TABLE OF CONTENTS
Residents throughout the state of Tennessee have plenty of choices when it comes to health care. You can enroll in an employer health plan, sign up for TennCare (Medicaid), enroll in Medicare, or shop for individual health insurance policies provided by insurance companies.
This guide explains all of your health coverage options:
Tennessee doesn’t have a health care exchange website, so you’ll have to enroll for coverage under the ACA by visiting the federal healthcare exchange. To sign up, you need to create an account on Healthcare.gov first. The sign-up process requires providing your contact information, selecting a password, and answering multiple security questions. Make sure that you retain the answers you provided just in case you need them in the future.
After you create your account, you can begin reviewing plans offered through the ACA exchange. One of the benefits of signing up through the ACA exchange is that you receive an automatic notification if you qualify for Medicaid and the Advanced Premium Tax Credit. Make sure that before you proceed, you’ve got all of the information you need. You’ll need to provide the full name, birth date, and Social Security number for each person you want to include in your plan.
You’ll be required to provide the following information with your application:
Once you’ve completed this step, you can compare plans and see up to three plans side by side. Side-by-side comparison helps you determine which health plan is best for you and your household’s needs. Once you’ve found the health plan that you wish to enroll in, all you do is complete the process by following the prompts.
Six health insurance companies offer individual coverage in Tennessee:
You can use the Health Insurance Marketplace if you need an individual policy or a family plan. If you need coverage for more than one person, consider the medical needs of every person you’re going to put on your health insurance plan. Decide what your budget is, what type of plan provides the coverage options you want, and what your deductibles will be.
Individuals have more options when it comes to health insurance if you don’t need to consider the needs of a household. It’s possible to save money on policies that have higher annual deductibles and lower monthly premiums.
There are three types of plans, according to the network of providers:
Six insurance companies offer individual coverage in Tennessee:
Shopping for family coverage is a little more complicated because you need to consider everyone’s needs within your household. Lower premiums don’t always amount to savings if you’re going to need to pay more out-of-pocket, whether that is for the deductible or higher copays and coinsurance. That could make a difference for you if one or more members of your family have medical needs that require routine treatment or high-cost prescription medications.
Consider the deductible and coinsurance requirements of each plan. Paying more money each month can be worth it if you’re paying less out-of-pocket for state-of-the-art treatments. You’ll also want to think about whether an HMO, PPO, or POS suits your needs. To do this, review the networks to see if it includes specialists that provide care for your family’s specific needs. If an HMO network consists of the specialists you feel will provide the care you need and don’t mind seeking referrals, you can save some money.
The same insurance providers that offer policies to individuals in the state also provide family coverage. Some insurers are only available to residents in some regions of the state.
The Health Insurance Marketplace divides plans into four tiers: Bronze,, Silver, Gold, and Platinum plans. Plans fit into these tiers based on factors such as monthly premiums, copayment requirements, annual deductibles, and the overall level of your coverage. Before you choose the least expensive monthly premium, determine your or your family’s needs and whether paying for a more expensive policy may save you money on your care overall. Consider the maximum out of pocket and how affordable that is to you. That amount acts as the stop loss for your medical expenses.
A Bronze plan only covers 40% of your medical expenses after you meet your deductible. Bronze plan deductibles are usually higher. People who choose Bronze plans tend to be young, healthy, and only seek coverage in an emergency that places them into the hospital or requires rehabilitative therapy. Suppose you’re suffering from a chronic condition or caring for a family member needing routine care. In that case, a Bronze plan may be costlier because you’d have to pay more out-of-pocket. The most affordable Bronze plan for Tennesseans in 2022 costs $338 per month.
Silver plans cost a little more than Bronze plans. However, some residents might qualify for subsidies that make a Silver plan more affordable than a Bronze plan. These plans offer lower deductibles and require you to cover 30% of your medical expenses after meeting your deductible. The most affordable Silver plan in 2021 is $441 per month.
Gold and Platinum plans have the most expensive monthly premiums, but will also cover more. A Gold plan requires you to pay a 20% copayment, while a Platinum plan only requires you to cover 10%. These plans are best suited to families with one or more members who suffer from medical conditions requiring regular medical treatment or advanced therapies. The most affordable Gold plan in Tennessee for 2022 costs $488 per month.
|Average premiums in Tennessee||2018||2019||2020||2021||2022|
|Most affordable Bronze plan||$411||$351||$351||$340||$338|
|Most affordable Silver plan||$597||$506||$485||$454||$441|
|Most affordable Gold plan||$914||$825||$617||$564||$488|
Families with low income and residents living with or caring for a person with a disability have access to Tennessee’s Medicaid program (TennCare) and the CoverKids program. These programs are joint initiatives with the state and federal governments.
TennCare offers medical coverage to low-income families and residents with disabilities as long as you meet specific requirements. Recipients must be disabled, over the age of 65, pregnant, or have children in your care under the age of 19. TennCare covers preventative care, emergency care, and any therapies or treatments deemed medically necessary.
