Frequently asked questions about health insurance
coverage options in Tennessee
Tennessee has a federally run exchange, so enrollees use HealthCare.gov to sign up for exchange plans. The exchange offers individuals and families in Tennessee an opportunity to enroll in self-purchased (as opposed to employer-sponsored) health plans. These policies are used by early retirees, the self-employed, and anyone employed by a small business that doesn’t offer health benefits.
The exchange is also the only place where premium subsidies and cost-sharing reductions are available, based on household income.
Read our overview of the Tennessee health insurance marketplace – including news updates and exchange history.
Open enrollment for 2021 health plans in Tennessee ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
This enrollment window is a good opportunity for both uninsured residents and current marketplace enrollees to take advantage of the newly enhanced premium subsidies created by the American Rescue Plan.
After August 15, Tennessee residents with qualifying events, including loss of other minimum essential coverage, will still be able to enroll or make changes to their 2021 coverage. Open enrollment will begin again on November 1, 2021, for coverage effective January 2021.
For 2021, there are six insurers offering plans for sale in the exchange, albeit with varying service areas (ie, not all plans are available in all areas). The following insurers are offering plans in Tennessee’s marketplace for 2021:
- Blue Cross Blue Shield of Tennessee
UnitedHealthcare rejoined the exchange in Tennessee for 2021. UnitedHealthcare offered plans in the exchange in 2016, but left at the end of that year.
Health insurance premiums in Tennessee’s individual insurance market decreased for 2019 and decreased again for 2020. But that followed two years of sharp increases, in 2017 and 2018.
Things have stabilized considerably since over the last few years; the approved rate changes for 2021 ranged from a decrease of about 6 percent to an increase of about 10 percent. And UnitedHealthcare rejoined the exchange in Tennessee for 2021, bringing the number of participating insurers to six.
212,052 people enrolled in private health plans through the Tennessee exchange during the open enrollment period for 2021 coverage. That was an increase of nearly 6% over the year before, when 200,445 people enrolled in plans for 2020. But enrollment had been higher in 2019, when 221,553 people bought coverage during the open enrollment period.
The COVID-related enrollment window in 2021, combined with the enhanced premium subsidies created by the American Rescue Plan, is expected to result in increasing enrollment throughout much of 2021. CMS reported that nearly 15,000 people had enrolled in plans through the Tennessee marketplace during the first month and a half of the COVID-related enrollment period (ie, through March 31, 2021). That compared with fewer than 5,000 enrollees during the same time period the year before, which would have been people enrolling during special enrollment periods triggered by their own individual qualifying events.
The ACA included a provision to create Consumer Oriented and Operated Plans (CO-OPs). In Tennessee, Community Health Alliance Mutual Insurance Company was an ACA-created CO-OP, and was one of Tennessee’s five exchange carriers in 2015.
But in October 2015, the Tennessee Department of Commerce and Insurance announced that Community Health Alliance would discontinue operation at the end of the year, and enrollees needed to select coverage from a different insurer for 2016.
Tennessee’s was one of several CO-OPs nationally that closed at the end of 2015 – due in large part to the fact that the federal government was only able to pay out a fraction of the money insurers were owed under the risk corridor program.
Read more about the Affordable Care Act’s CO-OP health plans.
Despite an overall aversion to Obamacare, Tennessee’s population has seen improved health insurance coverage under the healthcare reform law. The state’s overall uninsured rate has dropped from 13.9 percent in 2013 to 9.5% in 2017, although it rose to 10.1% in 2018 and remained at that level in 2019. Although the uninsured rate is lower than it was in 2013, it was still higher than the national average of 9.2% as of 2019. That’s due in large part to the fact that Tennessee has refused to accept federal funding to expand Medicaid under the ACA.
However, there are more than 212,000 Tennessee residents who enrolled in private plans through the marketplace in Tennessee for 2021, all of whom have coverage for the ACA’s essential health benefits, regardless of pre-existing conditions or coverage history.
As of 2020, 89% of Tennessee’s marketplace enrollees were receiving premium subsidies that made their monthly insurance premiums much more affordable than they would otherwise be. In addition, 52% were receiving cost-sharing reductions, which kept their out-of-pocket medical expenses (deductible, copays, coinsurance) lower than they would otherwise be.
Tennessee can be counted among the states with higher uninsured rates and persisting resistance to the Affordable Care Act. As such, it opted for a more hands-off approach with a federally facilitated exchange and has not yet expanded Medicaid.
Tennessee has allowed non-ACA-compliant Farm Bureau plans to continue to be sold to healthy Tennessee residents, which has resulted in a less healthy risk pool for ACA-compliant health insurance plans in Tennessee. The state has long regarded Farm Bureau plans as separate from the insurance industry, so they’re not regulated by the state’s rules that apply to insurance and thus have lower costs. By opting to continue that practice in 2014 and beyond, Tennessee allowed those plans to continue to be sold to healthy applicants. They were the only state in the country that allowed this for the first few years of ACA implementation, but Iowa joined them in 2019, as did Kansas in 2020.
