ensure that they receive Medicare Advantage Prescription Drug plan exactly as per their need so they should compare the plan formulary, which is a simple drug list covered under a plan. Besides plan formulary they should also check the prescription drug tiers because insurance companies have different coverage schedules for generics and brand name drugs.
Medicare Part D or Prescription Drug Plans
Medicare Part D plans are designed to provide individuals with prescription drug benefits, because Original Medicare doesn’t cover the cost of most prescription drugs. Medicare Part A only covers drugs given to insured during a covered inpatient hospital stay, whereas Medicare Part B covers medications which insured get in an outpatient setting like doctor’s office, which they cannot give themselves like vaccines and chemotherapy drugs. Medicare Part D or Medicare Prescription Drug plans are available in Tennessee through private insurance companies approved by Medicare. Medicare Part D is a stand-alone plan that works alongside Original Medicare coverage. In Tennessee there are 30 Medicare Part-D Plans available from 11 different health insurance providers. The Part D plan available in Tennessee with the lowest monthly premium is $13.20 and the highest monthly premium is $126.70. As in the rest of the country, in Tennessee too beneficiaries are eligible for medicare Part D plan if they are enrolled in Medicare Part A and Part B and they live in the plan’s service area. Individuals shopping for Medicare Prescription Drug Plans should always check the plan’s formulary to make sure that their medications are included in the list. Beside, individuals should also keep in mind that Medicare Part D plan categorizes medications into different cost tiers, and a plan comprising of prescription drugs of lowest tiers will cost less compared to plan having drugs of higher tier.
Medicare Supplement Plans in Tennessee
Medicare Supplement or Medigap plan is an insurance policy, which is designed to cover out-of-pocket costs and health-care expenses not covered under Original Medicare. The out-of-pocket costs include copayments, deductibles and other out-of-pocket expenses, thus this plan is designed to work along Original Medicare. Some of the Medicare Supplement plans available in Tennessee may also offer benefits that are not included with Original Medicare like coverage in foreign countries or coinsurance for hospice care. In Tennessee like most of the states there are ten standardized Medicare Supplement plans where each plan is designated with a letter. Since each plan is standardized by Medicare, so plan with the specific letter type will have identical coverage. Individuals shopping for Medigap plans must keep in mind that every insurance company offering Medigap plans in Tennessee will offer all the ten Medigap plans in the state. So, individuals must check the Medigap plans available in their area. Besides, even the monthly premium for each plan may vary from company to company and they must be aware that lower monthly premiums result in higher out-of-pocket expenses for medicals services, so people must keep both the factors in mind when comparing the overall cost of the plan.