- Nearly 1.4 million people are enrolled in Medicare in Tennessee; 20 percent are eligible due to a disability.
- A little more than a third of Tennessee Medicare beneficiaries select Medicare Advantage plans.
- Tennessee Medicare Advantage enrollees can select from between 28 and 58 Medicare Advantage plans for 2021, depending on their county.
- Tennessee law guarantees access to Medigap plans for enrollees under age 65, but insurers can charge them much higher premiums.
- About 77 percent of Tennessee Medicare beneficiaries have Medicare Part D prescription drug coverage, either as a stand-alone policy or as part of a Medicare Advantage plan.
- Per-enrollee Medicare spending in Tennessee is just slightly higher than the national average.
Medicare enrollment in Tennessee
As of September 2020, Tennessee Medicare enrollment stood at 1,383,117, including those with Original Medicare and those with Medicare Advantage plans. That’s about 20 percent of the state’s total population, compared with about 19 percent of the United States population enrolled in Medicare.
Of Tennessee’s Medicare beneficiaries, 81 percent are eligible based on their age (ie, being at least 65 years old), while the other 20 percent are eligible due to a disability (24+ months of receiving Social Security Disability Insurance, or a diagnosis of ALS or end-stage renal disease).
Nationwide, 85 percent of people filing for Medicare benefits are eligible due to age, while 15 percent are eligible due to disability. But as of 2016, Tennessee was among the states with the highest percentage of residents receiving disability benefits, so it makes sense that the percentage of Medicare beneficiaries in Tennessee who qualify because of a disability is higher than the national average.
Medicare Advantage in Tennessee
Medicare Advantage is available as an alternative to Original Medicare. Medicare Advantage includes all of the benefits of Original Medicare (hospital and outpatient/physician coverage), although the out-of-pocket medical costs can be very different, as Advantage plans can set their own coinsurance, copays, and deductible levels (within parameters set by CMS). Most Advantage plans also include Part D coverage for prescription drugs, as well as extra programs like dental and vision coverage.
But Advantage plans tend to have localized provider networks, as opposed to Original Medicare’s nationwide access to medical providers. There are pros and cons to either option.
Thirty-six percent of Tennessee Medicare beneficiaries selected private Medicare Advantage plans in 2018, which was comparable to the 33 percent of all Medicare beneficiaries nationwide who were enrolled in Medicare Advantage plans. The remaining 64 percent of Tennessee’s Medicare beneficiaries had opted instead for coverage under Original Medicare.
By mid-2020, however, more than 42 percent of the people enrolled in Medicare in Tennessee had Medicare Advantage plans. This aligns with the overall growth in Medicare Advantage enrollment nationwide; at that point, 40 percent of all Medicare beneficiaries nationwide were enrolled in private plans, nearly all of which were Medicare Advantage plans (there are still Medicare Cost plans available in some areas, and those are included in the private plan enrollment total as well).
The availability of Medicare Advantage plans in Tennessee varies from one county to another, but the market is fairly robust throughout the state. For 2021 coverage, availability ranges from 28 Medicare Advantage plans in Dyer and Obion counties to 58 plans in Davidson County.
Medicare beneficiaries can switch from Original Medicare to Medicare Advantage or vice versa during the annual election period in the fall (October 15 to December 7, with coverage effective January 1). And there’s also a Medicare Advantage open enrollment period (January 1 to March 31) during which Medicare beneficiaries who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
- Learn about Medicare’s annual open enrollment period.
- Questions to ask when you’re deciding between Medicare Advantage and Original Medicare.
- Learn how Tennessee Medicare beneficiaries with limited financial means can be helped by Tennessee’s Medicaid program.
Medigap in Tennessee
Medigap plans are optional coverage used to supplement Original Medicare, covering some or all of the out-of-pocket medical costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.
Medigap plans are standardized under federal rules, and people are granted a six-month enrollment window (which starts when they’re at least 65 years old and enrolled in Medicare Part A and Part B), during which coverage is guaranteed issue for Medigap plans and premiums cannot vary according to the applicant’s health. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.
