Paul Sanchez
Tennessee has a federally-facilitated health insurance exchange, also referred to as the Health Insurance Marketplace, where residents can purchase ACA Marketplace plans. This means that Tennessee residents can access health insurance products from private insurers, although the availability of plans varies across the state. Tennessee's ACA Marketplace may be a good choice for many consumers, especially with premium subsidies and cost-sharing reductions. The state's federally-run health insurance exchange also provides a navigator program to assist consumers in making choices about their healthcare options and accessing their new healthcare coverage.
| Characteristics | Values |
|---|---|
| Name | Tennessee Health Insurance Exchange |
| Opening Date | October 1, 2013 |
| Coverage Start Date | January 1, 2014 |
| Type of Exchange | Federally-facilitated |
| Website | HealthCare.gov |
| Phone Number | 800-318-2596 |
| Dental Coverage | Available as an add-on |
| Medicaid Program | TennCare |
| Pharmacy Assistance Program | CoverRx |
| Behavioral Health Services | Behavioral Health Safety Net of TN |
| Community Health Centers | Federally Qualified Health Centers (FQHCs) |
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What You'll Learn
Tennessee Health Insurance Exchange
The Tennessee Health Insurance Exchange is a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. It was created as part of the Affordable Care Act (ACA) to provide health insurance coverage for individuals and small businesses through new state health insurance exchanges. The Tennessee Health Insurance Exchange opened for enrollment on October 1, 2013, with coverage starting on January 1, 2014.
To qualify for a Marketplace Health Insurance plan in Tennessee, you must meet the following requirements:
- Live in the United States
- Be a U.S. citizen, national, or be lawfully present in the country
- Not be in prison
The marketplace offers health plan benefits similar to those found in employer-sponsored health insurance plans, including doctor visits, outpatient care, prescription drugs, emergency care, and mental health services. The health insurance marketplace indicates a health plan's costs by metal tier, allowing individuals to choose a plan with higher premiums or higher out-of-pocket costs.
The Tennessee Health Insurance Exchange navigator program assists consumers in making choices about their healthcare options and accessing their new healthcare coverage, including premium tax credits for eligible consumers. The federal government runs the navigator program, and trained and certified health insurance Navigators are required by law to provide fair, accurate, and unbiased enrollment assistance.
If you don't qualify for TennCare, Tennessee's Medicaid program, there are other healthcare options available through the Health Insurance Marketplace. Some locations also offer primary health care and dental care on a sliding fee scale based on income. Federally Qualified Health Centers (FQHCs) are community-based organizations that provide comprehensive primary care and preventative care, including health, oral, and mental health/substance abuse services, to all uninsured and underinsured individuals regardless of their ability to pay.
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Affordable Care Act (ACA)
The Affordable Care Act (ACA) was enacted in 2010 to increase access to affordable and comprehensive health insurance coverage, enhance consumer protection, improve prevention and wellness services, and expand access to health insurance coverage. The ACA has provisions that allow states to expand their Medicaid programs and prevent insurance companies from denying coverage to individuals with pre-existing conditions. It also offers affordable health insurance options through tax credits, coverage for young adults under their parents' plans until they turn 26, and mandatory coverage of specific preventive services without out-of-pocket expenses for consumers.
Tennessee, a red state, has witnessed a significant surge in ACA enrollments, with a 59% increase as of January 17, 2024, the fifth-highest in the nation. The state has a federally-facilitated health insurance exchange, with the Tennessee Health Insurance Exchange following federal guidelines for insurance professionals and navigators assisting consumers and small businesses.
Get Covered Tennessee, a non-profit statewide ACA Navigator agency, provides free and unbiased guidance to Tennessee residents about publicly funded health insurance options. They help residents understand eligibility requirements, provide enrollment assistance, and aid in choosing the right care plan.
Tennessee also has TennCare, the state's Medicaid program, which provides health care insurance to low-income children, pregnant women, parents or caretakers of minor children, the elderly, and people with disabilities. For those who do not qualify for TennCare, other options are available through the Health Insurance Marketplace, including CoverKids, which offers health coverage for eligible children under 18 and pregnant women.
