The information provided here is intended for general guidance only and may not apply uniformly in all cases. Statements are subject to change and may be adjusted based on individual circumstances, specific situations, or evolving policies. For personalized advice or clarification, please call 866-475-7879 or schedule an appointment to discuss your personal case.
Medicare is a federal health insurance program for people age 65 and older, people under 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (ESRD). For help with Medicare, we recommend contacting your local SHIP agency , or call 877-801-0044
Medicaid, on the other hand, is a joint federal and state program that provides health coverage to low-income individuals and families, including children, pregnant women, and people with disabilities. In Tennessee Medicaid is called TennCare
Typically, no monthly premium is required for TennCare or CoverKids. However, small co-pays may apply for services like doctor visits or prescriptions for CoverKids
TennCare: Public insurance for low-income individuals, often free or at a very low cost.
Marketplace Insurance: Private insurance purchased through the Marketplace, costs are determined by the plan chosen and offset by subsidies, if applicable.
Tennessee Residents who are:
Yes—if your income rises above eligibility levels, if you move out of state, fail to renew, or are found ineligible during periodic reviews.
Apply via TennCare Connect online, or by phone at 855-259-0701.
Pro Tip: How to Set Up Your Own Account
Applications typically take 2-3 weeks, however TennCare has up to 45 days (90 for certain program) to make a final decision. Consumers can file an appeal if there is no decision within that timeline.
If you feel like you have been denied when you are eligible, you have the right to appeal. The denial letter includes instructions on requesting a fair hearing.
You can fill out an appeal form and fax it to TennCare or call the appeals number.
TennCare Appeal Phone number: 855-259-0701
TennCare Appeal fax number: 1-855-315-0669
Yes, renewal is required annually via TennCare Connect website, phone, or by mail. To find your renewal date, check your TennCare connect account or call TennCare 855-259-0701.
Upload them through your TennCare Connect account, or submit by mail or fax if instructed.
TennCare will send a renewal packet to update each members’ information and see if you still qualify for coverage annually. Click for more renewal information.
These packets are sometime referred to as questionnaires to renew coverage, redetermination packet, TennCare Re-enrollment, etc.
Report any changes—income, household size, address, employment, pregnancy, or new benefits—within 30 days of the change.
Pro tip: Changes in household size, income, address, ect. can affect your insurance plan and eligibility.
You can change managed care plans 45 after enrollment or during the following times based on where you live.
The kind of benefits you have depends on the kind of TennCare you have. If you have questions about covered services, please call Get Covered Tenn at 866-475-7879 or call TennCare Connect at 855-259-0701.
Yes- both Marketplace and TennCare plans include drug coverage. Contact your insurance plan on the back of your card to get specific information on covered prescriptions.
Children under 19 with TennCare or CoverKids receive both dental and vision coverage. Adults with TennCare or CoverKids are eligible for dental benefits, but vision coverage is not included.
Yes—both TennCare and Marketplace plans must cover pre-existing conditions with no exclusions.
Please check the provider directory and drug formulary listed in your specific plan documents on the Marketplace or TennCare Connect.
For additional help, contact your insurance carrier directly using the phone number on your insurance card.
Contact your insurer via phone or online portal to request a replacement.
Pro- tip: Save or download your insurance plans website or mobile app to get access to digital cards, find providers, see explanations of benefits, and access up to date coverage information.
Wellpoint (formerly known as Amerigroup)
Three Lakeview Place
22 Century Blvd., Suite 310
Nashville, TN 37214
BlueCare
1 Cameron Hill Circle, Suite 0002
Chattanooga, TN 37402-0002
Fax 800-357-0453
UnitedHealthcare Community Plan
10 Cadillac Dr., Suite 200
Brentwood, TN 37027
TennCare Select
1 Cameron Hill Circle, Suite 0002
Chattanooga, TN 37402-0002
FAX: 800- 218-3190
Apply for SNAP (food stamps) through Tennessee Department of Human Services 833-772-8347 or at your local DHS office.
Dial 211 on your mobile phone for options or text your zip code to 898-211 to get started.
Apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) online at SSA.gov or at your local Social Security Administration office.
Area Agencies on Aging and Disability AAAD
You can begin the application at SSA.gov or visit a local Social Security Administration office for help with benefits, retirement, or disability applications.
For help with Medicare, we recommend contacting your local SHIP agency or call 877-801-0044.
In Tennessee, the Health Insurance Marketplace (HIM) is a federal online platform where individuals and families can compare and purchase private health insurance plans that meet minimum essential coverage standards. The official site is healthcare.gov. Costs of plans may be subsidies by premium tax credits to lower out of pocket costs.
TIP: We refer to the HIM as “The Marketplace” in this document. It is also sometimes referred to “ObamaCare” or ACA.
TennCare is the state of Tennessee’s Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability. It is often free, or at a very low cost.
Marketplace Insurance is private insurance purchased through the Marketplace, costs are determined by the plan chosen and offset by subsidies, if applicable.
