October 6, 2016
If you are a Medicare beneficiary living in Tennessee, you may have multiple Medicare plan options available, depending on where you live. Most people receive their Medicare coverage in one of two ways: through Original Medicare (which includes both Part A and Part B), the federally administered program, or through a Medicare approved health plan such as Medicare Advantage (Part C).
Original Medicare (Part A and Part B) is the traditional fee-for-service program that is government-run, meaning benefits and rules will generally be the same in all 50 states, including Tennessee.
Original Medicare comes with two parts: Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient services, including hospital, skilled nursing facility, hospice, and limited home health care. Part B covers outpatient services, such as doctor visits, durable medical equipment, and preventive care. Some limitations and restrictions apply; for example, your care typically must be delivered by Medicare-assigned providers in Medicare-approved facilities.
It’s important to note that Original Medicare doesn’t include everything. For example, you generally won’t be covered outside of the U.S. except in limited situations such as emergencies. Original Medicare also doesn’t cover routine vision and dental services, hearing aids, acupuncture, or dentures. Medicare Part A and Part B provide limited prescription drug coverage, usually not extending to medications you take at home.
In Tennessee, much like the rest of the United States, you must be 65 years old and either a U.S. citizen or a permanent legal resident of at least five continuous years to be eligible for Medicare. Some people can get Medicare before 65 if they’ve been receiving disability benefits for at least two years in a row or have end-stage renal disease or Lou Gehrig’s disease.
Individuals who have worked for 10 years (or 40 quarters) usually get Medicare Part A with no premium. If you don’t qualify for premium-free Part A, you can still enroll and pay a monthly premium. Medicare Part B always comes with a premium, unless the state covers your premium because you have limited income. Part A and Part B premium costs are set by the federal government and may change from year to year.
Many people are automatically enrolled in Medicare as soon as they become eligible. Otherwise, you can sign up for Medicare Part A and/or Part B during your Initial Enrollment Period (IEP). If you don’t sign up during your IEP, you can still enroll during the General Enrollment Period that occurs every year from January 1 to March 31. However, you may have to pay a higher premium for Part A and/or Part B for not enrolling when you were first eligible.
Outside of the IEP and GEP, you might qualify for a Special Enrollment Period (SEP). If you didn’t sign up for Medicare Part B when you were first eligible (for example, because you were working or had other health coverage), you can enroll in Part B when your other health coverage or employment ends. You won’t have to pay a late enrollment penalty if you qualify for and sign up during an SEP.
To sign up for Medicare Part A and/or Part B, you can:
If you are a Medicare beneficiary in Tennessee, you may have Medicare plan options available as well, depending on where you live. Some of these Medicare plan options may provide coverage not included in Original Medicare, such as routine dental care. You may want to carefully consider all of your options when deciding how you want to receive your Medicare coverage.
The Medicare Advantage (Part C) program offers another way to receive your Original Medicare benefits. Private insurance companies contract with the federal government to provide your Part A and Part B coverage. All Medicare Advantage plans are required to offer your Medicare Part A and Part B benefits (except for hospice care, which Part A covers), but many plans offer additional benefits, such as routine vision and dental coverage.
Some Medicare Advantage plans include prescription drug coverage (also known as MA-PD plans), providing all of your health and drug benefits in the same plan.
No matter what type of Medicare Advantage plan you may sign up for, you must continue paying your Medicare Part B premium, as well as any premium the plan might charge.
The Medicare Part D program provides optional prescription drug coverage through private, Medicare-approved insurance companies. If you’re enrolled in Original Medicare, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan. This plan would have its own premium, as well as separate costs determined by the plan. Each Medicare prescription drug plan has different costs for the drugs it covers, so it’s important to shop around and compare prices.
If you have Medicare Advantage, you normally wouldn’t sign up for a stand-alone Medicare Part D Prescription Drug Plan. Instead, you’d get your prescription drug coverage by signing up for or switching to a Medicare Advantage Prescription Drug plan. If you sign up for a Medicare Prescription Drug Plan while enrolled in a Medicare Advantage plan, you might be automatically disenrolled from Medicare Advantage.
As mentioned above, a stand-alone Medicare Part D Prescription Drug Plan can work alongside your Original Medicare (Part A and Part B) benefits. If you decide on this option, instead of getting your Medicare benefits through a Medicare Advantage plan, you may also be able to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.
The Tennessee Plan
Tennessee has an additional type of Medicare supplemental coverage, known as the Tennessee Plan. This coverage is state-sponsored and is available for retired public and education employees with Medicare Part A.
Under the Tennessee Plan, the state may pay for part of the plan premium if you have worked at least 15 years as an educator or public employee. If you apply within 60 days of when you’re first eligible, you generally can’t be rejected because of age or pre-existing health conditions. You cannot be enrolled in this plan if you qualify for Medicaid. Effective 2015, a spouse of a retiree can be enrolled in the Tennessee Plan only if the retiree is also enrolled in the Tennessee Plan.
For more information, visit www.tn.gov or contact the POMCO Group, the company that administers claims for the Tennessee Plan. To reach the POMCO Group, call 1-888-477-9307; TTY users can call 1-866-256-7256; Monday through Friday, from 8AM to 6PM Eastern Time.
For more information on Medicare and health services in Tennessee, refer to the following resources:
Learn more about how Medicare plans work in Tennessee including:
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.