What You Need to Know About Health Insurance in Tennessee

Every American wants the freedom to choose the best health insurance that fits their lifestyle and budget; fortunately, Tennessee offers many different types of health insurance.

Medicaid

If health insurance is out of reach for you, you should consider applying for Medicaid. This is one of the best options for low cost health insurance in Tennessee for those living below the federal poverty line. Although Medicaid differs by state, Tennessee’s program is called TennCare Medicaid or Medicaid Standard, which provides low-cost or no-cost health insurance plans to qualifying individuals and their families.

To qualify for TennCare Medicaid, here are the requirements:

• You cannot receive TennCare if you’re not disabled or not a pregnant adult without dependent children, regardless of income.
• Adults with children earning a household income below 95% of the poverty line.
• Pregnant women with infants under the age of one with a household income below 200% of the poverty line.
• Children from 1-5 years of age with a household income below 147% and children from 8-18 with a household income below 138% of the poverty line.
• CHIP, also called Cover Kids, is offered to households that are ineligible for Medicaid because they earn above the poverty line, for up to 255%.

It’s relatively simple to apply for Medicaid in Tennessee. Here’s how:

• Apply year-round, which means you don’t have to wait for open enrollment
• Enroll via HealthCare.org virtually or by phone
• Enroll online via TennCare
• Go to a Tennessee Department of Human Services to enroll in person

What services does TennCare cover?

• Specialist appointments
• Transportation to your appointments
• Wellness and preventative care, e.g., hospital or primary care provider 
• Dental services, including for children
• Pregnant and postpartum dental care
• Mental health services

Medicare

If you’re approaching your Golden Years or for qualifying individuals under the age of 65, there is Medicare, a federally-funded health insurance program. Medicare is sold in units called parts. Qualifying individuals can buy into an Original Medicare plan that bundles Part A and Part B, or they can purchase Medicare Advantage (Part C) through private insurance that bundles Part A, Part B, and other supplemental coverage (e.g., Part D). 

• Part A: Plan A covers hospital visits. Typically hospital visits are free unless you’re new to Medicare.
• Part B: Part B covers medical services such as primary care provider visits.
• Part C: Part C or “Medicare Advantage”, bundles Part A, Part B and supplemental coverage, like dental, eye care, or prescription medication. Medicare Advantage is a popular choice, only offered through independent insurance companies.
• Part D: Part D is optional coverage for prescription medication.

Note, Medicare is just for individual health insurance in Tennessee, it doesn’t provide family coverage.

Individual Health Insurance

The beauty of individual health insurance in Tennessee is that it’s straightforward, so residents can effortlessly browse their choices—sold in metallic tiers—until they find the best health insurance for their needs.

There are four metallic tiers offered by individual health insurance in Tennessee:

• Catastrophic: Catastrophic coverage was designed for individuals who are healthy and under the age of 30 or those who cannot afford higher premiums (note, you’ll need a financial hardship to qualify). Here are some policy highlights:
  
  • Low monthly premiums
  • High deductibles
  • Has high out-of-pocket maximums
  • It protects you from the essential health benefits (10 listed in ACA) and some preventative services
  • Not eligible for premium tax credits for cheaper rates
  • Only for healthy, young individuals that don’t need routine medical treatment or for those who can’t afford health insurance
• Bronze: Bronze is the most affordable metallic tier health insurance, as long as you don’t need regular medical care. With bronze health insurance, you’ll get these features:
  
  • Low monthly premiums, but more than Catastrophic
  • High deductibles but less than Catastrophic
  • High out-of-pocket expenses if you need medical treatment
  • Bronze coverage is excellent for healthy individuals that don’t require routine medical care
• Silver: Silver policies are among the most popular health insurances sold on the state exchange offering mid-level protection. Silver plans are so popular because they are the only tier eligible for premium tax credits, which in turn, decreases the cost of your health insurance premiums.
  
  • Moderate monthly premiums
  • Lower deductibles than bronze plans
  • Eligible to apply for low-income subsidies or “cost-sharing” with silver plans for more affordable rates
  • Policies pay 70% of your medical treatment costs, but with tax credits for qualifying low-income individuals, the figure can jump to up to 94% coverage
• Gold: Gold health insurance plans are ideal for policyholders that require routine medical treatment, as the higher monthly premiums result in lower deductibles and net expenses.
  
  • Higher monthly premiums
  • Lower deductible amounts