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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 www.getcoveredtenn.org 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

Open Enrollment For Federal ACA Healthcare Coverage Now Underway

NASHVILLE, TENN. – Every year, millions of Tennesseans enroll in health insurance – while millions more go without health insurance due to the high cost of coverage. There is a nonprofit group who wants all Tennesseans to have access to quality healthcare, and they are passionate about helping those who need help navigating the often-confusing health insurance landscape to find what they need and can afford.

That group is Get Covered Tennessee, a program operated by Nashville-based Family & Children’s Service (F&CS), in partnership with Matthew Walker Comprehensive Health Center, Appalachian Mountain Project Access, Cherokee Health Systems, and approximately 400 other partners across Tennessee. Launched in 2015, the network of navigator agencies and serves all 95 counties of the state.

New this year is that many more families are now eligible for Marketplace than ever before due to the “family glitch” being resolved, allowing for larger number of people eligible than in year’s prior.

It is especially important for these newly eligible families to be informed of their eligibility. Now, If a family has to pay more than 9.12% (in 2023) of household income for the employer-sponsored plan, they will potentially be eligible for premium tax credits in the Marketplace for the first time.

[*see reference below about “Family Glitch” numbers]

The Open Enrollment period for health insurance sign ups is traditionally held each year from Nov. 1 – Dec. 15; however, this year it will again be extended through Jan. 15, 2023, just as last year, in anticipation of additional enrollments.

This week, F&CS hosted an “Open Enrollment Open House” at its Honey Alexander Center in Nashville Tennessee to officially kick off the open enrollment period statewide and raise awareness about this free service provided by Get Covered Tennessee. Speakers at the event included:

  • Mayor John Cooper, Nashville & Davidson County
  • Kathy Floyd-Buggs, Nashville Mayor’s Office, Dir. of Neighborhoods
  • Sherard McKie, Regional CMS Administrator
  • Cullen Douglass, Board Pres., Family & Children’s Service (F&CS)
  • Sharon Barker, ACA Navigator/Community Engagement Specialist (F&CS)
  • Paul Dodson, Get Covered Tennessee client

Enrollment in health insurance can be stressful for many individuals and families as healthcare costs continue to rise; healthcare plans seem to change with frequency; and the numerous products and programs can be confusing. Get Covered Tennessee has a team of Healthcare Access Navigators who are trained to help consumers review their health coverage options and complete eligibility and enrollment forms. These services are free, unbiased, and available to anyone who needs them.

While providing services to anyone that needs help, the Get Covered program team focuses on traditionally underserved populations.

“We can provide product information and enrollment assistance to anyone in Tennessee, regardless of where they live, by phone, video conference, or in person,” said Aram Khoshnaw, Senior Director, Healthcare Access Services, F&CS. “We want to meet them where they are, and provide them the information they seek in the way that is most comfortable for them. That’s what we do.”

According to the Center for Medicare and Medicaid Services (CMS), thanks to the American Rescue Plan and the Inflation Reduction Act, a majority of people continue to have access to affordable premiums that help lower costs for families. Four out of five customers will be able to find plans for 10 dollars or less per month after tax credits.

GetCoveredTenn network partners provides language interpretation services and accommodation for people with disabilities to ensure everyone has access to these services.

Health insurance through www.HealthCare.gov is often more affordable than many people think. Of new enrollees, 44% obtained coverage for less than $10 per month, and 91% of new enrollees received financial help that lowered their monthly health insurance premiums during the special enrollment period early this year. The government has also boosted ACA subsidies, making even more individuals and families eligible for these discounts.
For more information about the federal insurance marketplace, the open enrollment period, or www.GetCoveredTenn.org, call 866-475-7879 or visit www.getcoveredtenn.org. For more information about Family & Children’s Service, visit www.fcsnashville.org . Alternatively, consumers not needing assistance can enroll in insurance products through the www.HealthCare.gov federal insurance enrollment website.

About Family & Children’s Service

Family & Children’s Service (F&CS) serves all people in crisis and transition by meeting them where they are, understanding their needs, and connecting them to the resources they need. F&CS often ‘fills in the gaps’ in social services, creating a safety net to ensure that all children and families can be safe and healthy. Each year, F&CS provide services to more than 50,000 Tennesseans. F&CS’ mission is to connect individuals and families to hope, to healing, and to one another. Founded in 1943 by volunteers who helped find adoptive homes for children orphaned during WWII, F&CS is one of Nashville’s oldest and most venerated nonprofits. Throughout its history, F&CS has focused on the most vulnerable children and families, adapting its services to meet the changing needs of the community. www.FCSNashville.org

This publication is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $3,052,030.00with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

