Medicare can be a cost-effective way to get medical coverage. When you become eligible for Medicare, you can choose to get coverage through Original Medicare, which includes Medicare Parts A and B, or through a Medicare Advantage Plan.

Medicare Advantage Plans are bundled plans that provide the same coverage as Original Medicare, but these plans are offered through Medicare-approved insurance companies. This allows Medicare Advantage Plans to provide a wider scope of coverage than Original Medicare. Many plans include prescription drug coverage and some may offer even more benefits such as vision, dental and hearing coverage. But since each plan is different, it’s important to compare your options before choosing a Medicare Advantage Plan in Tennessee.

Read this article to learn everything you need to know about Medicare Advantage Plans in Tennessee.

Medicare Advantage Plans in Tennessee

Compare ratings of insurance companies offering Medicare Advantage Plans in Tennessee:

Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars Fifth out of 10
Anthem Blue Cross Blue Shield 4 to 4.5 stars A+ A+ Not rated Sixth out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of 10
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

What You Should Know About Medicare Advantage Plans in Tennessee

  • In 2022, there are 112 Medicare Advantage plans available in Tennessee, compared to 117 plans in 2021.
  • 100% of Medicare beneficiaries have access to a zero premium Medicare Advantage plan in 2022.
  • The average Medicare Advantage monthly premium in 2022 is $18.74, a decrease from 2021.
  • Through the CMS Innovation Center’s Value-Based Insurance Design (VBID) Model, 14 plans will offer Medicare Advantage enrollees eliminated Part D cost-sharing; rewards and incentives programs related to healthy behaviors; and customized, innovative benefits that address social determinants of health, such as food insecurity and social isolation, for certain underserved and/or chronically ill enrollees.

Is Medicare Advantage Right for You?

You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.

Original Medicare Medicare Advantage Plans
Original Medicare covers your Part A hospital insurance and Part B medical insurance. Medicare Advantage Plans combine Part A, Part B, and additional benefits.
You can add Part D prescription drug coverage. Prescription drug coverage is usually included.
You’re able to use any medical provider in the U.S. that accepts Medicare. You’ll usually need to use doctors in your plan’s network.
You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance. Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.
Vision, hearing, dental, and other benefits aren’t covered. Your plan may offer additional benefits, including vision, hearing, and dental.
Note:

  • You can’t have both a Medicare Advantage Plan and a Medicare Supplement Plan.
  • You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan.

What’s covered with a Medicare Advantage Plan?

Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.

Hospital and skilled nursing facility inpatient care Home health care Prescription drug coverage (if included in your plan)
Medically necessary outpatient services, such as:

  • Doctor’s visits
  • Ambulance services
  • Emergency and urgent care
  • Durable medical equipment (DME)
  • Mental health care
  • Prescription drugs that you cannot self-administer
  • X-rays
  • Laboratory tests
Preventive services, such as:

  • Vaccinations
  • Cancer screenings
  • Diabetes screenings
  • Depression screenings
Additional benefits (depending on your plan), such as:

  • Routine vision exams with allowance for glasses
  • Routine dental exams
  • Hearing exams with allowance for hearing aids
  • Fitness and wellness programs and discounts
  • Transportation to medically necessary care
  • Over-the-counter (OTC) drugs

How to Compare Medicare Advantage Plans in Tennessee

With 112 Medicare Advantage Plans available in Tennessee, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:

  • Monthly premium: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
  • Plan network: You may need to use doctors and providers who are within a plan’s network. Before choosing a Medicare Advantage Plan, think about the doctors and facilities (including pharmacies) you prefer to use, then check if the plan offers coverage at those locations. Some plans may provide out-of-network coverage, but this usually comes at a higher cost.
  • Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles, and these may change only once per year on January 1.
  • Copayments and coinsurance: Copayments or coinsurance are how much you pay for each service or doctor’s visit, such as $20 per doctor visit. Each Medicare Advantage Plan sets its copayment or coinsurance amount that can differ from what you would pay through Original Medicare.
  • Out-of-pocket maximum: Each Medicare Advantage Plan sets a yearly limit on the maximum amount you’d be responsible for paying for services covered by Medicare. Once you reach this limit, you won’t have to pay anything for the services you receive covered by Part A and Part B in that year.
  • Additional coverage: Most Medicare Advantage Plans also provide prescription drug coverage and often include additional benefits that Original Medicare won’t cover, such as vision, dental, and hearing. Plans may provide even more benefits, like discounted gym membership or transportation to doctor’s visits. Medicare Advantage Plans can also tailor their benefits to the specific needs of particular chronically ill beneficiaries.

