Medicare Advantage Plans Memphis 2025
Are you trying to find the right Medicare Advantage Plans Memphis that fits your health needs and budget? Dive into our straightforward guide that simplifies the selection. We’ll help you understand your options, from benefits to costs, ensuring you can confidently make the best decision for your healthcare without financial stress.
Key Takeaways
- Memphis residents can choose from a variety of Medicare Advantage Plans, which offer benefits beyond Original Medicare, such as prescription coverage and caps on out-of-pocket costs, with at least one zero premium option available to all Tennessee beneficiaries.
- It’s essential for beneficiaries to assess individual healthcare needs, compare plan costs and benefits, including networks and extra coverages, and weigh these against potential out-of-pocket expenses before selecting a Medicare Advantage Plan.
- Eligible individuals can enroll in Medicare Advantage Plans during specific periods, including the Initial Enrollment Period around their 65th birthday or during annual Open Enrollment from October 15 to December 7, with special enrollment circumstances available for qualifying events.
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Medicare Advantage Plans in Memphis: An Overview
Medicare Advantage Plans in Memphis present a wide spectrum of options tailored to cater to the diverse healthcare needs of its residents. In 2025, there will be 123 plans available, slightly less than the 129 plans in 2024.
Despite this minor decrease, the range of options remains extensive. The average monthly premium is set to rise to $18.29, a slight increase from the previous year’s $17.08. However, all Tennessee residents will still have access to plans with $0 premiums.
These Advantage Plans, also known as Medicare plans, are designed to provide coverage that matches or surpasses Original Medicare.
They cover:
- Hospitalizations
- Doctor visits
- Outpatient care
- Prescription drugs
Moreover, they often have added perks such as dental, vision, and hearing benefits. What makes these plans even more attractive is the cap on out-of-pocket costs, a feature that Original Medicare does not offer.
Types of Medicare Advantage Plans in Memphis
When it comes to the types of Medicare Advantage Plans available in Memphis, residents can opt for:
- Local health maintenance organization (HMO) plans
- Local Preferred Provider Organizations (PPOs)
- Regional PPO plans
- Private Fee-For-Service (PFFS) plans
SNPs, in particular, are designed for individuals with certain chronic conditions or those who qualify for both Medicare and Medicaid. They provide targeted benefits tailored to meet the specific needs of these groups, thus ensuring comprehensive care for those who need it the most.
Plan Providers in Memphis
There’s a host of health insurance providers offering Medicare Advantage plans in Tennessee. Among them, Humana, National HealthCare Corporation, and Blue Cross BlueShield of Tennessee have received high ratings for their Medicare Advantage plans.
These providers offer a variety of plans that cater to different healthcare needs and budgets.
However, it’s important to note that the availability of benefits and plans can vary depending on location. Therefore, beneficiaries should confirm plan availability for their specific ZIP code before making a decision. This ensures they choose a plan that provides the best coverage in their area.
Comparing Medicare Advantage Plans in Memphis
When it comes to Medicare Advantage Plans, one size does not fit all. Each plan comes with its own set of benefits, costs, and provider networks. Therefore, it’s crucial to compare Medicare Advantage plans before making a decision, keeping in mind the Medicare rules.
The Centers for Medicare and Medicaid Services (CMS) simplify this process by awarding star ratings to Medicare Advantage plans based on their overall performance. These ratings, which can be checked using the Medicare.gov plan finder tool, reflect the experience of being enrolled in such coverage.
On average, Medicare Advantage Plans in Shelby County, Tennessee, come with a monthly premium of $17.96. The average out-of-pocket limit is $5,128 per year, and the average drug plan deductible is $198.83 per year. However, these figures are just averages, and the actual costs can vary from plan to plan.
Therefore, it’s important to consider these costs and the benefits each plan offers. Online resources, including educational materials and comparison charts, can help Memphis residents understand and compare different Medicare Advantage plans.
Assessing Your Healthcare Needs
Understanding your healthcare needs is crucial when choosing a Medicare Advantage Plan. If you have chronic health conditions, a Medicare Advantage plan might provide more beneficial and affordable coverage compared to separate Original Medicare and Medigap policies.
The cost-effectiveness of a Medicare health plan is heavily influenced by your healthcare needs, especially if you require regular treatment or medications.
One key aspect to consider is the provider network. Medicare Advantage plans, offered by Medicare-approved private companies, generally require enrollees to use a specific network of healthcare providers. Therefore, you should ensure that your preferred doctors are in-network to avoid higher out-of-pocket costs.
Evaluating Costs and Benefits
When evaluating the costs and benefits of Medicare Advantage Plans, it’s important to look beyond the monthly premium. Plans may offer $0 premiums, but out-of-pocket costs like copayments can accumulate quickly, especially in the event of illness. This could potentially lead to higher expenses than Original Medicare.
Moreover, Medicare Advantage plans generally provide a more limited choice of healthcare providers compared to Original Medicare plus Medigap. This could impact the access and costs of care.
