Accessing quality healthcare in Tennessee remains a fundamental necessity. To achieve this goal, individual insurance policies and other plans are available for residents looking to get reliable and affordable health coverage year-round. Get Covered Tennessee, a non-profit statewide ACA Navigator agency provides free and unbiased guidance to Tennessee residents about publicly funded available health insurance options to help them make informed decisions.
The program aims to help you understand eligibility requirements, provide step-by-step enrollment assistance, and help you choose the right care plan. Feel free to contact us if you need personalized assistance.
About the Affordable Care Act
The Affordable Care Act (ACA) became law in 2010. Its goal is to increase access to affordable and comprehensive health insurance coverage, increase consumer protection, improve prevention and wellness services, and expand access to health insurance coverage.
ACA includes provisions that allow states to expand Medicaid, prevent insurance companies from denying coverage for individuals with pre-existing conditions, provide affordable health insurance options by offering tax credits (discount), coverage for young adults who wish to stay on their parent’s health insurance plans until they turn 26 years old, a requirement for insurance plans to cover certain preventive services without out–of–pocket costs for the consumer.
The Affordable Care Act (ACA) expands health insurance coverage options by creating a platform – the Health Insurance Marketplace (Exchanges) that offers insurance plans to individuals, families, and small businesses. The Marketplace facilitates competition among private insurance companies in a central location so uninsured consumers who do not have access to employer-based coverage can find affordable and comprehensive coverage.
Consumers can compare different plans and submit their applications once they find one that meets their medical needs and budget. Individuals can also compare and apply for plans via the Marketplace during the Open Enrolment Period.
The open enrollment period is usually from November 1st to January 15th. However, consumers can also apply outside of the open enrollment period if they have a qualifying life event that qualifies them for the Special Enrollment Period.
Choosing the Right Plan: Expert Advice on Selecting Affordable Coverage
Choosing the right plan can be intimidating, particularly during the enrollment stage. You must choose from multiple options based on your needs and budget. Here are some valuable GetCoveredTenn tips to help you select the best health insurance plan:
Understanding the Different Health Insurance Categories
Health insurance coverage exists in the bronze, silver, gold, and platinum categories. Bronze plans have lower monthly premiums and higher out-of-pocket costs. They are a desirable choice for generally healthy individuals who simply want to protect themselves from worst-case medical scenarios, like serious sickness or injury.
Silver plans usually have moderate monthly premiums and moderate costs when accessing medical services. Extra savings are available with a Silver plan for individuals who qualify for cost-sharing reductions. Cost-sharing reduction is a discount that lowers the amount you must pay for deductibles, copayments, and coinsurance. Silver plans are an excellent choice if you qualify for cost-sharing reduction “extra savings,” if not, the monthly premium will be slightly higher than Bronze, and it covers most of the cost for routine care.
Gold plans usually have high monthly premiums and low costs when accessing care. Gold plan is a viable choice if you are willing to pay more each month to have most of your medical care cost covered.
Platinum options have the highest monthly premiums and the lowest out-of-pocket costs. These options are excellent for individuals with an elevated risk of health issues.
If unsure, our Certified Navigators can help you review each plan category to help you narrow down your insurance options based on your budget and health care needs.
Your Budget
When choosing a plan, it is a clever idea to think about your total health care costs (including the premium, deductible, and copayment/coinsurance amounts). Do not focus solely on the monthly payment; other medical-related costs (out-of-pocket costs) you pay when accessing services have a significant impact on your total health care spending.
Think about the health services and prescription drugs your household usually gets. Then, estimate the services you are likely to use in the year ahead. This will help you balance coverage and affordability to ensure you do not default on paying your premiums or other medical expenses. To avoid surprises, our Certified Navigators can help you review your policy thoroughly to see if the total cost of your health care is manageable based on your budget.
Understand the Network of Healthcare Providers Included
You must understand your plan’s network of healthcare facilities or providers. A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They are known as “network providers’ or “in-network providers.” A provider that is not contracted with the plan is called an “out-of-network provider.”
For instance, in-network services are cost-effective and easily accessible. They also guarantee seamless, quality healthcare. Before making your plan selection, make sure all the providers and facilities you use are in-network.
Navigating Enrollment: Step-by-Step Assistance
Enrollment assistance is available through GetCoveredTenn. We offer step-by-step aid in navigating the available health insurance options through the Marketplace. With the Marketplace, we will help you to:
- Create an account.
- Analyze and understand your eligibility and the insurance plans available to you.
- Upload required documents.
- Complete and submit enrollment applications.
- Access your medical care plan.
- Access Marketplace tax forms.
- Access referrals to available customer assistance programs.
- Report income changes and file insurance appeals.
Our free and unbiased assistance ensures you make an informed decision when enrolling in an affordable care policy.
Putting Healthcare Within Reach for All Tennesseans
Get Covered Tennessee commits to putting healthcare services within reach for all Tennesseans by providing outreach and enrollment services. Our trained and Certified Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the Marketplace and the state Medicaid program (TennCare/CoverKids). In addition, our Certified Navigators provide outreach and education to raise awareness about the Marketplace, TennCare, and other consumer assistance programs when necessary.
Whether you want to better understand the ACA, compare insurance options, or navigate the enrollment process, we have enough information to help you make informed decisions. If you’re looking for an affordable insurance plan through the Marketplace or need help applying for TennCare/CoverKids, schedule an appointment today to get our expert advice. You can schedule a phone or in-person appointment.