Advanced Premium Tax Credit (APTC) is federal financial aid that lowers monthly Marketplace insurance premiums based on your estimated annual income.
Pro tip: You can use all, some, or none of your premium tax credit in advance to lower your monthly bill for insurance.
If you use more advance payments of the tax credit than you qualify for based on your final yearly income, you must repay the difference when you file your federal income tax return.
If you use less premium tax credit than you qualify for, you’ll get the difference as a refundable credit when you file your taxes.
Pro tip: Some people think APTCs are credits that must be paid back at tax time. However, consumers are eligible for these tax credit based on their annual income. Make sure you have estimated your income as accurately as possible, and update as needed throughout the year to ensure credits are calculated accurately.
Open Enrollment is the annual window when anyone can sign up for or change a Marketplace plan. Open Enrollment is usually from Nov 1st– Dec 15th each year. Some years it is extended into January. For your coverage to begin January 1st, your enrollment should be completed by December 15th. See healthcare.gov for current dates.
A Special Enrollment Period (SEP) is a limited opportunity to enroll or switch Marketplace plans outside of Open Enrollment. SEPs are triggered by a qualifying life event like losing coverage, moving, marriage, change in immigration status, or birth/adoption.
Create an account and apply through HealthCare.gov You’ll enter income and household details, compare plans, and enroll.
During Open Enrollment
Or, if you qualify for a Special Enrollment Period
* Tip: If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan.
You must wait until next year’s Open Enrollment, unless you experience a qualifying event to trigger a Special Enrollment Period.
If you feel like you have been denied a Marketplace eligibility decision, you have the right to appeal. The eligibility letter includes instructions on requesting an appeal.
How do I file a Marketplace appeal?
Marketplace Appeals phone number: 855-231-1751
No, you will need to apply for Medicaid and Marketplace.
See Eligibility
Reenrollment happens each year during Open Enrollment
Pro tip: If elected Marketplace will try to auto enroll you in a similar plan using previous data. We recommend that you manually update your income with a new application and choose a plan to ensure adequate coverage.
Upload them through your Marketplace account or submit by mail or fax if instructed.
Report any changes—income, household size, address, employment, pregnancy, or new benefits—within 30 days of the change.
Pro tip: Changes in household size, income, address, ect. can affect your insurance plan and eligibility.
Yes— only during Open Enrollment, or if you have a SEP.
Advanced Premium Tax Credit (APTC) is federal financial aid that lowers monthly Marketplace insurance premiums based on your estimated annual income.
Pro tip: You can use all, some, or none of your premium tax credit in advance to lower your monthly bill for insurance.
If you use more advance payments of the tax credit than you qualify for based on your final yearly income, you must repay the difference when you file your federal income tax return.
If you use less premium tax credit than you qualify for, you’ll get the difference as a refundable credit when you file your taxes.
Pro tip: Some people think APTCs are credits that must be paid back at tax time. However, consumers are eligible for these tax credit based on their annual income. Make sure you have estimated your income as accurately as possible, and update as needed throughout the year to ensure credits are calculated accurately.
Deductible: The amount of money you must spend each year on health care before your plan starts paying for certain services. After you pay your deductible, you may still have to pay copayments or coinsurance when you get services.
More information for Deductibles
Out of pocket Maximum: The most you must pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
Copayments and coinsurance are the amount you pay toward the cost of your health care.
Copayment: an amount you may pay each time you get a service, like going to the doctor or getting a prescription. It’s usually a set dollar amount, like $20.
Coinsurance: your share of the costs of a covered health service. Coinsurance is calculated as a percentage of the allowed amount for the service.
More information on Coinsurance
All essential health benefits including hospital care, lab tests, maternity, mental health, prescription drugs, and preventive services
A limited number of plans include vision and dental bundled with the medical coverage. Stand-alone dental plans are also available after selecting a medical plan.
Yes—both TennCare and Marketplace plans must cover pre-existing conditions with no exclusions.
Please check the provider directory and drug formulary listed in your specific plan documents on the Marketplace or TennCare Connect.
For additional help, contact your insurance carrier directly using the phone number on your insurance card.
Contact your insurer via phone or online portal to request a replacement.
Pro- tip: Save or download your insurance plans website or mobile app to get access to digital cards, find providers, see explanations of benefits, and access up to date coverage information.
Pay directly to the insurance company by phone, online, or by mail.
Pro tip: Make sure that you make your initial payment by the due date to ensure your coverage goes into effect.
Apply for SNAP (food stamps) through Tennessee Department of Human Services 833-772-8347 or at your local DHS office.
Dial 211 on your mobile phone for options or text your zip code to 898-211 to get started.
Apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) online at SSA.gov or at your local Social Security Administration office.
Area Agencies on Aging and Disability AAAD
You can begin the application at SSA.gov or visit a local Social Security Administration office for help with benefits, retirement, or disability applications.
For help with Medicare, we recommend contacting your local SHIP agency or call 877-801-0044.
