Medicare is a federally funded healthcare program for seniors, medicare eligibles and some disabled Americans. The program is administered by CMS, the Centers for Medicare and Medicaid services. Medicare Plan Finder provides Medicare help in Tennessee and 37 other states.
Even though CMS manages both Medicare and Medicaid, remember that Medicare and Medicaid are not the same thing. While Medicare is mainly for seniors and those with certain disabilities, Medicaid (TennCare) is for low-income individuals. It is possible to qualify for both Medicare and Medicaid, but they are NOT the same program.
If you qualify for both Medicare and Medicaid in Tennessee, you’ll qualify for extra benefits. You’ll likely have a special enrollment period, meaning you don’t have to wait until the fall to change plans. You may also qualify for Extra Help, the Medicare prescription drug savings program, or another Medicare Savings Program.
Let’s talk about Medicare in Tennessee eligibility. Anyone who is age 65 or older is eligible for Medicare in Tennessee. Unlike some private health insurance plans, pre-existing conditions will not change your eligibility. You can and should enroll starting three months before your 65th birthday. If you wait too long to enroll, you will need to pay a late enrollment penalty fee, so it is best to enroll as soon as you are eligible.
Some people who are not yet 65 can still qualify for Medicare programs in Tennessee. If you have been receiving SSDI (Social Security Disability Income) for over 24 months, you will be automatically enrolled in Medicare benefits in Tennessee during your 25th month. You can also qualify for Medicare if you are under 65 but have ESRD (End-Stage Renal Disease) or ALS (otherwise known as Lou Gehrig's Disease). Finally, those who receive railroad retirement benefits may qualify for Medicare before turning 65.
No matter which state you reside in, you will begin your Medicare journey with Original Medicare. Original Medicare is comprised of Part A, hospital coverage, and Part B, medical coverage. Once you have Original Medicare, you’ll need to add a prescription drug plan.
Once you have your basic coverage, you can choose to enroll in a Medicare Advantage plan, otherwise known as Part C, or a Medicare Supplement plan, otherwise known as Medigap. Most insurance carriers offer Medicare Advantage plans in Tennessee that include Original Medicare, prescription drug coverage, dental, vision, and hearing coverage, and even fitness benefits. Most major carriers also offer Medicare Supplements in Tennessee, which usually do not offer extra benefits but can help you pay for your coinsurance, copayments, and deductibles.
In Tennessee, Medicare Supplement plans are organized by letter. Options are A, B, C, D, F, G, K, L, M, and N. Each plan letter will offer a different amount of coverage for a different price. The first thing your insurance agent can help you decide is which letter plan you should look for.
Tennessee Medicare Dental Coverage
Dental is one benefit that is missing from Original Medicare. The only way Original Medicare will cover any dental services or treatments is if it directly relates to another hospital stay. For example, if you are in the hospital due to an oral cancer treatment and your doctor performs an oral exam, that "dental" care can fall under Medicare Part A.
Additionally, there are low-cost dental clinics throughout the state of Tennessee available exclusively for low-income individuals and families. If you don't fall below the poverty line, this may not apply to you. If you believe you may qualify, check out this post about the Interfaith Dental Clinic located in both Nashville and Murfreesboro.
The Tennessee Commision on Aging and Disability offers several different programs for the elderly and disabled:
The National Family Caregiver Support Program (NFCSP) provides assistance to counselors, adult day care, in-home adult care and more. They can even help with medical equipment, personal response systems, meal delivery, and minor home modifications.
You don’t have to be a formal caregiver to receive support from the NFCSP. If you are over 18 and are providing care to an individual who is above age 60 or has Alzheimer’s or a related disease, or if you are providing care to a person who is under age 60 and you are not their parent, you may be eligible for caregiver support. You can find contact information for your local NFCSP here.
Information and Assistance (I&A)
The I&A program connects people like you with health care services. When you call in, a specialist will help you figure out what you need, who you need to reach out to, and what programs you are eligible for. To find a local I&A specialist, call the Eldercare Locator hotline at 1-800-677-1116 or click here.
Long-Term Care Ombudsman
The Ombudsman helps long-term care facility residents and their families answer questions and resolve problems related to the facility and its quality of care, financial issues, resident rights, and admissions.
The Nutrition Services department of the Tennessee Commission on Aging and Disability serves close to a million meals at senior centers, community centers, and other locations with people in need each year. They also deliver over a million meals to homebound and sick seniors & medicare eligibles in Tennessee. The meal delivery person performs a quick safety check. These meals are all free, but donations are encouraged.
The options program is a way for you to receive home services like personal care, home meals, and homemaker services. To be eligible for OPTIONS, you must meet the ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living) requirements. This means that to qualify, you must be unable to complete household functions like cleaning, laundry, grocery shopping, cooking, handling medications, and transportation on your own.