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“Family Glitch” details

  • From 2014 – 2022, people were ineligible for Advanced Premium Tax Credits (financial assistance for insurance) if they had access to quality, affordable employer coverage for EMPLOYEE ONLY — regardless of cost to add family members
    With the family glitch fix ~1 million people will see coverage become more affordable
  • It’s estimated that 200,000 uninsured people will obtain coverage
  • Applies to 2023 plan year
  • Replaces a 2013 IRS rule that created the family glitch
  • KFF analysis: according to the Kaiser Family Foundation more than 5 million Americans fell through the cracks as a result of the family glitch
  • Dependents of a worker with employer coverage may now be eligible for APTCs if the cost for the family premium through the employer exceeds 9.5% of their income
  • Previously, family member eligibility was determined by the single employee premium alone.
  • ~12% of workers in the US pay more than $10,000/year in premiums for dependents in employer plans
  • Since 2013, the average annual employee contribution for family coverage has increased by 30%
  • Families might find that the fix puts affordable coverage within reach and will enroll at least some members in MPcoverage with new APTC
  • Analysis predicts 20% of new APTC recipients will gain insurance
  • Most will see lower premiums after switching from employer coverage
  • Not anticipated to have a significant impact on the employer-sponsored insurance market
  • Will lead to meaningful savings for families
  • Many will be newly eligible for plans with $0 premiums
  • Families of low-paid workers, small business employees, service industry, and children under age 18 will see largest impact
  • Overall, Third Way estimates that fixing the family glitch would reduce health care costs by $4,152 for a typical family of four with an income of $53,000
  • Overall, about 12 percent of covered workers were asked to pay at least $10,000 for coverage for a family of four.
  • The Urban Institute found that 4.8 million people, nearly half of them children, would be newly eligible for premium tax credits if the glitch were fixed.
    the cost of family coverage has more than tripled since 2000
  • Overall, Third Way estimates that fixing the family glitch would reduce health care costs by $4,152 for a typical family of four with an income of $53,000

F&CS’ GetCoveredTenn.org Launches Statewide Campaign

“For many people, enrolling in healthcare can be intimidating and complicated. We make that process easy, free, and accessible to everyone in Tennessee.”
— Michael McSurdy, Pres. & CEO of Family & Children’s Service

NASHVILLE, TENNESSEE, November 9, 2021 — Every year millions of Tennesseans enroll in health insurance – while millions more go without health insurance due to the high cost of coverage. There is a nonprofit group who wants all Tennesseans to have access to quality healthcare, and they are passionate about helping those who need help navigating the often confusing health insurance landscape to find what they need and can afford.

That group is Get Covered Tennessee, a program operated by Nashville-based Family & Children’s Service (F&CS), in partnership with Matthew Walker Comprehensive Health Center, Appalachian Mountain Project Access, Cherokee Health Systems, and approximately 400 other partners across Tennessee. Launched in 2015, the network of navigator agencies and serves all 95 counties of the state.

The Open Enrollment period for health insurance sign ups is traditionally held each year from Nov. 1 – Dec. 15; however, this year it has been extended through Jan. 15, 2022, in anticipation of increased need. Enrollment in health insurance can be stressful for many individuals and families as healthcare costs continue to rise; healthcare plans seem to change with frequency; and the numerous products and programs can be confusing. Get Covered Tennessee has a team of Healthcare Access Navigators who are trained to help consumers review their health coverage options and complete eligibility and enrollment forms. These services are free, unbiased, and available to anyone who needs them.

“For many people, enrolling in healthcare can be intimidating and complicated,” said Michael McSurdy, President & CEO of Family & Children’s Service. “Our Get Covered Tennessee team exists to make that process easy, free, and accessible to everyone in Tennessee.”
While providing services to anyone that needs help, the Get Covered program team focuses on traditionally underserved populations, and this year there will be a focus on those that lost their insurance due to pandemic-related job loss.

“We can provide product information and enrollment assistance to anyone in Tennessee, regardless of where they live, by phone, video conference, or in person,” said Aram Khoshnaw, Senior Director, Healthcare Access Services, F&CS. “We want to meet them where they are, and provide them the information they seek in the way that is most comfortable for them. That’s what we do.” GetCoveredTenn network partners provides language interpretation services and accommodation for people with disabilities to ensure everyone has access to these services.

Health insurance through www.HealthCare.gov is often more affordable than many people think. Of new enrollees, 44% obtained coverage for less than $10 per month, and 91% of new enrollees received financial help that lowered their monthly health insurance premiums during the special enrollment period early this year. The government has also boosted ACA subsidies, making even more individuals and families eligible for these discounts.

Over the last three years, GetCoveredTenn Healthcare Access Navigators have held 1,028 in-person and virtual events reaching more than 1.6 million consumers; provided one-to-one assistance to 18,641 consumers; and directly assisted 7,064 consumers. These efforts have reached an estimated 12.4 million people total over the last six years of the program, helping consumers to understand their health coverage options and make better-informed choices. The GetCoveredTenn network is composed entirely of nonprofit organizations that do not benefit in any way from providing these services to consumers, and the program is paid for by a grant from the federal government.

