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Healthcare Advisor

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in 34+ states.

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.

What to know about health insurance in Tennessee

  • Coverage types: Almost 48% of Tennesseans receive health insurance through an employer’s health benefits. Just over 10% of residents are uninsured. An additional 5.6% of residents have individual policies, while 19.5% are enrolled in TennCare. Another 15% have Medicare.
  • Multiple plans: Tennessee residents can have multiple health insurance policies and can purchase insurance from any health insurance company that offers coverage. A secondary plan can offset your out-of-pocket expenses and reduce the total cost of your health care.
  • Marketplace plans: The Health Insurance Marketplace offers insurance plans that conform to Affordable Care Act standards. The annual open enrollment period is usually from November 1 to December 15. If you miss the enrollment period, you’ll need to qualify for a special enrollment period or wait until the next open enrollment to enroll through the marketplace.
  • Special Enrollment: Special enrollment periods allow you to enroll for coverage if you’ve had a qualifying life event, such as having child, relocating, losing your job, or getting
  • Premium tax credit: Tennessee allows residents to enroll through the federal Health Insurance Marketplace. You must enroll through the exchange to take advantage of the Advanced Premium Tax Credit.
  • Individual policies: You can purchase an individual policy without consequence if you’re not interested in receiving the Advanced Premium Tax Credit.

How do I enroll in Tennessee’s health insurance marketplace?

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:

  • Whether you are single or married
  • Who you claim as dependents on your tax returns
  • Your income
  • Whether or not you wish to apply for financial assistance

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:

  • Blue Cross and Blue Shield of Tennessee
  • Bright Health of Tennessee
  • CIGNA Life & Health
  • Oscar Insurance Company
  • Celtic Insurance Company/Ambetter
  • UnitedHealthcare

How do I enroll in Tennessee individual and family insurance?

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.

Insurance for individuals in Tennessee

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:

  • Health Maintenance Organization (HMO) plansThese are the cheapest plans available and the most restrictive. To see a specialist, you need a referral from your pre-assigned Primary Care provider (PCP). You’ll only be covered for medical care if you go to the doctors and hospitals within the plan’s network.
  • Preferred Provider Organization (PPO) plansYou’re not required to receive referrals if you need to see a specialist. You also have more power to choose which doctors you’d like to see, but you will also need to pay a higher monthly premium for coverage.
  • Point-of-Service (POS) plansA POS plan is a more flexible insurance policy. It still has a network of doctors but allows you to see doctors outside of that network if you agree to a higher coinsurance requirement.

Insurance for families 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 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.

How much does health insurance cost in Tennessee?

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

  • 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 don’t need routine coverage. The most affordable bronze plan for Tennesseans in 2021 costs $340 per month.
  • Silver plans cost a little more than bronze However, you 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 $454 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 2021 costs $564 per month.

What kind of low-income health insurance is available in Tennessee?

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.

Medicaid in Tennessee

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:

  • Disabled
  • Over the age of 65
  • Pregnant
  • Care for children under 19

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.

TennCare CoverKids Program

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.

What are Tennessee’s Medicare options for seniors and people with disabilities?

Tennesseans have plenty of options available through Medicare to cover medical expenses.

  • Medicare Part A and B are Original Medicare. Part A covers inpatient services, including emergency room visits, nursing care, and hospice treatment. Medicare Part B covers outpatient procedures, preventive care, medical devices, medical transportation, and more. Neither plan covers prescription drugs, but you can enroll in a Part D plan for this type of coverage.
  • Medicare Advantage Plans allow 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. Medicare Advantage Plans may offer 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.

Eligibility and Enrollment
Eligibility
  • To enroll in Medicare, you must be a United States citizen or permanent resident. You must also be over 65 years old or suffer from a physical disability and drawn SSDI benefits for at least two years. You may also qualify for Medicare at a younger age if you have end-stage renal disease or ALS.
Enrollment
  • You’re able to enroll in Medicare during the initial enrollment period beginning three months before your 65th birthday and ending three months after your birthday.
  • Open enrollment allows you to make changes to your plan for the following year or enroll if you’ve missed your initial enrollment. This period runs from October 15 to December 7 each year. General enrollment starts at the beginning of the year and ends on March 31. You may also qualify for a special enrollment period if you have a qualifying life event.

Medicare Resources

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.

Are there short-term health insurance plan options in Tennessee?

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.

Tennessee insurance FAQs

Does Tennessee require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Tennessee?

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.

How many health insurance carriers offer insurance through the marketplace in Tennessee?

There are currently six insurance carriers that offer insurance through the Health Insurance Marketplace. Availability will depend on where you reside within Tennessee.

What types of alternative health insurance plans (like cost-sharing plans) are available in 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.

Do I need health insurance if I have HSA/FSA?

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.

Do I need short-term disability coverage in Tennessee if I have health insurance?

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.

Do I need long-term disability coverage in Tennessee if I have health insurance?

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.

What does CoverKids cover?

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.

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