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TennCare
Tennessee's Medicaid program is called TennCare. It is designed to provide health care insurance to low-income children, pregnant women, parents or caretakers of minor children, the elderly, and people with disabilities. Eligibility information can be found on the Categories web page of the TennCare website.
If you do not qualify for TennCare, there are other healthcare options available through the Health Insurance Marketplace. This is a federally-facilitated exchange, operated by the federal government, which opened for enrollment on October 1, 2013, with coverage starting on January 1, 2014.
The Tennessee Health Insurance Exchange navigator program assists consumers in making choices about their health care options and accessing their new health care coverage, including premium tax credits for eligible consumers.
If you have recently experienced a major life event, you may be eligible for a special enrollment period to help you get the coverage you need.
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Dental and vision insurance
Tennessee has a federally-facilitated health insurance exchange, which opened for enrollment on October 1, 2013, with coverage starting on January 1, 2014.
BlueCross BlueShield of Tennessee offers dental and vision plans. Their dental plan includes two exams and cleanings per year, X-rays, fillings, and other services with access to the largest dental network in the nation. Their vision plans include annual eye exams, glasses, contacts, and extra savings for all eye care needs.
Farm Bureau Health Plans' DentalVision combines dental and vision coverage into one affordable plan. It utilizes the Delta Dental PPO and VSP Choice networks, which offer savings and flexibility, helping you get the most out of your benefits while keeping costs down.
Delta Dental of Tennessee also offers fully insured dental plans with comprehensive vision care. Their DeltaVision plan includes quality coverage and exceptional service from a large network of dentists and doctors.
Additionally, TennCare, Tennessee's Medicaid program, provides health care insurance to low-income children, pregnant women, parents or caretakers of minor children, the elderly, and people with disabilities. They also offer dental care services and Community Health Centers or Federally Qualified Health Centers (FQHCs) that provide comprehensive primary and preventative care, including oral health services.
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Medicare Advantage Prescription Drug plans (MAPD)
Tennessee has a federally-facilitated health insurance exchange, which opened for enrollment on October 1, 2013, with coverage starting on January 1, 2014. The Tennessee Health Insurance Exchange follows federal guidelines for insurance professionals selling policies and for navigators assisting consumers and small businesses.
Now, Medicare Advantage Prescription Drug plans (MAPD) are a type of Medicare Advantage plan with prescription drug coverage. This means that with a MAPD plan, you get a comprehensive coverage package that includes everything covered by Original Medicare (parts A and B) and prescription drug coverage. MAPD plans are a popular type of Medicare Advantage plan because they cover multiple services, including medical services, hospital stays, and prescription drugs.
You can find MAPD plans from several major insurance companies, and the type of MAPD plan available to you will depend on your area. Most MAPD plans are Health Maintenance Organization (HMO) plans, where you’ll be restricted to a healthcare professional network and you’ll normally need a referral from your doctor to see a specialist. Another common type of MAPD plan is a Preferred Provider Organization (PPO) plan, where you’ll usually have a less restrictive network but your premium costs might be higher.
When choosing a MAPD plan, you’ll need to enter all your medications and your current pharmacy to see drug prices for the plans in your area. You can then click on the plans to see details, including the price you’ll pay for your current medications under that MAPD plan.
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Frequently asked questions
The Tennessee Health Insurance Exchange is a federally-facilitated health insurance exchange, also referred to as the Health Insurance Marketplace, where individuals and small businesses can purchase health insurance coverage.
The Tennessee Health Insurance Exchange opened for enrollment on October 1, 2013, with coverage starting on January 1, 2014.
You can visit the Health Insurance Marketplace website at HealthCare.gov to find, compare, and purchase ACA health exchange plans offered in Tennessee.
Yes, there are other options available through the Health Insurance Marketplace, such as Medicare Advantage Prescription Drug plans (MAPD), Dual Eligible Special Needs Plans (DSNP), and standalone Prescription Drug Plans (PDP). You can also explore short-term health plans that provide temporary coverage.