It’s also important to consider the extra coverage and benefits offered by each plan. These can vary significantly and can affect overall costs. Some common extra coverages and benefits to consider are:
- Dental coverage
- Hearing coverage
- Fitness benefits
- Transportation benefits
Additionally, assistance programs like the Low-Income Subsidy (LIS) can help cover prescription drug costs.
Enrollment and Eligibility for Medicare Advantage Plans in Memphis
Individuals must meet specific qualifications to enroll in Medicare Advantage Plans in Memphis. Eligibility is based on age, with most people becoming eligible when they turn 65. Individuals under 65 can also qualify if they have a specific disability.
Medicare Advantage plans in Memphis must accept any Medicare-eligible participant, and at least one zero-premium Medicare Advantage plan is available to all Medicare beneficiaries in Tennessee.
Enrollment for these plans starts three months before you turn 65 and extends for three months after your 65th birthday month. In addition to this Initial Enrollment Period, there is also a fall open enrollment period that runs from October 15 to December 7.
Initial Enrollment Period
The Initial Enrollment Period is a seven-month window that begins three months before your 65th birthday, includes the month of your birthday, and extends for three months after your birthday. For individuals under 65, the Initial Enrollment Period is available if they qualify due to a disability.
During the Initial Enrollment Period, beneficiaries can:
- Join a Medicare Advantage Plan
- Switch to a different Medicare Advantage Plan
- Opt for Original Medicare within their first three months of having Medicare Part A and Part B.
Open Enrollment Period
The Open Enrollment Period is another opportunity for beneficiaries to change their Medicare Advantage plans. It runs annually from October 15 to December 7. During this period, beneficiaries can:
- Join a Medicare Advantage Plan
- Drop their current Medicare Advantage Plan
- Switch to another Medicare Advantage Plan, including plans with or without prescription drug coverage
Any changes made during the Open Enrollment Period become effective on January 1 of the following year.
Beneficiaries also have the option to switch back to Original Medicare during this period.
Special Enrollment Circumstances
Aside from the Initial and Open Enrollment Periods, beneficiaries might qualify for a Special Enrollment Period under certain circumstances.
These include:
- Moving to a new plan’s service area
- Becoming eligible for Medicaid
- Losing current coverage
- Becoming eligible for Extra Help with prescription costs
During the Special Enrollment Period, consumers can change to any available plan in their area and are not limited to the same level of coverage as their current plan.
In Tennessee, beneficiaries may be eligible for a Special Enrollment Period from February 15 through August 15, with coverage starting the following month after plan selection. No documentation of a qualifying event is required during this period.
What’s more, the availability of 5-star rated Medicare Advantage plans in Shelby County allows switching to a higher-quality plan outside the standard enrollment periods.
Prescription Drug Coverage in Memphis Medicare Advantage Plans
Prescription drugs are a significant part of healthcare, and most Medicare Advantage plans in Memphis understand this by including the plan’s prescription drug coverage. This coverage follows the same rules as Medicare Part D, providing comprehensive medication coverage to beneficiaries.
Medicare Advantage Prescription Drug plans (MAPDs) are also available in Memphis, offering additional benefits such as dental, vision, and fitness along with drug coverage.
However, it’s important to note that if you’re enrolled in a Medicare Advantage plan that includes drug coverage, you cannot sign up for a separate Part D drug plan. Therefore, it’s crucial to ensure that the Medicare Advantage plan you select provides adequate drug coverage for your needs.
Medicare Part D and Medicare Advantage
Medicare Part D and Medicare Advantage offer different ways of providing prescription drug coverage. Medicare Part D provides standalone prescription drug coverage. On the other hand, Medicare Advantage plans often include drug coverage along with hospital and medical coverage.
To enroll in a Medicare Part D plan, an individual needs to be enrolled in either Medicare Part A or Part B. On the other hand, a Medicare Advantage plan requires an individual to have both Part A and Part B.
While Medicare Part D plans typically include separate costs in addition to Medicare Part A and B premiums, Medicare Advantage plans generally incorporate drug coverage costs into their overall plan costs. This makes Medicare Advantage plans a convenient one-stop solution for many beneficiaries.
Choosing the Right Prescription Drug Coverage
Choosing the right prescription drug coverage is crucial to ensure that you get the medication you need at a cost you can afford. Prescription drug coverage under Medicare Part C (Medicare Advantage) and Part D is structured into four distinct phases:
- Deductible Phase
- Initial Coverage Phase
- Coverage Gap Phase
- Catastrophic Coverage Phase
The cost of drugs under this coverage is determined by a tier system. This ranges from:
- Tier 1 for preferred generic drugs
- Tier 2 for non-preferred generic drugs
- Tier 3 for preferred brand-name drugs
- Tier 4 for non-preferred brand-name drugs
- Tier 5 for specialty medications
The tier a medication falls into significantly affects the cost that beneficiaries pay. Therefore, it’s important to understand this system when choosing a plan.
Additional Benefits of Medicare Advantage Plans in Memphis
Medicare Advantage Plans in Memphis go beyond standard healthcare coverage by offering additional benefits. These benefits are not covered by Original Medicare and provide an expanded scope of coverage to beneficiaries.
