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Affordable Care Act Health Insurance Marketplace:

Understanding your health insurance options can be challenging, and even navigating the Health Insurance Marketplace that was intended to simplify the process is often easier said than done. Although healthcare costs are rising, individuals can qualify for sliding-scale subsidies that lowers premiums and out-of-pocket expenses when applying through the Health Insurance Marketplace. Finding the right health insurance policy that meets your budget and medical needs can be complicated. However, our trained and certified health insurance Navigators can help simplify the process and answer your questions.

Family & Children’s Services‘ Get Covered Tennessee program aims to assist individuals and families struggling to find affordable healthcare options that meet their needs in Tennessee. As a federally funded program, our Navigators are required by law to provide fair, accurate, and unbiased enrollment assistance.

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace is a platform where individuals/families and small businesses compare health insurance plans, enroll in or change a health insurance plan, and evaluate eligibility for tax credit (discount). Every Marketplace health plan offers the same essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice.

There are two types of health insurance marketplaces: federal marketplace and state-run marketplaces. In Tennessee, the federal government facilitates the Health Insurance Marketplace on the website.

To qualify for a Marketplace Health Insurance plan, you must meet these requirements:

  • Must live in the United States.
  • Must be a U.S. citizen or national (or be lawfully present).
  • Cannot be in prison.

Marketplace Health Insurance Options for Tennessee Families 

The marketplace offers health plan benefits similar to those found in employer-sponsored health insurance plans, with many of the same comprehensive benefits as doctor visits, outpatient care, prescription drugs, emergency care, and mental health services.
One difference is that the health insurance marketplace indicates a health plan’s costs by metal tier, so you can know whether the plan will have higher premiums vs. higher out-of-pocket costs. There are platinum, gold, silver, and bronze health plans.

  • Bronze: You pay 40 percent, the insurance company pays 60 percent
  • Silver: You pay 30 percent, and the insurance company pays 70 percent
  • Gold: You pay 20 percent, the insurance company pays 80 percent
  • Platinum: You pay 10 percent, the insurance company pays 90 percent

The Affordable Care Act created a discount system called “premium tax credit” that helps people purchase health insurance at a discounted rate. The “premium tax credit” is available immediately upon enrollment in an insurance plan so that families can receive help when needed rather than waiting until they file taxes. People can choose to have premium tax credit payments go directly to insurers to pay a share of their monthly health insurance premiums charged or wait until they file taxes to claim them.

To receive a premium tax credit, individuals must be U.S. citizens or lawfully present in the United States. In addition, household income must be between 100% and 400% of the federal poverty level, and coverage must be applied for through the Health Insurance Marketplace.

Individuals eligible for other “minimum essential coverage,” which includes most other types of health insurance, such as Medicare or Medicaid, or employer-sponsored coverage that is considered adequate and affordable, will not qualify for the premium tax credit.

According to the Kaiser Family Foundation, an independent source for health policy research, more than 310,000 Tennesseans were able to receive premium tax credits to lower their health insurance expenses in 2023.

Get Expert Guidance on ACA Marketplace Plans from GetCoveredTenn

At Family & Children’s Service, we know that understanding the options available to you is not always easy when it comes to finding adequate health insurance and medical care for your family. Get Covered Tennessee aims to simplify the process of understanding and comparing some of the most common options available to Tennessee residents to help you find the best coverage for you and your children. Letting us help you is a significantly more user-friendly alternative to navigating the marketplace on your own, and we are here to help you consider every detail of your family’s situation to find an affordable health insurance plan that meets your family’s needs.

Contact us today to learn more about the process of finding and signing up for health insurance plan that meets your needs or to schedule a phone or in-person appointment with a member of our team who can help you determine which marketplace plan is the best fit for you and walk you through every step of the application and enrollment process!

How can we help:

As Certified Navigators we provide free, unbiased guidance on health insurance options available through the Marketplace, Medicaid (TennCare), and the Children’s Health Insurance Program (CoverKids).

With the Marketplace we can help with:

  • Account creation on
  • Submitting applications
  • Understanding eligibility results and available insurance plans
  • Completing enrollment
  • Uploading documents requested by the Marketplace
  • Billing and payment questions
  • Accessing medical care and using your insurance
  • Reporting changes in income, contact information and family size 
  • Accessing Marketplace tax forms (1095-A)
  • Referrals to consumer assistance programs 
  • Filing Marketplace eligibility and insurance appeals