Medicare Coverage Guidance for Tennessee Residents

Navigating Medicare requires accurate, current information and guidance suited to individual circumstances. Wilkinson Insurance Agency provides residents throughout the state with the information and support needed to select coverage appropriate to their healthcare needs and financial circumstances.

Medicare Coverage Overview

Original Medicare consists of two parts:

• Part A (Hospital Insurance) provides coverage for inpatient hospital stays, skilled nursing facility care, hospice care and certain home health services. Most beneficiaries are not subject to a monthly premium for Part A if they or a spouse paid Medicare taxes for a sufficient period while employed.
• Part B (Medical Insurance) provides coverage for physician visits, outpatient care, preventive services and durable medical equipment.

Additional options include the following:

• Part C (Medicare Advantage) allows beneficiaries to receive Part A and B benefits through a private insurance plan approved by Medicare. These plans may include additional benefits beyond what Parts A and B cover, such as dental and vision coverage.
• Part D is designed to help cover prescription drugs through private insurance plans approved by Medicare. 

Medigap Plans

Medicare Supplement insurance, commonly known as Medigap, is private coverage designed to help pay for costs that Original Medicare (Parts A and B) does not cover, such as copayments, coinsurance and deductibles, and policies are standardized by letter so that a given letter provides the same basic benefits regardless of which company sells it, though premiums vary by insurer.

Because Medigap does not include prescription drug coverage and cannot be used together with a Medicare Advantage plan, individuals considering their options are encouraged to speak with a licensed agent to compare available policies and confirm current eligibility rules.

Medicare Costs

Medicare costs are established annually by the federal government. Beneficiaries are subject to a standard monthly premium for Part B, and those with higher reported income may be subject to an additional adjustment tied to income. Part B also carries an annual deductible. Once that deductible is met, Medicare generally covers 80% of covered services, with the beneficiary responsible for the remaining 20%.

Part A carries an inpatient hospital deductible that applies per benefit period. Extended hospital stays are subject to daily coinsurance after a certain number of days, and skilled nursing facility care is subject to daily coinsurance after an initial coverage period within a benefit period.

Because these figures change annually and can vary based on income and plan selection, we encourage individuals to confirm current amounts with one of our licensed agents.

Enrollment Periods

Relevant enrollment periods include the following.

• The Initial Enrollment Period is a seven-month period surrounding an individual’s 65th birthday.
• The Annual Enrollment Period runs from October 15 through December 7 of each year, during which coverage may be reviewed and modified for the following year.
• The General Enrollment Period runs from January 1 through March 31 for individuals who did not enroll during their Initial Enrollment Period.

Contact Us

Please contact us to speak with a licensed agent about your Medicare coverage options.