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Tennessee Medicare Insurance Options
I will be happy to educate you on your many Medicare options and explain the differences between a Medicare Supplement and the Medicare Advantage Plans offered in TN.
What services does Medicare cover?
Medicare Part A and Part B cover certain medical services and supplies in
hospitals, doctors’ offices, and other health care settings. Prescription drug
coverage is provided through Medicare Part D.
If you have both Part A and Part B, you can get all of the Medicare-covered
services listed in this section, whether you have Original Medicare or a
Medicare Advantage Plan or other Medicare health plan.
What does Part A cover?
Part A (Hospital Insurance) helps cover:
- Inpatient care in a hospital
- Inpatient care in a skilled nursing facility (not custodial or
long-term care) - Hospice care
- Home health care
- Inpatient care in a religious nonmedical health care institution
What does Part B cover?
Medicare Part B (Medical Insurance) helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services.
What’s NOT covered by Part A and Part B?
Medicare doesn’t cover everything. If you need certain services that aren’t
covered under Medicare Part A or Part B, you’ll have to pay for them yourself unless:
- You have other coverage (including Medicaid) to cover the costs.
- You’re in a Medicare Advantage Plan that covers these services.
Some of the items and services that Original Medicare doesn’t cover include:
- Most dental care.
- Eye exams related to prescribing glasses.
- Dentures.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Acupuncture.
- Hearing aids and exams for fitting them.
- Long-term care. See the next page for more information.
- Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).
What are Medicare Advantage Plans?
A Medicare Advantage Plan is another way to get your Medicare coverage.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. However, many plans offer out-of network coverage, but sometimes at a higher cost.
Medicare Supplement Insurance (Medigap) Policies
Original Medicare pays for much, but not all, of the cost for covered health
care services and supplies. Medicare Supplement Insurance policies, sold
by private companies, can help pay some of the remaining health care
costs for covered services and supplies, like copayments, coinsurance,
and deductibles. Medicare Supplement Insurance policies are also called
Medigap policies. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Medigap policies are standardized
Every Medigap policy must follow federal and state laws designed to protect
you, and they must be clearly identified as “Medicare Supplement Insurance.”
Insurance companies can sell you only a “standardized” policy identified
in most states by letters A through D, F, G, and K through N. All policies
offer the same basic benefits, but some offer additional benefits so you
can choose which one meets your needs.
Confused already?
Don’t worry, I can help, just fill out my contact form or call and I can answer any questions you might have to help you navigate through your medicare insurance options.
All information seen above can be read in full in the CMS MEDICARE AND YOU 2020 Handbook, along with a vast amount more information about your medicare insurance.
Medicare and You can be found here:
Medicare Costs at a Glance
This guide will show you exactly what medicare parts A and B will pay for and explains exactly what costs you’re still responsible for paying when you have Medicare Part A and B coverage.
Part B IRMAA Penalty Table
Part D IRMAA Penalty Table
Medicare Extra Help
You may be able to get extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. However, you must be enrolled in a Medicare Prescription Drug plan to get this extra help.
2022 Extra Help
Income and Resource Limits
To qualify for Extra Help, your annual income must be limited to $20,385 for an individual or $27,465 for a married couple living together.
Even if your annual income is higher, you may still be able to get some help. Some examples where your income may be higher and you can still get Extra Help include if you or your spouse:
- Support other family members who live with you.
- Have earnings from work.
- Live in Alaska or Hawaii.
To qualify for Extra Help, your resources must be limited to $15,510 for an individual or $30,950 for a married couple living together. Resources include the value of the things you own.
Some examples are:
- Real estate (other than your primary residence).
- Bank accounts including checking, savings and certificates of deposit.
- Stocks.
- Bonds, including U.S. Savings Bonds.
- Mutual funds.
- Individual Retirement Accounts (IRAs).
- Cash at home or anywhere else.
What does not count as a resource? We do not count:
- Your primary residence.
- Your personal possessions.
- Your vehicle(s).
- Resources you couldn’t easily convert to cash, such as jewelry or home furnishings.
- Property you need for self-support, such as rental property or land you use to grow produce for home consumption.
- Non-business property essential to your self-support.
- Life insurance policies.
- Burial expenses.
- Interest earned on money you plan to use for burial expenses.
Certain other money you are holding is not counted for nine months, such as:
- Retroactive Social Security or Supplemental Security Income (SSI) payments.
- Housing assistance.
- Tax advances and refunds related to earned income tax credits and child tax credits.
- Compensation you receive as a crime victim.
- Relocation assistance from a state or local government.
You should complete this application for Extra Help on the Internet if:
- You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
- You live in one of the 50 States or the District of Columbia; and
- Your combined savings, investments, and real estate are not worth more than $29,160, if you are married and living with your spouse, or $14,610 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. However, you can still enroll in an approved Medicare prescription drug plan for coverage.
EXCEPTION: Even if you meet these conditions, it is unnecessary to apply if you already have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid because you automatically will get the extra help.