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Tennessee State FlagMedicare Part D Plans in Tennessee

President Lyndon Johnson signed Medicare into law in 1965. The Medicare program didn't cover prescriptions until Congress passed the Medicare Modernization Act of 2003 (MMA). This legislation increased beneficiaries' Medicare plan options, introducing both Part C, (Medicare Advantage) and Part D (prescription drug coverage). On this page, we explain Medicare Part D in Tennessee.

How Can You Get Medicare Part D in Tennessee?

You have two options to get Medicare Part D in Tennessee: A standalone Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug plan (MA-PD)

Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Medicare Advantage plans must provide the same benefits as Original Medicare does. However, most plans also offer additional coverage. The most common added benefits are prescription drug coverage, routine vision and dental care, hearing aids, and fitness programs.

You can add a standalone Part D plan to either Original Medicare or an MA plan that doesn't offer prescription drug coverage. (Around 10 percent of MA plans do not cover prescriptions.)

If you're looking for an all-in-one plan, you should consider a Medicare Advantage Prescription Drug plan, which combines Original Medicare and Part D benefits into one policy.

Please note that you cannot have both an MA-PD and a standalone Part D plan.

Who Is Eligible for Medicare Part D in Tennessee?

If you have Medicare Part A and/or Part B, you qualify for Part D as well. In addition, you must also meet the individual plan's requirements. This usually means living in the plan's service area.

If you are a U.S. citizen or permanent legal resident, you will become eligible for Medicare when you turn 65. You are only automatically enrolled, though, if you begin receiving Social Security benefits at least 4 months before your 65th birthday. If not, you must apply for Medicare through the Social Security Administration.

You may also qualify for Medicare before you turn 65 if you collect Social Security disability benefits for 24 months. In this case, you will be automatically enrolled in both Parts A and B in month 25.

Nobody is ever automatically enrolled in Medicare Part D. Even you already collect Social Security, you must still choose to join a Part D prescription drug plan.

When Can You Enroll in a Prescription Drug Plan in Tennessee?

Medicare Part D enrollment in Tennessee in limited to specific times.

  • Initial Enrollment Period: Your IEP lasts for a full 7 months and begins 3 months before you become eligible for Medicare. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in June, your IEP begins on March 1 and ends on September 30. After you enroll in Part A and/or Part B, you may then sign up for a Part D prescription drug plan.
  • General Enrollment Period: If you missed your Initial Enrollment Period AND do not qualify for a Special Enrollment Period (SEP), you may sign up for Medicare Part A and/or Part B during General Enrollment from January 1 through March 31. You then have from April 1 through June 30 to join a prescription drug plan.
  • Medicare Annual Enrollment Period: AEP is available from October 15 through December 7 for current Medicare beneficiaries. During this time, you can make pretty much any changes you want to your Medicare coverage, including joining an MA-PD or Part D prescription drug plan.
  • Medicare Advantage Open Enrollment Period: From January 1 through March 31, Medicare Advantage beneficiaries may either switch to a new MA plan or return to Original Medicare. If making that change causes you to lose your prescription drug coverage, you may also sign up for a standalone Part D plan.
  • Special Enrollment Periods: If you experience certain life changes, like moving to a new address or losing your current coverage, you may qualify for a Special Enrollment Period. Medicare.gov provides the complete list of qualifying special circumstances here.

Comparing Medicare Part D Plans in Tennessee

Private insurance companies provide Medicare prescription drug plans, which means that coverage and costs can vary widely. To ensure you get the best plan for your particular needs and budget, you need to compare your Tennessee prescription drug plan options carefully.

Start by making a list of your prescription medications and then comparing it to the plan's drug formulary. If a plan does not include one or more of your medications, keep looking until you find one that does.

Next you should review the drug tiers, which lets you know approximately what your copay or coinsurance will be for a medication. Drugs on a lower tier cost less, with costs rising as the tiers do.

In addition to copays or coinsurance, your out-of-pocket costs for Medicare Part D may include an annual deductible and monthly premium. To understand the full cost of a plan, you need to look at all three of these metrics.

Extra Help is available to Medicare beneficiaries who have limited income and resources. You usually receive notification from either Medicare or Social Security if you qualify for Extra Help in Tennessee. If you believe you meet the requirements but did not receive this notification, contact your plan provider.

Please note that nobody from either Medicare or Social Security will ever call you. All communications are via U.S. mail unless you requested a phone call. If you receive a call from someone claiming to be from Medicare or Social Security, hang up the phone. Then, call the appropriate program (1-800-MEDICARE or 1-800-772-1213) and follow their instructions.

Do You Have to Have Medicare Part D in Tennessee?

No, there is no law that requires you to have any part of Medicare, including prescription drug coverage. However, the Medicare program encourages enrollment by penalizing people who qualify for Medicare but do not enroll AND do not have creditable coverage elsewhere. To be considered creditable, your prescription drug plan must offer comparable benefits to what you'd get with Medicare Part D and at a similar price. If you go 63 days or more without Part D coverage, you face lifelong late penalties when you do finally join.

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