Your income must fall under the state’s poverty level to qualify. Levels will vary based on the size of your household. For example, an individual cannot make more than $17,131 per year, while a family of four cannot make more than $35,245. The Medicaid program also covers adults over 18 admitted into a nursing facility for an extended period.
To apply for benefits through TennCare, visit the web portal or call 855-259-0701 for assistance.
Children under the age of 19 and pregnant mothers can receive assistance through the CoverKids program. Enrollment has similar income requirements as TennCare, but the income thresholds are different for families with multiple children. To learn more about CoverKids, you can call 855-259-0701.
Tennesseans have plenty of options available through Medicare and Medicaid to cover medical expenses. Medicare Part A and B are traditional Medicare. Part A covers inpatient services, including emergency room visits, nursing care, and hospice treatment. Medicare Part B covers outpatient procedures, preventative care, medical devices, medical transportation, and more. Neither plan covers prescription drugs, but enrollees can enroll in a Part D plan for this type of coverage.
Medicare Advantage allows Tennessee residents to seek coverage through an insurer, subsidized through the federal government. Medicare Advantage Plans must cover everything covered under Medicare Part A and B. Conversely, Tennesseans may be able to add things like prescription coverage, vision, dental, and rebates on services like gym memberships and transportation.
Medicare Supplement Plans help Medicare enrollees cover copayments. These types of plans can help if you’re worried about your ability to cover an unexpected medical expense. The plans also a good supplement if you’re already suffering from a chronic condition.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
If you have questions about Medicare options or need assistance with enrollment, you can contact the Tennessee Commission on Aging and Disability by calling 877-801-0044. You can also visit the web portal and provide your contact information to get support.
Tennessee doesn’t have any state restrictions on short-term health insurance, so insurers must follow federal rules. A short-term health insurance policy isn’t a long-term solution to health care coverage. If you’ve found yourself facing a coverage gap, one of these plans can help pay for your medical expenses until you enroll in a different plan. The most common use for a temporary health insurance policy is if you’ve changed jobs and will go several months without health insurance.
According to federal law, a short-term policy may not have an initial term that exceeds one year. You may be able to renew a short-term policy but can’t remain on temporary insurance for more than 36 months. You should be aware that the ACA doesn’t protect people seeking short-term plans. You can be denied coverage. Your rates may increase if you’re suffering from a chronic condition. Insurers don’t need to cover preexisting conditions either.
You might be denied coverage for a short-term insurance plan if you suffer from the following:
The best time to apply for a short-term health insurance policy is as soon as you know you’re going to need it. If you delay action, it could result in a gap in health insurance coverage. If you fall ill or are injured while uninsured, you’d be responsible for the entire cost of your medical care.
If you know that you’re going to enroll in Medicare but have a short period between retirement and when you’ll receive Medicare coverage, seek a short-term policy to cover the gap. It’s also useful if you’ve missed your enrollment period and need to wait for a special enrollment period or general enrollment to sign up.
There is no state mandate for health insurance in Tennessee. However, the Affordable Care Act requires all United States citizens to have health coverage. After 2019, the tax penalty for not having coverage became unenforceable, which means if you don’t have insurance, it won’t impact your taxes. However, it’s still a good idea to have health insurance even though you’re not required to.
You’re not required to use the marketplace, but most people use it because it’s the only way to qualify for the Advanced Premium Tax Credit. If you know that you won’t qualify for any tax credit or subsidies, you’re free to enroll in coverage directly with any insurer that offers you the policy you want. It may be more cost effective to research alternative options if your income is too high to qualify for affordable healthcare coverage on the marketplace.
There are currently six insurance carriers that offer insurance through the Healthcare Marketplace. Availability will depend on where you reside within Tennessee.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
An HSA or FSA doesn’t replace health coverage. What a health savings account or flexible savings account does is prepare you for unexpected medical expenses. It doesn’t lower the cost of your medical care. It’s a good idea to have one of these accounts in addition to insurance, but you still need health care coverage.
Short-term disability coverage helps you whenever you cannot pay your regular bills due to your inability to work. These plans are not designed to cover your medical expenses, so it doesn’t replace health insurance. It can, however, help you pay food, utility bills, and your mortgage payment.
Long-term disability coverage functions the same way short-term disability plans do. When you’re unable to work for an extended period due to an injury or medical disability, a disability plan will cover your day-to-day expenses. An insurance policy covers the cost of your medical care. You’re not required to have long-term disability coverage, but it’s also not a bad idea.
CoverKids covers children under the age of 19 and pregnant women for the cost of preventative care, prenatal care, diagnostic testing, immunizations, emergency care, dental appointments, and eyecare. Children who qualify have parents who pay very low premiums and coinsurance requirements. Pregnant women can enroll if you’re unable to afford the cost of prenatal care.