In fact, some Medicare Advantage plans in Tennessee focus on innovative benefits that cater to underserved populations and individuals with chronic illnesses by addressing social determinants of health.
In 2023, twenty-three Medicare Advantage Plans in Tennessee offered innovative benefits such as wellness and healthcare planning, reduced cost-sharing, along with rewards and incentive programs. These Medicare health plans emphasize promoting a healthy lifestyle among enrollees, with fitness club memberships being a common offering.
Dental Coverage
Maintaining oral health is a critical part of overall health, and many Medicare Advantage plans in Memphis include dental coverage as a benefit.
This can cover:
- Routine dental exams
- Teeth cleanings
- X-rays
- Fillings
- Extractions
- Dentures
- Root canals
- Crowns
- Bridges
This comprehensive coverage ensures that beneficiaries have access to the dental care they need.
Plans like Humana Gold Plus and Aetna Medicare Value Plan offer comprehensive dental coverage with low or $0 co-pays in Memphis. This makes these plans an attractive choice for individuals who require regular dental care.
Vision Coverage
Vision coverage is another crucial healthcare aspect often covered by Medicare Advantage Plans in Memphis. Regular vision exams are essential for maintaining good eye health and catching any potential issues early. By including vision coverage in their benefits, Medicare Advantage Plans provide comprehensive healthcare coverage to beneficiaries.
Wellness Programs
Promoting healthy living is a key focus of Medicare Advantage plans in Memphis, with many plans offering wellness programs as part of their benefits. These programs often include fitness benefits such as gym memberships or at-home fitness programs, encouraging beneficiaries to stay active and fit.
Preventive health screenings are another integral part of wellness benefits. These screenings help in the early detection of health issues, allowing for timely treatment and better health outcomes.
In addition, some Medicare Advantage plans in Memphis offer incentives for completing health assessments and participating in wellness activities, further promoting healthy living.
Resources for Choosing a Medicare Advantage Plan in Memphis
Choosing the right Medicare Advantage Plan is a crucial decision that can significantly impact your healthcare experience. Fortunately, there are several resources available to aid you in this process.
Websites like Medicare.gov and CMS’s website offer comprehensive information for understanding Medicare coverage components in Tennessee.
Additionally, licensed insurance agents can provide personal assistance with Medicare Advantage or Original Medicare enrollment and answer related questions.
Tennessee SHIP Program
The Tennessee SHIP Program is a valuable resource for Medicare beneficiaries. This program provides free, unbiased insurance counseling and assistance to Tennessee Medicare beneficiaries, helping them understand and compare different Medicare options.
Seniors in Memphis can utilize the services of the Tennessee SHIP Program for support in understanding the varieties of Medicare Advantage plans, comprehending the benefits they offer, and navigating through the enrollment procedures.
Online Tools and Resources
Apart from the Tennessee SHIP Program, there are also numerous online tools and resources available to help you make an informed decision.
The Plan Compare feature on Medicare.gov is a useful tool for evaluating different aspects of Medicare Advantage plans and drug plan costs. It is also useful for reviewing the list of medications covered under specific Medicare Advantage plans.
Additionally, Memphis residents can locate and compare local Medicare Advantage plans using the Medicare Plan Finder tool on Medicare.gov. This tool provides a comprehensive overview of all available plans in your area, making it easier for you to choose the one that best fits your needs.
Summary
Navigating the world of Medicare Advantage Plans in Memphis can seem daunting, but with the right resources and understanding, it doesn’t have to be. With a variety of plans to choose from and various additional benefits available, it’s possible to find a plan that aligns with your healthcare needs and financial capabilities.
Remember, the key is to assess your healthcare needs, compare the costs and benefits of different plans, and make use of available resources like the Tennessee SHIP Program and online tools.
Frequently Asked Questions
→ How much does the Medicare Advantage plan cost in Tennessee?
In Tennessee, the average cost for a Medicare Advantage plan is around $18.29 per month in 2025, but $0 premium plans are also available for everyone in the state.
This means you may not have to pay any additional premium beyond your Part B premium to enroll in a Medicare Advantage plan.
→ What are 4 types of Medicare Advantage plans?
Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, and Special Needs Plans, each with its own set of rules and benefits. It is important to compare the options to find the best fit for your needs.
→ What types of Medicare Advantage Plans are available in Memphis?
In Memphis, residents have the option to select from different Medicare Advantage Plans such as Local HMOs, Local PPOs, Regional PPO plans, SNP, and PFFS plans. Choose the plan that best suits your needs.
→ How do I compare different Medicare Advantage Plans in Memphis?
To compare different Medicare Advantage Plans in Memphis, assess their star ratings, average premiums, out-of-pocket limits, and drug plan deductibles, and use online tools such as the Plan Compare feature on Medicare.gov and the Medicare Plan Finder tool.
→ When can I enroll in a Medicare Advantage Plan in Memphis?
You can enroll in a Medicare Advantage Plan in Memphis three months before turning 65, up to three months after your 65th birthday, or during the fall open enrollment period from October 15 to December 7. Act within these time frames to ensure coverage.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.