About Medicare Advantage Plans in Tennessee

There are 112 Medicare Advantage Plans offered in Tennessee. Depending on the county you live in, you could have many plans to choose from. These plans include:

  • Local HMOs
  • Local PPOs
  • Regional PPO plans
Number of Medicare Advantage Plans available Medicare Advantage Plan types available Medicare Advantage Plans rated 3.5 or higher by NCQA
112
  • Local HMO
  • Local PPO
  • Regional PPO
  • Aetna HMO
  • Aetna PPO
  • Cariten Health HMO
  • HealthSpring HMO
  • Humana PPO
  • Sierra Health PPO
  • UnitedHealthcare HMO-POS
  • UnitedHealthcare PPO

Types of Medicare Advantage Plans in Tennessee

In Tennessee, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.

Types of Medicare Advantage Plans
HMOs HMOs typically require that you receive all services from in network providers:

  • You must have a primary care physician (PCP), referrals for specialists, and prior authorizations for treatments and some prescriptions.
  • Drug coverage usually is included. You aren’t able to purchase standalone drug coverage.
  • Lower costs if you stay in network.
PPOs PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.

  • You don’t need to choose a primary care doctor or referrals for specialists.
  • Drug coverage is usually included.
  • You aren’t able to purchase stand-alone drug coverage.
  • Higher premium and out-of-network costs.
PFFS Plans PFFS plans don’t require a primary care physician or referrals for specialists:

  • You can go to any Medicare-approved health care provider or facility that accepts the plan’s payment terms and agrees to treat you.
  • May include drug coverage, or you can purchase a standalone drug plan.
  • Higher cost if you choose a provider that doesn’t agree to the plan’s terms.
SNPs SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:

  • You need a PCP and referrals to specialists.
  • Drug coverage is always included.
  • If you’re eligible, you can join an SNP at any time.

Enrollment and Eligibility for Medicare Advantage Plans in Tennessee

You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:

  • You’ve received Social Security Disability Insurance or Railroad Board Disability Annuity for 24 months
  • You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
  • You have End-Stage Renal Disease

When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.

  • Your IEP begins three months before the month you turn 65 and extends for three months after the month you turn 65. During this period, you can enroll in a Medicare Advantage Plan. If you join before the month you turn 65, your coverage will begin the first day of the month you turn 65. If you enroll in the three months after turning 65, your coverage will begin the first day of the month after you enroll.
  • If you miss your IEP, you can sign up for Medicare during the General Enrollment Period from January 1 to March 31.
  • After you enroll in Medicare, you can enroll in or make changes to your Medicare Advantage Plan coverage during the Medicare OEP from October 15 and December 7 of each year. During this time, you can change from Original Medicare to Medicare Advantage, switch to a different Medicare Advantage Plan, or change from Medicare Advantage back to Original Medicare.

Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.

There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.

Medicare Enrollment Periods
Enrollment period When it happens Medicare plans you can choose What you can do
Initial Enrollment Period Three months before you turn 65, the month you turn 65, and three months after Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.
General Enrollment Period January 1 – March 31 Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June. Sign up for Medicare if you missed your IEP
Open Enrollment Period October 15 – December 7 Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan Join, switch, or drop a plan
Medicare Advantage Open Enrollment Period January 1 – March 31 Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare
Special Enrollment Period When you have a qualifying event Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan Make changes to your plan

Tennessee Medicare Advantage Plans With Prescription Drug Coverage

Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Tennessee Medicare Advantage Plan to use.

Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.

Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.

Getting Help with Medicare Advantage Plans

Tennessee-wide Medicare Advantage Resources
Resource Contact How they help
TennCare Medicaid Phone: 800-342-3145 TennCare is the state of Tennessee’s Medicaid program, which provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children and individuals who are elderly or have a disability
Tennessee Commission on Aging and Disability Phone: 866-836-6678 The mission of the Tennessee Commission on Aging and Disability is to bring together and leverage programs, resources, and organizations to protect and ensure the quality of life and independence of older Tennesseans and adults with disabilities
Tennessee Department of Commerce & Insurance Phone: 615-741-2241 The Tennessee Department of Commerce & Insurance\protects Tennesseans through balanced oversight of insurance and regulated professions while enhancing consumer advocacy, education and public safety
Tennessee Senior Medicare Portal Phone: 866-836-7677 SMP offers assistance in educating beneficiaries on identifying and preventing Medicare and Medicaid fraud, waste and abuse
Tennessee State Health Insurance Assistance Program (SHIP) Phone: 877-801-0044

email: [email protected]

