Health insurance in Tennessee
- Tennessee operates a federally run exchange with enrollment through HealthCare.gov.
- Open enrollment for 2021 Tennessee health insurance plans ended December 15, 2020. Residents with qualifying events can enroll outside of open enrollment.
- Short-term health insurance plans can be sold in Tennessee with initial plan terms up to 364 days.
- Six insurers will offer medical insurance in the Tennessee marketplace for 2021, including newcomer UnitedHealthcare.
- More than 200,000 Tennessee residents enrolled in 2020 coverage through the Tennessee health insurance marketplace, down from 268,000 in 2016.
- Tennessee has not adopted the ACA’s Medicaid expansion, but is seeking a Medicaid work requirement and a federal block grant for Medicaid funding.
- As of 2020, there are more than 1.38 million people covered by Medicare in Tennessee.
- Community Health Alliance, the state’s ACA CO-OP, stopped operations in 2015.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Tennessee. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the Tennessee health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid in Tennessee, which has refused to enact the ACA Medicaid expansion; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; and a collection of Montana health insurance resources for residents.
Tennessee’s health insurance marketplace defined by state resistance to ACA’s reforms
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.
The state has also allowed non-ACA-compliant Farm Bureau plans to continue to be sold to healthy residents, resulting in an ACA-compliant risk pool that’s sicker than in most states.
Tennessee uses HealthCare.gov as its exchange. 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.
Tennessee open enrollment period and dates
Open enrollment for ACA-compliant 2021 health plans ran from November 1 through December 15, 2020. During the open enrollment period, new enrollees can apply for coverage, and current enrollees can renew or change their coverage for 2021. It’s also an opportunity to update the financial information the exchange has on file, to ensure that financial assistance for the upcoming year is accurate.
The open enrollment period also applies to plans purchase outside the exchange. People who enroll directly through a health insurer must use the same open enrollment period, unless they have a qualifying event (premium subsidies and cost-sharing reductions are not available outside the exchange).
200,445 people enrolled in private individual market plans through Tennessee’s exchange during the open enrollment period for 2020 coverage. Enrollment peaked in 2016 (as was the case in most states that use HealthCare.gov), when 268,867 people enrolled. Enrollment has declined since then, under the Trump administration.
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 range from a decrease of about 6 percent to an increase of about 10 percent. And UnitedHealthcare is rejoining the exchange in Tennessee for 2021. UnitedHealthcare offered plans in the exchange in 2016, but left at the end of that year. For 2021, there will be six insurers offering plans for sale in the exchange, albeit with varying service areas (ie, not all plans are available in all areas).
Read more about the Tennessee health insurance marketplace.
Medicaid/CHIP enrollment in Tennessee
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 ACA called for Medicaid to be expanded to cover all Tennessee residents with incomes up to 138 percent 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 percent of poverty, however – a more generous threshold than many of the other non-expansion states use.
Read more about Medicaid in Tennessee.
Tennessee’s CO-OP closed in 2015
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.
Short-term health insurance in Tennessee
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.
Did Obamacare help Tennessee?
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 percent in 2017, although it rose to 10.1 percent in 2018. Although the uninsured rate is lower than it was in 2013, it’s still higher than the national average of 8.9 percent. 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 186,000 Tennessee residents who are covered under private plans through the marketplace in Tennessee, all of whom have coverage for the ACA’s essential health benefits, regardless of pre-existing conditions or coverage history. And 89 percent of them are receiving premium subsidies that make their monthly insurance premiums much more affordable than they would otherwise be. In addition, 52 percent are receiving cost-sharing reductions, which keep their out-of-pocket medical expenses (deductible, copays, coinsurance) lower than they would otherwise be.
Tennessee lawmakers generally opposed to the ACA
Donald Trump, who campaigned on a promise to repeal and replace the ACA, easily won Tennessee in the 2016 election.
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 Trump Administration has encouraged states to impose work requirements on their Medicaid populations, which was a non-starter under the Obama Administration. Tennessee enacted a law in 2018 that directed the state to seek federal approval for a TennCare (Tennessee Medicaid) work requirement. The waiver proposal was submitted to the federal government in late 2018, and was still pending approval as of mid-2020. While the Trump administration has approved work requirements in many states, courts have blocked implementation of four such waivers, and other states have withdrawn their waivers or postponed implementation. No Medicaid work requirements are currently in effect.
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.
Medicare coverage and enrollment in Tennessee
As of August 2020, there were 1,380,678 Tennessee residents with Medicare coverage, including 590,202 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).
Tennessee health insurance resources
- 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.
Health reform legislation in Tennessee
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.
You can find a summary of recent state-level health reform bills at the bottom of this page.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.