Orlando Harmon
TennCare, also known as Tennessee Medicaid, is a government-funded health insurance program that offers coverage to low-income individuals who are pregnant, support dependents, have disabilities, or are senior adults. While TennCare covers most major health services, there are certain limitations and eligibility requirements. If an individual qualifies for TennCare, they may still need supplemental insurance from a third-party provider to cover additional costs such as routine exams, prescription glasses, and therapeutic medical equipment. This supplemental coverage can be sought from other affordable insurance providers to supplement one's TennCare coverage.
| Characteristics | Values |
|---|---|
| Name of Supplemental Insurance | TennCare |
| Administered by | State of Tennessee |
| Funded by | State and federal government |
| Coverage | Doctor’s visits, prescription drug costs, medical procedures, dental exams, and more |
| Eligibility | Low-income individuals who are pregnant, currently support dependents, have a disability, or are senior adults |
| Application Methods | Online, over the phone, or with a paper application |
| Contact Number | 855-259-0701 |
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What You'll Learn
Qualifying for TennCare Medicaid
To qualify for TennCare Medicaid, there are certain conditions that must be met. Firstly, individuals must meet specific income requirements, which are not explicitly stated. Secondly, TennCare Standard is available only for children under the age of 19 who are already enrolled in TennCare Medicaid and lack access to group health insurance through their parents' employers, or whose time of eligibility is ending and they no longer qualify for TennCare Medicaid. In this case, the Department of Human Services will determine if they qualify for TennCare Standard.
Additionally, TennCare offers the CoverKids program, which assists children aged 18 and younger and pregnant women. The Katie Beckett Program is also available to help children with disabilities or complex medical needs who would typically not qualify for TennCare. The Medicare Savings Program (MSP) helps with Medicare costs, and individuals receiving Supplemental Security Income checks may also qualify for TennCare.
For those who do not have TennCare, contacting the local Area Agency on Aging and Disability (AAAD) is recommended. They can provide information on other programs that may be beneficial, even if individuals do not qualify for Medicaid. The AAAD will even offer in-person assistance with the TennCare application process for individuals with disabilities. Alternatively, individuals can call TennCare Connect for phone assistance with their TennCare application.
There are three ways to apply for TennCare Medicaid: online through the TennCare Connect self-service portal, over the phone, or with a paper application. Conditional Assistance, a form of temporary coverage, may be available for individuals who have excess resources that would typically disqualify them from receiving TennCare Medicaid.
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Third-party supplemental insurance
Tennessee's Medicaid program, also known as TennCare, is a managed care programme that is jointly funded by the state and federal government. It offers healthcare coverage to low-income or disabled individuals and families. TennCare covers most major health services and procedures, but there are some limitations and exemptions. For example, it does not cover routine exams, prescription glasses, diapers, therapeutic medical equipment, or funeral costs.
As a result of these limitations, some individuals may seek additional coverage from third-party supplemental insurance providers. This is especially true for low-income adults without dependents or qualifying conditions who may struggle to access affordable healthcare. Third-party supplemental insurance can help cover the costs of services that TennCare does not, such as mental and behavioural health treatments, and funeral expenses.
There are several options for obtaining supplemental insurance from third-party providers. One option is to use a service like Insurdinary, which helps individuals find affordable plans that extend their healthcare coverage. Another option is to purchase private insurance, such as life insurance, which can help pay for medical costs that Medicaid does not cover. Additionally, Qualified Income Trusts (QITs) or Miller Trusts allow individuals over Medicaid's income limit to become income-eligible for Medicaid nursing home care. By depositing excess income into an irrevocable trust, individuals can use the funds to pay for unreimbursed medical expenses and health insurance premiums.
It is important to note that TennCare coverage must be renewed annually, and individuals must meet certain eligibility requirements, including income and asset limits, to qualify for TennCare or Medicaid. Seniors can apply for TN Medicaid online, over the phone, in person, or by submitting a paper application, and there are similar options for applying for TennCare.
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Medicare Savings Program
The Medicare Savings Program (MSP) is a Medicaid-administered program that assists individuals with limited incomes and assets in covering their Medicare costs. MSPs are also referred to as Medicare Buy-In programs or Medicare Premium Payment Programs. Each state offers a State Health Insurance Assistance Program (SHIP) to provide free counselling and assistance to those interested in learning more about MSPs.