But Tennessee is among the majority of the states that have adopted rules to ensure that people under age 65 have at least some access to Medigap plans. Since 2011, under state law, Tennessee Medigap insurers that offer plans to people age 65 and older are required to offer all of the same plans to people under 65 who become eligible for Medicare as a result of a disability. Disabled Tennessee residents have the same six-month open enrollment window for Medigap as those who gain eligibility for Medicare due to their age. The six-month window starts when the person is enrolled in Medicare Part B, and coverage is guaranteed issue during the enrollment window.
Tennessee residents under age 65 can be charged higher premiums for their Medigap coverage. Under the terms of the state law regarding Medigap access for people under age 65, Tennessee was to conduct a study after five years (which would have been in 2016) to determine whether the state should continue to allow Medigap insurers to place under-65 enrollees in a separate risk pool for rating purposes. But as of 2020, a quick look at Medicare’s Medigap plan finder tool indicates that the state has not changed anything about the rating requirements: A non-smoking male who is 65 years old will pay between $56 and $222 per month for Medigap Plan A in Tennessee, whereas a non-smoking male under the age of 65 will pay between $243 and $786 per month for the same policies.
People who are enrolled in Medicare and a Medigap plan prior to age 65 are granted another Medigap open enrollment period when they turn 65, allowing them to switch to a lower-priced Medigap plan at that point.
Medicare Part D in Tennessee
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription drug plan.
As of September 2020, there were 503,832 Medicare beneficiaries enrolled in stand-alone Part D prescription drug plans in Tennessee, and another 560,509 beneficiaries who had Part D coverage integrated with their Medicare Advantage plans. Two years earlier, in 2018, the number of people enrolled in stand-alone Medicare Part D plans in Tennessee had been higher than the number of beneficiaries with Part D coverage integrated with Medicare Advantage. But the growth in Medicare Advantage enrollment has resulted in declining enrollment in stand-alone Part D coverage and increasing enrollment in Advantage plans that include Part D coverage (overall enrollment in Medicare has been growing, as has overall enrollment in Part D coverage).
For 2021 coverage, there are 32 stand-alone Part D plans available in Tennessee, with premiums ranging from $7 to $139 per month.
Medicare Part D enrollment is available when a person is first eligible for Medicare, and beneficiaries can make changes to their Part D coverage each fall, from October 15 to December 7. Changes made during that time will take effect the following January. Beneficiaries can use Medicare’s plan finder tool to see how each plan would cover the drugs they need, keeping in mind that Part D plans change from one year to another, and each person’s prescription needs change as well.
Medicare spending in Tennessee
In 2018, Original Medicare spent an average of $10,194 per beneficiary in Tennessee, based on data that were standardized to eliminate regional differences in healthcare payment rates. That figure does not include costs for Tennessee Medicare Advantage enrollees, as the data were only based on Original Medicare spending. The national average that year was $10,096 per enrollee, so Medicare spending in Tennessee was only slightly higher than the national average.
On the high and low ends of the spectrum, Medicare spending in Louisiana was the highest in the nation in 2018, at an average of $11,932 per beneficiary. And it was the lowest in Hawaii, at just $6,971 per beneficiary.
How does Medicaid provide financial assistance to Medicare beneficiaries in Tennessee?
Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Tennessee includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Medicare in Tennessee: Resources
The Tennessee State Health Insurance Assistance Program for Medicare Participants can provide a variety of assistance and information, including answering your questions about Medicare eligibility in Tennessee and Medicare enrollment in Tennessee.
The Tennessee Commission on Aging and Disability is also an excellent resource for Medicare beneficiaries in Tennessee, or people who will soon be eligible for Medicare in Tennessee.
The Tennessee Department of Commerce and Insurance licenses and oversees the health insurers that offer coverage in the state, as well as the brokers and agents who sell the policies. Their office can provide assistance and guidance for consumers with various insurance-related questions. Medicare Advantage and Part D plans are regulated at the federal level by CMS (states oversee financial solvency and licensing), but the state is responsible for much of the regulations that apply to Medigap plans, other than the federal standardization described above.
The Medicare Rights Center is a nationwide service that can provide assistance and information about Medicare enrollment, eligibility, and benefits.
This resource explains how Tennessee Medicaid can provide assistance to Medicare beneficiaries who have limited income and assets.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.