As a physician practicing in Tennessee, I frequently work with patients who are becoming eligible for Medicare. My goal is to help them understand this federally subsidized health insurance system, so they can make informed decisions and feel confident about their coverage.

What Tennessee Patients Need to Know

Here in Tennessee, we have a valuable resource: the Tennessee State Health Insurance Assistance Program (TN-SHIP).
This federally funded program provides free, unbiased counseling and assistance for Medicare-eligible individuals, their families, and caregivers. Importantly, TN-SHIP counselors do not promote any insurance agency, and all inquiries remain confidential.

How to contact TN-SHIP:

Call: 1-877-801-0044
Email: dda.ship@tn.gov
Website: TN-SHIP

Whether you’re new to Medicare or have questions about your existing coverage, the trained counselors at TN-SHIP can guide you through the process.

Understanding the Parts of Medicare

Here’s a breakdown of the main components of Medicare to discuss with patients:

Part A – Hospital Insurance

Covers inpatient hospital services, skilled nursing facility stays, some home health care and hospice. Medicare+1

Part B – Medical (Outpatient) Insurance
Key component of “Original Medicare,” Part B covers a wide range of outpatient services and items. For example:

Visits with doctors and nurse practitioners in our clinic
Lab tests, outpatient care such as treatments for depression or OCD
Certain drugs are administered by a physician or nurse practitioner

Costs for Part B vary by income. In 2025, the standard monthly premium is $185, the annual deductible is $257. Kiplinger+1
After the deductible, Original Medicare typically pays 80% of Medicare-approved charges; you pay 20%. KFF+1
Note: There is no annual out-of-pocket maximum with Original Medicare. Medicare

Part C – Medicare Advantage (MA) Plans
Must have Part A and B first. MA plans are private-insurance alternatives that bundle Parts A and B (and often Part D) into one plan. Medicare+1
Pros: Often lower premiums, extra benefits.
Cons: Limited provider networks, more rules (prior authorizations), changing benefits each year.

Part D – Prescription Drug Coverage
Provides outpatient prescription drug coverage through private plans. If you choose Original Medicare, enrolling in Part D is strongly recommended to avoid penalties. Medicare Interactive+1

Eligibility & Enrollment

Who is eligible?

Most people become eligible for Medicare when they turn 65. CMS+1
Younger people may also qualify if they have certain disabilities, end-stage renal disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). KFF

Automatic Enrollment
If you are already receiving Social Security or Railroad Retirement Board benefits at least four months before turning 65, you will be automatically enrolled in Part A and Part B.

Late Enrollment Penalties
Part B is optional—but if you don’t enroll when first eligible and don’t have other “creditable coverage” (like employer coverage), you may face a lifelong penalty: an extra 10% for each 12-month period you were eligible but didn’t enroll.

Enrolling
The best time to sign up is during your Initial Enrollment Period (IEP):

Begins 3 months before your 65th birthday
Includes your birthday month
Ends 3 months after your birthday

Filling the Gaps: Supplemental Coverage

Original Medicare leaves “gaps” (deductibles, coinsurance, no max out-of-pocket). Patients should know their options:

Medicare Advantage (Part C)

Replaces Original Medicare (Parts A & B)
Bundles benefits, often lower premium
But restricts providers and has more rules

Medicare Supplement (“Medigap”) Plans

You must have Parts A & B first
These plans pay secondary to Medicare—helping cover deductibles, coinsurance, etc.
Example: Plan G is currently the most popular supplement plan
Different plan types: Attained Age, Community Rated, Issue Age
Encourage patients to ask questions via TN-SHIP before choosing.

Practical Tips for Tennessee Practices

Since our practice does not accept Medicare Advantage plans (and many psychiatrists or psychiatric nurse practitioners may face the same limitation), it’s helpful to:

Ask incoming Medicare-eligible patients if they’re enrolled in a Medicare Advantage plan or Original Medicare + Medigap.
If they’re in Advantage plans that we don’t accept, provide resource referrals (like TN-SHIP) and encourage evaluation of switching.
Use TN-SHIP as a trusted referral source for patients who need independent guidance about their Medicare options.

Final Thoughts

Education is key when patients become eligible for Medicare—especially here in Tennessee. By using programs like TN-SHIP, you provide a neutral, reliable resource. And by clearly explaining the structure (Parts A, B, C, D), eligibility, enrollment timelines, and supplemental options, you empower your patients to make better decisions about their healthcare coverage.

Still Want more? Watch this video:

https://www.youtube.com/watch?v=ooZKCnbXw-M (information about Part B starts about 10 minutes in)

We, like other physician offices, unfortunately, do not accept Advantage Plans.

If you have Medicare and need a psychiatrist or a psychiatric nurse practitioner who offers care with Medicare Part B? We can do this.

Come see any of our licensed Clinicians who accept Medicare at our 5 locations to learn more!: https://hopeforyourbrain.com/

Synaptic Psych – Brentwood Clinic is located at 5300 Maryland Way Ste 103, Brentwood TN 37027 – Welcome to Synaptic Psych’s Brentwood clinic, where compassionate, cutting-edge mental health care meets the heart of Williamson County. We serve Brentwood, Nolensville, Antioch, and beyond!

Synaptic Psych – Franklin Clinic is located at 381 Riverside Dr Suite 460, Franklin, TN 37064 – Welcome to Synaptic Psych’s Brentwood clinic, where compassionate, cutting-edge mental health care meets the heart of Williamson County. We serve Brentwood, Nolensville, Antioch, and beyond! Our expert team of Brentwood Psychiatrists offers a full spectrum of behavioral health services

Synaptic Psych – Nashville Clinic is located at 2125 Belcourt Ave, Nashville, TN 37212. – Welcome to Synaptic Psych’s Nashville clinic, where compassionate, cutting-edge mental health care meets the heart of Davidson County. Our expert team of Nashville Psychiatrists and Nashville Child Psychiatrists offers a full spectrum of behavioral health services

Synaptic Psych – East Nashville Clinic is located at 3800 Gallatin Pike, Nashville TN 37216 – Welcome to Synaptic Psych’s East Nashville clinic, where compassionate, cutting-edge mental health care meets the heart of Davidson County. Our expert team of East Nashville and Inglewood Psychiatrists offers a full spectrum of behavioral health services

Synaptic Psych – 871 Ridgeway Loop Road, Suite 108 Memphis TN 38120 – Welcome to Synaptic Psych’s Memphis clinic, where compassionate, cutting-edge mental health care meets the heart of Shelby County. Our expert team of Memphis and Germantown Psychiatrists and behavioral health experts offers a full spectrum of behavioral health services