For more information about the federal insurance marketplace, the open enrollment period, or www.GetCoveredTenn.org, call 866-475-7879 or visit www.getcoveredtenn.org. For more information about Family & Children’s Service, visit www.fcsnashville.org . Alternatively, consumers not needing assistance can enroll in insurance products through the www.HealthCare.gov federal insurance enrollment website.

About Family & Children’s Service

Family & Children’s Service (F&CS) serves all people in crisis and transition by meeting them where they are, understanding their needs, and connecting them to the resources they need. F&CS often ‘fills in the gaps’ in social services, creating a safety net to ensure that all children and families can be safe and healthy. Each year, F&CS provide services to more than 50,000 Tennesseans. F&CS’ mission is to connect individuals and families to hope, to healing, and to one another. Founded in 1943 by volunteers who helped find adoptive homes for children orphaned during WWII, F&CS is one of Nashville’s oldest and most venerated nonprofits. Throughout its history, F&CS has focused on the most vulnerable children and families, adapting its services to meet the changing needs of the community. www.FCSNashville.org

This program is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,452,030.00 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

Family & Children’s Service Awarded $8 million to Support ACA Outreach and Enrollment

NASHVILLE, TENN.— Sept. 1, 2021Family & Children’s Service (F&CS) was awarded the largest federal grant in its history this week. The Nashville-based nonprofit received nearly $8M in funding to use over the next three years to support its Affordable Care Act (ACA) outreach and enrollment work. The majority of this work is done through F&CS’ www.GetCoveredTenn.org initiative to connect Tennesseans to healthcare access.

This is a big expansion of funding for this program, and is especially notable in the wake of the current pandemic and increasing awareness around healthcare coverage needs.

The GetCoveredTenn Coalition, which is composed of more than 400 community-based partners statewide, will target all 621,500 uninsured consumers in all 95 Tennessee counties. The project will expand services and activities in the Middle and Southern regions of Tennessee and create new services and activities in Western and Eastern Tennessee.

“This kind of federal grant allows us to make a significant impact across the state,” said Michael McSurdy, CEO of F&CS. “We will be creating a statewide coalition, which means harnessing established and new relationships with local social service and healthcare providers and hospitals throughout Tennessee. We will bring our resources and experience to these cities, but the local experts will drive what works best for the specific communities in which they operate. This is what we have found works best. It isn’t a ‘one size fits all’ approach. But for sure spreading the resources, knowledge, and funding around will assure our success and the success of all our Tennessee communities.”

“We are ecstatic that such an excellent, well-regarded organization like Family and Children’s Service received this funding for such vital work in helping uninsured Tennesseans access health coverage,” said Brian Haile, CEO of Neighborhood Health Business Office.  “F&CS is uniquely positioned to make the largest possible impact, and we are celebrating the news they will receive this funding.”

As Lead Applicant, Family & Children’s Service, along with approximately 400 named partners, will perform the cooperative agreement activities in partnership with three 501(c)3, community and consumer-focused, non-profit organizations that will be paid subcontractors under this cooperative agreement. F&CS plans to spread funding resources throughout the state, as indicated by the map and chart below:

GetCoveredTenn Navigator Subrecipients (Primary Partners)

  1. Matthew Walker Comprehensive Health Center
  2. Cherokee Health System
  3. Appalachian Mountain Project Access

 

 

 

Region Name and Number

 

Eligible Uninsured Uninsured % # of Navigator FTE Proposed*
Greater Memphis Region 1 116,800 13% 3
Northwest Region 2 25,900 13% 1
Southwest Region 3 25,100 13% 1
Northern Middle Region 4 144,500 9% 8
Southern Middle Region 5 45,700 12% 1
Upper Cumberland Region 6 33,800 12% 1
Southeast Region 7 67,300 13% 2.5
East Region 8 108,900 11% 3.79
Northeast Region 9 53,500 13% 3
Totals 621,500 11% 24.29

 

Family & Children’s Service currently has contracts with HHS, SAMHSA, OCJP, TN Department of Health, TN Department of Children’s Services, TN Department of Human Services, and the United Way, among others. F&CS has been an HHS-CMS Navigator grantee since 2015. Prior to 2015, F&CS was a Navigator subrecipient, and we were a founding partner in launching ACA outreach and enrollment efforts in our state.

About Family & Children’s Service

Family & Children’s Service (FCS) serves all people in crisis and transition by meeting them where they are, understanding their needs, and connecting them to the resources they need. FCS often ‘fills in the gaps’ in social services, creating a safety net to ensure that all children and families can be safe and healthy. Each year, FCS provide services to more than 50,000 Tennesseans. FCS’ mission is to connect individuals and families to hope, to healing, and to one another. Founded in 1943 by volunteers who helped find adoptive homes for children orphaned during WWII, FCS is one of Nashville’s oldest and most venerated nonprofits. Throughout its history, FCS has focused on the most vulnerable children and families, adapting its services to meet the changing needs of the community. For more information go to www.FCSNashville.org and/or www.GetCoveredTenn.org.

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