American citizens over the age of 65 can enjoy a more affordable health insurance package from Medicare, and the program also accepts workers under the age of 65 with specific disabilities as beneficiaries. Tennessee Medicare insurance is funded by the US government, and in the state, beneficiaries also receive assistance from the state government’s public programs for Medicare.
Medicare is much more affordable than a typical health insurance plan, which in Tennessee costs an average of $435 a month in premiums. Medicare coverage starts with Original Medicare which includes Part A and Part B. Part A doesn’t typically require premium payments. Part B requires a monthly premium, but for those whose annual income is less than $85,000 the Part B premium is only $134 a month. Both Part A and Part B have out of pocket expenses for beneficiaries, including deductibles, coinsurances, and copayments.
Part A offers hospital insurance, which includes inpatient hospital and psychiatric care. Part B covers various treatments, medical supplies, and preventive services.
Original Medicare may not offer sufficient coverage for some. To compensate for these perceived gaps some beneficiaries of the program can also purchase “Medigap” supplemental plans to obtain additional coverage. These Medicare supplemental plans will also require an additional premium, and they can be purchased from Medicare-approved private health insurance companies in Tennessee.
Perhaps the most common additional coverage is for Medicare prescription drugs, and this coverage is also known as Medicare Part D. Other plans may cover more services that are not covered by Part A and Part B, or they can help cover the out of pocket costs that may arise from Original Medicare.
Instead of obtaining the Original Medicare package and supplemental plans separately, Medicare beneficiaries can instead purchase Medicare Advantage Plans from Medicare-approved private carriers. These plans are known as Medicare Part C.
Each plan may have different extra benefits, though each one will provide the same coverage afforded by Original Medicare.
The state of Tennessee offers several Medicare Savings Programs (MSPs) for certain residents with lower income. These MSPs can provide varying degrees of assistance depending on the income and assets of the applicants.
The program for the Qualified Medicare Beneficiaries (QMB) pays for nearly all the costs of Medicare. These include the premiums for Part A (if needed) and Part B, along with the costs of deductibles, coinsurance, and copays. An individual can qualify with a monthly income of less than $1,032 while a married couple cannot have a combined monthly income of more than $1,392.
The next MSP is for Specified Low-Income Medicare Beneficiaries (SLMB) pays only for the Part B premium, but that still totals $1,608 in savings for the year. To benefit, an individual cannot earn more than $1,234 a month while a married couple has an income limit of $1,666 a month.
The MSP for Qualified Individuals (QI) also pays only for Part B premiums, but the funding may be limited. Applications can be granted only on a “first come, first served” basis as a result. An individual has to earn less than $1,386 a month, while the combined income of a married couple should be less than $1,872 a month.
These 3 MSPs (QMB, SLMB, and QI) also places a cap on assets for beneficiaries to qualify for any of them. An individual cannot have assets totaling more than $7,560 (the house and one vehicle aren’t counted) while the asset limit for married couples is $11,340.
Qualifying for these MSPs also qualifies the beneficiary for the Low-Income Subsidy (LIS) or “Extra Help” Program. This program pays for all or some of the Medicare Part D expenses, depending on the income and assets of the beneficiary.
Another program is for Qualified Disabled and Working Individuals. The QWDI pays for the premium for Part A if this is no longer free for the qualified beneficiary. The limits for an individual are $4,132 for monthly income and $4,000 for assets. For a married couple, the limits are $5,572 for monthly income and $6,000 for assets.
The Tennessee State Health Insurance Assistance Program (SHIP) offers free counseling and answers questions for Medicare beneficiaries in the state. Medicare beneficiaries can contact Tennessee SHIP at 877-801-0044.
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