In 2010, Tennessee’s U.S. Senators Lamar Alexander and Bob Corker (both Republicans), voted against the ACA. In the House, four Republican representatives voted no while five Democratic representatives voted yes. Alexander is still in the Senate, although Corker retired and did not seek re-election in 2018. But his replacement, Marsha Blackburn, is strongly opposed to the ACA. Prior to her election to the Senate, Blackburn was the Budget Chair in the House, and was thus responsible for shepherding the American Health Care Act (an attempt to repeal the ACA) through the House in 2017. The U.S. House now has just two Democratic representatives from Tennessee, and seven Republicans.
Former Governor Bill Haslam, a Republican, worked with the Obama Administration to try to gain approval for his modified version of Medicaid expansion, and he met with then-Secretary of HHS Sylvia Matthews Burwell in July 2014 to continue the discussions he had been having with Secretary Sebelius. Haslam said he would like to expand Medicaid to cover another 161,000 low-income Tennessee residents, but he wanted higher co-payments than the Obama Administration HHS would allow, and no compromise was reached.
Haslam was term-limited and could not run in 2018. His successor, Bill Lee, also a Republican, won by the election by a substantial margin.
The ACA called for Medicaid to be expanded to cover all Tennessee residents with incomes up to 138% of poverty. In 2012 however, the Supreme Court ruled that states could opt out of Medicaid expansion, which Tennessee has done so far.
Subsidies for private plans sold in the health insurance marketplace are not available for those who earn less than poverty level, and non-disabled childless adults are not eligible for Medicaid in Tennessee, regardless of income. Parents with dependent children can get Medicaid in Tennessee if their household income is up to 101% of poverty, however – a more generous threshold than many of the other non-expansion states use.
Tennessee made headlines in 2019 with the enactment of HB1280, which directed the state to seek federal permission to implement a block grant funding model for TennCare (the state’s Medicaid program), instead of the current open-ended federal matching funds. Critics of the legislation note that block grants are likely to result in reduced Medicaid funding over time. No Democrats were included on the House committee that worked on the block grant legislation, and the legislature was fraught with tension over the issue.
The Trump administration granted approval for the block grant funding in January 2021, shortly before leaving office. But the waiver approval is under review by the Biden administration, and may be changed or revoked.
Tennessee does not have state legislation limiting the duration of short-term health insurance plans, so the state defaults to the federal rules. Those rules allow short-term health insurance plans to have initial terms of up to 364 days, and total duration, including renewals, of up to 36 months.
Read more about short-term health insurance in Tennessee.
As of August 2020, there were 1,387,937 Tennessee residents with Medicare coverage, including 629,913 who had selected private Medicare Advantage plans instead of Original Medicare.
Read more about Medicare coverage in Tennessee, including specifics about optional Medicare Advantage and Part D plans, as well as the state’s approach to Medigap plans (optional supplemental coverage that helps to pay some or all of the out-of-pocket expenses that go along with Original Medicare).
- Family & Children’s Service — The federally-funded Navigator organization in Tennessee. Located in Nashville, but can provide phone assistance with health insurance and Medicaid enrollment statewide.
- HealthCare.gov — The health insurance marketplace that Tennessee individuals and families use to enroll in health coverage, with subsidies (to reduce out-of-pocket costs and premiums) based on income.
- Tennessee Department of Commerce and Insurance — Oversees, licenses, and regulates health plans in Tennessee, as well as the agents and brokers who sell policies to Tennessee residents.
- Tennessee State Health Insurance Assistance Program (SHIP) for Medicare Participants — A local resource for Medicare beneficiaries and their caregivers.
- Medicare Rights Center — A nationwide service that provides information and assistance with Medicare-related questions.
Tennessee’s legislature has been quite active in the arenas of healthcare and healthcare reform, but not all of their legislation has been beneficial to the state’s residents.
In 2018, Tennessee enacted legislation that directed the state to seek federal approval for a Medicaid work requirement. And in 2019, the state enacted legislation that directs the state to seek federal approval to transition the state’s federal Medicaid funding to a block-grant system.
Also in the 2019 session, Tennessee enacted H.B.655, which allows any healthcare professional to use barter agreements when treating uninsured patients.
And H.B.1342, which was also enacted in 2019, strengthens protections against surprise balance billing by requiring medical facilities to provide patients with written notification — at least three days in advance of a medical procedure — if they’ll be receiving services from an out-of-network provider at the facility.
The state already required facilities to provide these notifications to patients, but the legislation adds the provision that the disclosure be provided at least three days in advance. Out-of-network physicians who fail to provide the necessary disclosures will not be allowed to balance bill the patient.