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Medicare Part D Plans in Tennessee

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How Medicare Part D works in Tennessee

Medicare Part D is the Medicare prescription drug benefit and is available through private insurance companies that are approved by Medicare. As a Tennessee beneficiary, you can get prescription drug benefits in a few ways, depending on whether you’re enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage plan.

Original Medicare, Part A and Part B, doesn’t cover the cost of most prescription drugs. You’ll be covered under Medicare Part A for prescription drugs you get during a covered inpatient hospital stay. Medicare Part B covers certain medications you get in an outpatient setting, such as a doctor’s office; these tend to be prescription drugs that you can’t give yourself, such as chemotherapy drugs or vaccines. For coverage of most other prescription medications, you’ll need to enroll in a Medicare Prescription Drug Plan. These are stand-alone plans that work alongside your Original Medicare, Part A and Part B, coverage.

Another option for Tennessee beneficiaries is to enroll in a Medicare Advantage Prescription Drug plan. Also known as Medicare Part C, Medicare Advantage plans offer another way to get your Medicare Part A and Part B coverage. These plans cover at least the same level of coverage as Original Medicare, but may also cover additional benefits, such as wellness programs, hearing, or prescription drugs.

If you have Medicare Part C and want prescription drug coverage, you should enroll in a Medicare Advantage Prescription Drug plan, not a stand-alone Medicare Prescription Drug Plan. If you are already enrolled in a Medicare Advantage plan that includes prescription drug coverage and then subsequently enroll in a Medicare Prescription Drug Plan, you’ll be automatically disenrolled from your Medicare Advantage plan and reverted back to Original Medicare.

Enrolling in Medicare Part D in Tennessee

In Tennessee, as in the rest of the country, beneficiaries are eligible for Medicare Part D if they:

  • Have Medicare Part A and/or Part B, and
  • Live in the service area of a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan.

Like other parts of Medicare, you can sign up for Medicare Part D and make changes to your coverage during certain times. Those periods include:

  • Initial Enrollment Period (IEP) for Part D: This is the period when you’re first eligible for Medicare Part D. It typically takes place at the same time as your Initial Enrollment Period for Part B, starting three months before you turn 65, including the month you turn 65, and ending three months later. For beneficiaries who get Medicare because of disability, the IEP for Part D starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board, then continues for seven months.
  • Annual Election Period (AEP) (October 15 to December 7): Also called the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, this is your yearly opportunity to make changes to your Medicare Part D coverage or sign up if you haven’t already done so. During this time, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch Medicare plans, or disenroll from a plan.
  • Medicare Advantage Open Enrollment Period (OEP), January 1 to March 31: If you’re enrolled in a Medicare Advantage plan and want to go back to Original Medicare, you can use this period to disenroll from your Medicare Advantage plan. You can then use this same period to enroll in a stand-alone Medicare Prescription Drug Plan.

You can switch from one Medicare Advantage plan to a different one during the Medicare Advantage OEP described above.

  • Special Election Period: Outside of the above periods, you can’t make changes to your Medicare coverage unless you’re eligible for a Special Election Period. Some examples of circumstances that may qualify you for a Special Election Period include (but aren’t limited to) if you move out of your Medicare plan’s service area, lose your Medicaid eligibility, or move into a nursing home.

Comparing Medicare Part D coverage in Tennessee

As a Tennessee beneficiary, you may have many Medicare plan options when it comes to Medicare prescription drug coverage. Remember that plan availability often depends on where you live. Each county has different Medicare plan options, and your benefits and costs may also vary by location.

When you’re considering a Medicare plan that includes prescription drug coverage, it’s a good idea to check the plan’s formulary first to make sure your current medications are covered. The formulary is the list of medications covered by the plan. Medicare plans cover different prescription drugs, so it’s important to shop around and find Medicare plan options that cover all of the medications you currently take. The formulary may change at any time. You will receive notice from your plan when necessary.

Another factor to keep in mind is that Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans organize prescription drugs into cost tiers. Lower-tier medications will have lower copayments and coinsurance costs than higher-tier medications. Every Medicare plan categorizes medications into cost tiers differently. Ideally, your costs will be lowest if you enroll in a Medicare plan that covers your prescription drugs on the lowest possible tiers.

Need help finding Medicare plan options that cover your prescription drugs? Contact eHealth to speak with a licensed insurance agent about your Medicare prescription drug needs.

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