Seniors in Tennessee with Medicare know that original Medicare only covers up to 80% of the complete health-related costs. This is why, in addition to their traditional Medicare, many seek additional Medicare supplemental insurance to cover the remaining 20% that are not covered by Tennessee Medicare.
This 20% not paid by original Medicare is from also referred to as the “co-payment”, which some consumers basically are unable to pay. Considering the fact that most seniors live on a very tight budget, paying those 20% co-payment can be a major problem. Unfortunately, the government is on a yearly basis increasing the Medicare premiums and reducing the benefits that are covered.
Here is what Medicare will and will not pay and what you can do to fill in the gaps that are not covered by traditional Medicare:
Medicare Part A: Hospital Expenses: For persons who are in a hospital for 24 hours Tennessee Medicare will pay for all hospital cost for the first 60 days after deductible. This deductible is reinstated every 60 days for subsequent admissions to the hospital or possibly six times a year. From day 61 to day 149 on you’ll have to co-pay per day. After 150 days you will have to pay 100% of the costs.
Medicare Part B: Doctor’s visits or Surgery, including lab test, X-rays, etc. Tennessee Medicare Part B will only cover 80% of the cost which means you have to pay for the additional 20%.
Medicare Part C (Medicare Advantage Plans): Under Medicare Part C seniors can enroll with one of many private insurance carriers instead of traditional Medicare. The premiums are relatively low or even zero compared to your Medicare Part B premium which you will have to continue to pay. However, under a Tennessee Medicare Advantage Plan you can expect deductibles, co-pays, waiting periods, etc. Medicare Advantage plans are run like group health plans where the carrier dictates the doctors, the location, the time etc of your health care much like PPO’s and HMO’S.
Medicare Part D: Drug Prescription coverage. Generally, the premium for Part D coverage is relatively inexpensive. Unless you are taking very specific expensive drugs, many Tennessee drugstores provide affordable drug programs to senior citizens.
Medicare Supplemental Insurance (Medigap): Many private insurance providers in Tennessee offer Medicare supplemental insurance plans that help full in the gap that traditional Medicare does not pay under Part A and Part B. Supplemental policies cover parts of co-pays and deductibles for Part A and Part B that the senior otherwise has to pay out of pocket.
So which is better for you – a Medicare Advantage Plan or Medicare Supplemental Insurance? As explained above, Medicare Advantage Plan coverage by a private insurance carrier is administered much like group health insurance with co-payments, deductibles and a selection of doctors. With a Medicare supplemental plan you have control over which doctor you can see, anytime and anywhere. Medicare Supplemental insurance is by law standardized into 10 plans, Plan A through Plan N, which means that Company A must offer the same benefits in their Plan L as Company B. But although the benefits are required by law to be identical; the rates that different insurers may charge can widely vary. There are supplemental plans that pay all of the cost medicare does not pay under Part A and B to plans that may have a yearly deductible. Of course the less you have to pay for coverage of the uncovered Medicare expenses, the higher your Supplemental premium will be. Regardless of the premium, you will at any rate enjoy much better health care benefits than with traditional Medicare. Also, regardless of your pre-existing health condition most seniors qualify for Medicare Supplemental insurance.
So if you live in Tennessee and are turning 65 be sure to check out your Medicare options – Tennessee Medicare Advantage Plans or Tennessee Medicare Supplemental Insurance.