At a glance: Medicare health insurance in Tennessee
- More than 1.3 million Tennessee residents are enrolled in Medicare; 20 percent are eligible due to a disability.
- A little more than a third of Tennessee Medicare beneficiaries select Medicare Advantage plans.
- Tennessee enrollees can select from between 15 and 37 Medicare Advantage plans in 2019, depending on their county.
- Tennessee law guarantees access to Medigap plans for enrollees under age 65.
- About 39 percent of Tennessee Medicare beneficiaries have stand-alone Part D prescription coverage.
- Per-enrollee Medicare spending in Tennessee is just slightly higher than the national average.
Medicare enrollment in Tennessee
As of November 2018, 1,326,033 Tennessee residents had Medicare coverage, including those with Original Medicare and those with Medicare Advantage. That’s a little more than 19 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.
Of Tennessee’s Medicare beneficiaries, 80 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. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability. But as of 2011, Tennessee was among the states with the highest percentage of their residents receiving disability benefits, so it makes sense that the percentage of Medicare beneficiaries in the state who qualify because of a disability is higher than the national average.
Medicare Advantage in Tennessee
Thirty-six percent of Tennessee Medicare beneficiaries selected private Medicare Advantage plans in 2017, 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.
The availability of Medicare Advantage plans varies from one county to another, but Tennessee has a fairly robust market throughout the state. Plan availability ranges from 15 plans in Lake County to 37 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 as of 2019, 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.
Medigap in Tennessee
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket 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 window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. 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 Tennessee law, 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 2019, a quick look at Blue Cross Blue Shield of Tennessee’s Medigap pricing indicates that the state has not changed anything about the rating requirements: A person under 65 will pay $661/month for Plan A and at least $1,000/month for any other BCBSTN plan, whereas a person age 65 can buy most of the BCBSTN Medigap plans for under $150/month.
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 plan.
As of November 2018, there were 516,848 Medicare beneficiaries in Tennessee who were enrolled in stand-alone Part D prescription drug plans. That’s about 39 percent of the state’s total Medicare beneficiaries, so roughly comparable to the 43 percent of all Medicare beneficiaries nationwide who are enrolled in stand-alone Part D plans.
Another 482,106 Tennessee Medicare beneficiaries have Part D coverage integrated with their Medicare Advantage plans.
For 2019 coverage, there are 29 stand-alone Part D plans available in Tennessee, with premiums ranging from $16 to $120 per month.
Medicare spending in Tennessee
In 2016, Original Medicare spent an average of $9,749 per beneficiary in Tennessee, based on data that were standardized to eliminate regional differences in payment rates. Costs Medicare Advantage enrollees were not counted, as the data were only based on Original Medicare spending. The national average that year was $9,533 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 2016, at an average of $11,399 per beneficiary. And it was the lowest in Hawaii, at just $6,441 per beneficiary.
You can read more about Medicare in Tennessee in our state Medicare guide. You can also contact the Tennessee State Health Insurance Assistance Program for Medicare Participants, if you have questions related to Medicare coverage in Tennessee.
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.