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Tennessee-Specific Healthcare Options: Unveiling Your Coverage Choices

Health insurance is a way for individuals and families to stay protected in the case of sudden illness or injury. It can provide peace of mind and offer reassurance that even when you aren’t feeling your best, you have medical professionals on your side who can help you get back on your feet. However, navigating the complex world of Tennessee health insurance can sometimes be confusing. Get Covered Tennessee Navigators are trained and able to help Tennesseans as they look for health coverage options through the Marketplace and TennCare/CoverKids. Navigators also provide information about local resources to help those who may not be eligible for Marketplace or TennCare/CoverKids. 

Overview of Tennessee Healthcare System

Tennessee has a unique healthcare system that is governed primarily by the Bureau of TennCare which manages TennCare and CoverKids programs in Tennessee. Tennessee uses the Federally Facilitated Marketplace to allow residents to enroll in Affordable Care Act plans. The Tennessee Department of Health, or TDOH and county Health Departments provide various initiatives and programs to keep state residents healthy and well-informed. The Tennessee Board of Medical Examiners is the regulatory body responsible for licensing and overseeing Tennessee medical doctors and other healthcare professionals. At the same time, the Tennessee Hospital Association (THA) is a membership organization that represents and supports hospitals and health systems in the state. You might have to work with any or all of these organizations at some point in your health insurance journey.


Medical Insurance Options in Tennessee

Tennessee residents have several medical insurance options, depending on their unique qualifications and needs. The Health Insurance Marketplace, a component of the Affordable Care Act (ACA), is one of the options where individuals and families can shop around for insurance plans. Individuals and families who purchase insurance plans through the Marketplace may qualify for subsidies (premium tax credit) based on their household income. The premium tax credit lowers the premium and other medical costs for those enrolled in a plan through the Marketplace. 

The other option is Tennessee’s Medicaid program, also known as TennCare. TennCare provides healthcare services to low-income individuals, children, and elderly people. CoverKids is an extension of TennCare designed to provide coverage for eligible children ages 18 and younger or pregnant women who are not eligible for TennCare and do not have other private insurance. 


 Medicare and Medicaid in Tennessee

While Tennessee was one of the states that did not initially embrace Medicaid, opting against an initiative to expand it, it introduced a modified version of Medicaid expansion in 2021 known as the Tennessee Medicaid program or TennCare III. This program is primarily available to low-income individuals.


Tennessee residents who are 65 or older can qualify for Medicare and receive basic healthcare services. Medicare is also available to people with certain chronic diseases, such as ALS or Lou Gehrig’s Disease. Some low-income Medicare beneficiaries could be eligible for extra help through TennCare’s Medicare Saving Program (MSP). The program covers premiums and, in most cases, cost sharing for Medicare beneficiaries who meet financial eligibility requirements. If you have questions about your eligibility for Medicare Saving Programs (MSP), the specialists at GetCoveredTenn can assist.


Navigating Healthcare Options in Tennessee with GetCovered Tenn

Navigating what type of healthcare is right for you and your family can be tricky. Fortunately, assistance is available. GetCovered Tenn is here to help. Our nonprofit program offers free health insurance enrollment and healthcare advice to all Tennesseans, regardless of age, income level, or background.  We are proud to be a community-based resource for anyone who wants to take charge of their healthcare journey. Contact us today to learn how we can help you find the right insurance and healthcare programs for your unique needs.


Image Credits:  Millenius // Shutterstock

Navigating Open Enrollment: A Step-by-Step Guide

Having adequate healthcare coverage is a crucial step in ensuring you have the resources you need to stay on top of your health, prevent many types of potential health problems, and respond to concerns that occur as early as possible, especially for families. There are different ways to get health insurance to ensure you and your family are properly protected. 

One way that Tennesseeans can obtain health insurance coverage is through the health insurance marketplace. During the open enrollment period, individuals can compare and apply for coverage or make changes to their existing coverage through the Marketplace. 


Open Enrollment for the Marketplace usually occurs from November 1st to January 15th each year. Individuals who complete their enrollment or renewal by December 15th will have a January 1st effective date. However, if an individual enrolls after December 15th during Open Enrollment, the coverage effective date will be February 1st.


Securing the coverage you and your family need can be confusing, however, GetCoveredTenn’s certified Navigators can help make every step of the process easier.


Here is an overview of what the Open Enrollment process looks like.

Who Is Eligible? 

Everyone with a Marketplace (Affordable Care Act) plan and those new to the Marketplace can review their plan during the Open Enrollment period. Individuals and families who do not have health insurance or lost it recently can enroll in a Marketplace health insurance plan during this time as well. Because this is the main opportunity to change or add coverage, paying close attention to instructions and deadlines is necessary.

Healthcare Options Available

Many employers offer their own benefits package options that are uniquely tailored to align with the nature of your business and the typical needs of its employees. Still, employer-sponsored insurance may not always be affordable to your family. Suppose you are not currently employed or self-employed or that your employer’s health insurance benefits are not affordable based on Marketplace’s definition of affordability. In that case, you may also elect to apply for TennCare Medicaid or a Marketplace (Affordable Care Act) insurance plan that may better fit your unique situation. The Marketplace plans are categorized as Bronze, Silver, Gold, or Platinum, identifying each option’s typical cost, your share of healthcare expenses, and the carriers’ share of expenses. Even if you are not planning to change plans, it is important to review your current plan’s specific policies to be aware of any significant changes that may have occurred since last year’s Open Enrollment period. 


Regardless of whether you plan to stick with your current plan or switch to something new, it is important to know that the Marketplace may auto-enroll you in the same plan if you are already enrolled. However, the costs associated with the auto-enrolled plan may have changed since last year. That is why reviewing your Marketplace plan and making an informed decision about what is best for you and your family each year is important.

Benefits of Open Enrollment

Marketplace plans and prices change every year. The primary reason to take advantage of the open enrollment period is to periodically review your health insurance policy to ensure it is still a good fit for your needs. During the Open Enrollment period, individuals will have the option to change their health insurance plans, update expected income for the plan year, and report any household changes.


Taking the time to learn about any changes that may have occurred to your current plan or other options that may be a better fit for you in the past year can go a long way toward keeping your family covered by a plan that adequately meets their needs. During Open Enrollment, you can explore a wide range of healthcare options, increasing your peace of mind by helping you ensure that you have the best possible coverage for your family at any given time. You may also reduce the amount you pay in both premiums and deductibles by switching to a plan that better meets your needs if your current plan includes more coverage than you used in the past year.

What if I missed Open Enrollment?

You can enroll and change your health insurance plan outside of Open Enrollment during Special Enrollment Period (SEP). Special Enrollment Period is a time outside the yearly Open Enrollment period when individuals can sign up for health insurance or change their plans. To qualify for SEP, you must have certain qualifying life events like:


  • Losing health coverage
  • Moving
  • Getting married
  • Having a baby or adopting a child
  • Having income below a certain amount.


Special Enrollment Periods last 60 days after the qualifying event.

Navigating Open Enrollment Can Feel Overwhelming. GetCoveredTenn Is Here to Help. 

At Family & Children’s Service, we know that understanding the Open Enrollment process, choosing just the right healthcare option for you and your family, and completing the enrollment process on time can be confusing. GetCoveredTenn is a valuable resource for learning more about the Marketplace healthcare options that may be available to you and ensuring that you understand every detail of the Open Enrollment process and when each step needs to be completed. Our services are free  Contact us today  Call (866) 475-7879 or visit our website to learn more about the Open Enrollment process or to start the enrollment process with assistance from our experienced and knowledgeable team!


Image Credits:  Summit Art Creations // Shutterstock