There are three main types of MSPs, each with different benefits and eligibility requirements:
- Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums, deductibles, and coinsurance. Individuals with QMB coverage should not be billed for Medicare-covered services when seeing Medicare providers or providers in their Medicare Advantage plan.
- Specified Low-income Medicare Beneficiary (SLMB): Covers the Medicare Part B premium.
- Qualifying Individual (QI): Covers the Medicare Part B premium. QI is only available for individuals who do not qualify for any other Medicaid coverage or benefits but may still qualify for assistance from another Medicare Savings Program.
When an individual enrols in an MSP, they automatically receive assistance with their prescription drug plan costs through the federal Extra Help program. This program ensures that enrollees pay no more than $12.15 in 2025 for each drug covered by their Medicare drug plan.
To qualify for an MSP, an individual must meet certain income and asset guidelines, which vary by state. Some states do not consider certain types of income or resources when determining eligibility. Income limits for MSPs are slightly higher in Alaska and Hawaii compared to other states.
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Long-term care assistance
Tennessee's Medicaid program, also known as TennCare, offers long-term care assistance for seniors through its Long-Term Services & Supports division. This division includes the CHOICES program, which provides long-term care services to older adults (age 65 and older) and adults with physical disabilities (age 21 and older). CHOICES offers support to individuals who are at risk of needing the level of care provided in a nursing home but would prefer to remain in their own homes or communities. The program provides services such as personal care, adult day care, medical alert devices, and transportation assistance.
To be eligible for CHOICES, individuals must meet specific financial criteria and be "at risk" of needing nursing home care. Financially, an individual's income must not exceed $2,901 per month for 2025, and the total value of their assets must not be more than $2,000 (excluding their primary residence). Additionally, they must not have given away or sold any assets for less than their worth in the last five years.
For those who are interested in applying for CHOICES, the first step is to contact their local Area Agency on Aging and Disability (AAAD). These agencies serve as a resource for information and assistance with the application process. Seniors can also take the Medicaid Eligibility Test to determine their eligibility for long-term care services. It is important to note that not meeting all the criteria does not necessarily mean automatic ineligibility for TennCare, as Tennessee offers multiple pathways to Medicaid eligibility.
Another option for long-term care assistance is the Program of All-Inclusive Care for the Elderly (PACE). This program combines the benefits of Medicaid and Medicare into a single program, offering long-term care and additional benefits such as dental and eye care. Seniors can apply for TN Medicaid online, over the phone, in person at their local DHS office, or by submitting a paper application.
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Applying for TennCare
To apply for TennCare, you must create a TennCare Connect account and apply online. The application process takes most people 30 to 60 minutes to fill out. If you need help with the application, you can call TennCare Connect at 855-259-0701. You can also go to any DHS office in any of Tennessee's 95 counties for assistance. If you have a disability, someone from the local office can come to your house to help you apply.
If you are applying for TennCare for a child with a disability or complex medical needs, you can apply for the Katie Beckett Program online by creating a TennCare Connect account. If you have questions about how to apply for Katie Beckett, there is an FAQ page with more information.
If you are applying for long-term care, you can call your TennCare health plan (MCO). The number is on your TennCare card. If you do not have TennCare, you can contact your local Area Agency on Aging and Disability (AAAD) at 1-866-836-6678. If you have an intellectual disability or are helping someone with an intellectual disability apply for long-term care, call the Department of Disability and Aging (DDA) at 1-800-535-9725.
If you are already on TennCare and have a new baby (12 months old or less) that you want to enroll, you can enroll your baby over the phone by calling TennCare Connect at 855-259-0701.
If you applied for TennCare and have not heard back, you can call TennCare Connect at 855-259-0701 to file a delayed application appeal. If you have been receiving TennCare but did not receive a renewal packet in the mail, you can call the same number for assistance.
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Frequently asked questions
TennCare is the name of Tennessee's Medicaid program. It is a Managed Care Program jointly funded by the state and federal government but administered by the state within federally set parameters.
TennCare covers most major health services and procedures, including doctor's visits, prescription drug costs, medical procedures, and dental exams. However, it does not cover routine exams, prescription glasses, diapers, and therapeutic medical equipment.
Yes, if you qualify for certain Medicare programs beyond TennCare, you may need to seek supplemental insurance from a third-party provider to access certain treatments.
