TennCare & CoverKids in Tennessee

Get Covered Tennessee is a nonprofit program of Family & Children’s Service that provides free, unbiased health insurance enrollment assistance to all Tennesseans. It is a statewide initiative that includes subgrantees like Appalachian Mountain Project Access, Cherokee Health Systems, and approximately one hundred other partners across Tennessee. Get Covered Tennessee is the only statewide Navigator Program in the state of Tennessee funded by the United States Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS). 

The sole purpose of the Get Covered Tennessee program is to help people navigate health insurance coverage options through the Marketplace, Medicaid (TennCare), and the Children’s Health Insurance Program (CoverKids). Our Certified Navigators can help you cut through the confusion and get the coverage you need to stay in your best health. We are not an insurance agency or broker.

The guide below will introduce you to those options.

Overview of TennCare

TennCare is the name of Tennessee’s Medicaid program which provides health coverage for over a million low-income Tennesseans. The program is a joint effort between the state of Tennessee and the federal government, providing vital healthcare services to those who would otherwise be unable to afford it.

TennCare is designed to maintain and improve the health of Tennesseans. A key component of the program is preventative care. Beneficiaries receive regular check-ups, vaccinations, and screening for early detection and prevention of illness. The program also places a strong emphasis on pregnant women and children, fostering healthy development from the early stages of life.

TennCare provides healthcare to eligible low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability. The healthcare services provided by TennCare include primary care visits, hospital stays, emergency services, prescription drugs, long-term care, mental health services, dental care, and substance abuse services. For some people, lack of transportation presents a huge barrier to quality healthcare. For individuals without transportation, TennCare provides free rides to and from appointments so everyone can get the help they need.

Tennessee residents qualify for TennCare if they can fit into TennCare categories and meet all the federal requirements, including income, immigration status, and asset limits.

Overview of CoverKids

CoverKids is an extension of TennCare, providing full health coverage for children 18 and under and pregnant women whose families cannot afford employer-sponsored insurance or individual insurance and who make too much to be eligible for TennCare. It ensures that the state’s most vulnerable residents have access to necessary healthcare.

CoverKids provides a comprehensive set of services for those who qualify. Beneficiaries will receive doctor visits, hospital stays, prescriptions, emergency care, mental health services, physical, speech, and occupational therapy. In addition, CoverKids provides Dental and Vision coverage for children and maternal benefits for pregnant women. 

The program offers vital prenatal care for pregnant women regardless of their immigration status, a critical service for both mother and child health. By providing these services to children and pregnant women, the program not only keeps them healthy but provides a solid foundation for a strong generation.

Understanding the Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act, referred to as the Affordable Care Act or “ACA” for short, is the comprehensive health care reform law enacted in March 2010. The primary goal of the Affordable Care Act (ACA) is to make insurance available and affordable to more people. The law provides consumers with subsidies (premium tax credits) that lower the cost of medical care expenses. 

Under the Affordable Care Act (ACA), you have special patient protection when you are insured through the Health Insurance Marketplace:

  • Insurers cannot refuse coverage based on gender or a pre-existing condition.
  • There are no lifetime or annual limits on coverage for essential health benefits.
  • Young adults can stay on their family’s insurance plan until age 26.

To be eligible to enroll in health coverage through the Marketplace, you:

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

Helping Families Access Quality Healthcare

Lack of healthcare can be a huge problem. Not only does it bring with it the obvious health repercussions, but the mental impact of knowing you cannot afford help if you get sick can be an ever-present worry. At Get Covered Tennessee, we help you determine which options are available for you and your family. Contact us today for improved health and increased peace of mind.

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 TennCare or CoverKids we can help to:

  • Apply for coverage, including TennCare, CoverKids, Medicare Savings Programs, and other TennCare categories.
  • Find current enrollment status in the TennCare system.
  • Create a TennCare Connect account on www.tenncareconnect.tn.gov
  • Complete the renewal process (link to our tenncare renewal page)
  • Send requested documents to TennCare
  • Educate about coverage and how to use it
  • Update information including income change, address change, removing or adding household members and more.
  • Submit TennCare/CoverKids eligibility appeals
  • Answer questions about TennCare or CoverKids eligibility and coverage.

TennCare / CoverKids Renewals

Every year TennCare is required to make sure people on TennCare are still eligible. This is called renewal, redetermination, or reverification. After being on hold for three years, TennCare has started renewals again. Most people on TennCare will go through renewal sometime between April 2023 – April 2024. 

It is important that every household’s address is up to date with TennCare so that they receive the information about their renewal.

GetCoveredTennessee can help people who are going through TennCare renewal. We can help with:

  • Updating addresses in the TennCare system
  • Finding out a family’s renewal date 
  • Filling out and submitting renewal packets
  • Submitting additional information requested by TennCare
  • Reapplying for TennCare or transitioning to Marketplace for people who have lost coverage

To access this free assistance, call 866-475-7879 or schedule an appointment here.