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Tennessee-Specific Healthcare Options: Unveiling Your Coverage Choices

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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.


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