If you do not have a family member, friend, bank, or company that you feel comfortable trusting with your financial and medical decisions, you may be eligible for a Public Guardian, or Conservator. Conservators are free for those who are low-income and in need.
There are three main places where you can apply for Medicare in Tennessee through Social Security. You can go to www.SocialSecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday from 7 AM to 7 PM, or apply in-person at your local Social Security office.
We have agents throughout the state of Tennessee that can come to your home to help you sort through your options and enroll in the best plan for your needs. They can help you select whether you want Medicare Advantage or Medicare Supplements in Tennessee, and then which plan works best for you.
To get started enrolling in Medicare insurance in Tennessee, give us a call at 833-GET-ENROLLED (833-438-3676).
If you were employed and paid Medicare taxes for at least 39 quarters, you’ll get “premium-free Part A,” which means you will not have a premium for your hospital coverage. If you only paid Medicare taxes for 30-39 quarters, you’ll pay $240 per month in 2019. If you did not pay Medicare taxes for at least 30 quarters, you’ll pay $437 per month in 2019.
The standard premium for Part B (which covers your doctor visits) is $135.50 per month in 2019, but this can change based on your income. While Part A and Part B are standardized, other coverage will vary based on the plan you choose.
You’ll need to start by enrolling in Original Medicare (Part A and Part B), but then you’ll have some other Medicare options in Tennessee. You’ll want to consider your prescription drug coverage options first as you’ll be charged a late enrollment penalty fee if you wait too long. You can get prescription drug coverage and avoid the fee by enrolling in either Part D, Medicare Advantage, or Medicare Supplements.
Part D plans are standalone prescription drug plans, meaning prescription drugs are the only thing they cover. You’ll be charged a premium similarly to your medical coverage and you’ll have a pharmacy network and drug formulary. Your Medicare prescription drug formulary is a sheet that tells you what prescription drugs are covered and at what level. There are usually three or four tiers to your formulary, and evey tier provides a different amount of coverage. Generic drugs are usually cheaper than brand-name.
If you’d prefer you can enroll in a Medicare Advantage plan with prescription drug coverage instead. These are typically referred to as MAPD plans, or Medicare Advantage prescription drug plans. They always cover Part A, Part B, and Part D, and then usually include extra benefits like dental, vision, hearing, and fitness. You’ll have several different options in your area for a Medicare Advantage plan as they are offered by private insurance companies instead of CMS.
The third option is harder to find, but some Medicare Supplement (Medigap) plans include prescription drug coverage. However, Medigap plans are really designed to provide financial benefits instead of health benefits. They can help cover your deductibles, copayments, and coinsurance (for a separate premium).
The best Medicare plan is going to depend on your individual needs. That may not be the answer you want to hear, but it’s true! That’s why there are so many options - every Medicare beneficiary is different. You’ll want to look at your healthcare needs, what doctors and pharmacies you like, what prescription drugs you’re taking, and where your finances stand to determine which Medicare plans in Tennessee are best for you.
What is the Best Medicare Supplement in Tennessee?
Most Medicare Supplements in Tennessee are going to have the same basic coverage. You will pay a premium, and in turn you’ll have coverage for your copayments, coinsurance, and deductibles. Other benefits can vary and will depend on what you’re looking for out of your Medicare plan. A Medicare Plan Finder agent can answer your Medicare questions and help you choose the best Medicare Supplement.
What is the Medicare Savings Program in Tennessee?
There are four Medicare Savings Programs in Tennessee. If you qualify for any of the below, you will also qualify for Medicare Extra Help, a separate program that helps you pay for your prescription drug coverage.
Qualified Medicare Beneficiary Program (QMB)
The QMB program helps pay for the Part A and Part B premiums, deductibles, copayments, and coinsurance. If you are single, you may qualify if you earn no more than $1,032/month and have less than $7,560 in resources and assets. If you are married, you may qualify if you earn no more than $1,392/month and have less than $11,340 in resources and assets.
Specified Low-Income Medicare Beneficiary Program (SLMB)
The SLMB program covers Part B premiums. If you are single, you may qualify if you earn no more than $1,234/month and have less than $7,560 in resources and assets. If you are married, you may qualify if you earn less than $1,666/month and have less than $11,340 in resources and assets.
Qualifying Individual Program (QI)
The QI program helps pay for Part B premiums, and if you qualify, you must apply again every year. If you are single, you may qualify if you earn no more than $1,386/month and have less than $7,560 in resources and assets. If you are married, you may qualify if you earn less than $1,872 and have less than $11,340 in resources and assets.
Qualified Disabled and Working Individuals Program (QDWI)
The QDWI program program helps pay the Part A premium. To qualify, you must either be a working disabled person under 65, have lost your premium-free Part A because you went back to work, are not receiving state medical assistance, and/or meet the income and resource limits for your state. Federally, the limits are: $4,132/$4,000 single, $5,572/$6,000 married.
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