TABLE OF CONTENTS
Residents in 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 health insurance companies.
This guide explains all of your health coverage options in Tennessee.
You can enroll for coverage under the ACA by visiting the federal healthcare exchange. To sign up, you need to create an account on Healthcare.gov. The sign-up process requires providing your contact information, selecting a password, and answering multiple security questions.
One of the benefits of applying for health insurance through the ACA exchange is that you receive an automatic notification if you qualify for Medicaid or 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. After you apply, you can review plans.
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 out-of-pocket costs like deductibles and copays 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:
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 a higher monthly premium can be worth it if you’re paying less out-of-pocket for treatment. You’ll also want to think about whether an HMO, PPO, or POS suits your needs and review the networks to find your preferred specialists. 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.
|Average premiums in Tennessee||2018||2019||2020||2021|
|Most affordable bronze plan||$411||$351||$351||$340|
|Most affordable silver plan||$597||$506||$485||$454|
|Most affordable gold plan||$914||$825||$617||$564|
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 families with low income and residents with disabilities as long as you meet specific requirements. Recipients must be at least one of the following to qualify:
TennCare covers preventive 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 to cover medical expenses.
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.
|Eligibility and Enrollment|
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 residents can get short-term health insurance, though 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.
In Tennessee, 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.
The ACA doesn’t apply to 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.
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 Health Insurance Marketplace. Availability will depend on where you reside within Tennessee.
Cost-sharing plans may reduce the cost of your medical treatments because members pool money together to pay for medical expenses. Often, these are faith-based communities but you may not need to belong to a certain religion or denomination to purchase a plan. Consider the policy benefits and coverage for health sharing plans as it does not qualify as insurance at all and may not have a maximum out of pocket or offer all of the coverage you need.
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.