The Tennessee State Health Insurance Assistance Program (TN SHIP) is a federally funded program that provides free and unbiased counseling and assistance to Tennessee’s Medicare-eligible individuals, their families, and caregivers
Local Medicare Advantage Resources
Resource Contact How they help
Anderson County Office on Aging Services Phone: 865-457-3259

email: [email protected]

The Anderson County Office on Aging & Senior Center coordinates with other local agencies, organizations, businesses, and churches to provide for the needs of those 60+ years of age in Anderson County
East Tennessee Area Agency on Aging and Disability Phone: 866-836-6678 The East Tennessee Area Agency on Aging and Disability is responsible for developing an advocacy and service delivery system in east Tennessee for persons age 60 and over and for persons with disabilities
East Tennessee Senior Medicare Portal Phone: 877-801-0044

email: [email protected]

The purpose of the Senior Medicare Fraud Patrol Project is to reduce Medicare waste and abuse by increasing public awareness through educational programs and by assisting the beneficiary in reading and understanding Medicare documents and how to report suspicious claims
First Tennessee Area Agency on Aging and Disability Phone: 866-836-6678 The mission of the First Tennessee Area Agency on Aging and Disability is to assist older individuals and adults with disabilities in Northeast TN with information and services that promote quality of life and independence
Greater Nashville Aging and Disability Service Phone: 615-255-1010 The primary purpose of the Aging and Disability Program is to coordinate the delivery of services and programs which promote an environment conducive to enhancing the quality of life of the region’s older population
Greater Nashville Area Agency on Aging and Disability Phone: 877-973-6467 The Southeast Tennessee Area Agency on Aging and Disability is part of a statewide network of agencies who work to assure that our state’s older residents and individuals with disabilities receive the services they need to live as independently as possible for as long as possible
Middle Tennessee Age Well Phone: 615-353-4235

email: [email protected]

Middle Tennessee Age Well’s goal is to champion informed and positive aging and serve as the area’s catalyst for collaborative solutions
Northwest Tennessee Area Agency on Aging and Disability Phone: 731-587-4213 NWTAAAD identifies community and social service needs and assures that they are available to people 60 years and older and to adults with disabilities in the communities where they live in an effort to keep these individuals active, healthy and independent for as long as possible
South Central Tennessee Area Agency on Aging and Disability Phone: 931-379-2929

email: [email protected]

AAAD provides you with accurate, up-to-date information about community resources and support
Southwest Tennessee Area Agency on Aging and Disability Phone: 731-668-7112

email: [email protected]

The AAAD administers service coordination and assessment activities, awards annual grants to organizations providing services, sponsors activities established under the National Family Caregiver Support Program, operates a public guardianship program for the elderly, and organizes special activities/events in the region
Tennessee Aging Commission of the Mid-South Phone: 901-222-4111 Tennessee Aging Commission of the Mid-South provides information and assistance to connect seniors, adults with disabilities, their families and caregivers with the tools needed to maximize their independence and safety in their chosen community
Upper Cumberland Area Agency on Aging and Disability Phone: 866-836-6678 The Upper Cumberland Area Agency on Aging and Disability (AAAD) offers a wide array of programs and services for individuals over the age of 60 and other adults with disabilities
West Tennessee Healthcare Portal Phone: 731-541-5000 West Tennessee Healthcare provides you with secure, quick access to your medical records and a safe, private way to contact your healthcare provider
Williamson County 2021 Medicare Advantage Plan Comparison N/A A comparison chart of the two available Medicare Advantage plans in Williamson County
Federal Medicare Advantage Resources
Resource Phone How they help
CMS Medicare Managed Care Appeals & Grievances 1-800-MEDICARE Offers information and guidance on Medicare and its connected programs.
CMS Medicare Managed Care Eligibility and Enrollment 1-800-633-4227 This resource contains information for current and future contracting Medicare Advantage (MA) organizations, other health plans, and other parties interested in the operational and regulatory aspects of Medicare health plan enrollment and disenrollment.
CMS Medicare Prescription Drug Eligibility and Enrollment 1-800-424-4301 This page contains enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment.
Medicare.gov 1-800-MEDICARE The main government website for signing up for (or making changes to) Medicare coverage.
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Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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