Are you looking for health coverage?
There are many ways that someone can get health insurance. You can have health insurance through your job, through Medicare, through Medicaid (TennCare), through the Children’s Health Insurance Program (CHIP, or CoverKids), or through insurance bought on the Marketplace.
This page is to help you with questions about TennCare, CoverKids, and Marketplace insurance. Click on each question to read more information. If your question isn’t answered here, please, give us a call toll-free at 1-877-608-1009.
What groups does TennCare currently cover?
TennCare has multiple eligibility categories for families, children, and individual adults. Almost all of them have strict requirements on income and resources. If you’re not sure whether you’re eligible, you can always apply. For an overview of the most common groups that TennCare covers, check out this flyer. Or, take a look at our flow charts to help you find out what you might be eligible for.
The most common TennCare categories are for children, parents and caretaker relatives, and pregnant women. But there are many other ways that folks can get covered. Here are a few additional programs:
- Medically Needy Spend Down: Medically Needy Spend Down is a category of eligibility for TennCare for children and pregnant women. Most categories have very strict requirements on how much income a family can have. Medically Needy Spend Down lets a family use medical bills and expenses to offset that income. Use our Medically Needy Spend Down flyer and worksheet to help you find out if you are eligible.
Note: Standard Spend Down is no longer in the TennCare budget — this was a similar system, but for adults, and was only open twice a year.
- CoverKids: If you are a pregnant woman or a child and your income is over the limit for TennCare, you may be eligible for CoverKids. CoverKids is not the same as TennCare. It is our state’s Children’s Health Insurance Program (CHIP). Every state has a CHIP program. CoverKids does not cover quite as much as TennCare, but is affordable insurance for many people. You can learn more about CoverKids and apply for the program directly on their website.
- Former Foster Children: If you aged out of foster care when you were 18 in Tennessee, you can stay on TennCare until you turn 26. Find more information on this here.
- CHOICES Long Term Services: TennCare provides important financial protections for nursing home eligible patients and their families. If you are nursing home eligible, TennCare will either pay for you to get care in a nursing home, or they will pay for nurses and aides to come to your house if it is cheaper. Find out more about how to apply for nursing home coverage and in-home coverage.
- Medicare Savings Programs: There are Medicare Premium Assistance Programs that pay Medicare premiums for some people. One of the plans, sometimes called QMB, pays the Medicare Part B premium and also pays the portion of medical costs that Medicare does not pay. The other plans, SLMB and QI, only pay the Medicare Part B premium. Apply for QMB. The state will check to see if you can get on any of these plans. Find out more about how to apply for QMB.
- Pickle: The Pickle Amendment gives eligibility to some people who now get Social Security Disability payments (SSDI) but who used to get SSI. If you were ever eligible for SSI and SSDI in the same month, you might be eligible for TennCare. Learn more about Pickle Eligibility.
Even if you are not sure if you are eligible, you should apply. If you are not eligible for TennCare, take a look at our coverage gap page to find out why you can’t get TennCare, and what you can do to advocate for yourself, your family, and your neighbors.
Are you an immigrant? Many low-income, legal immigrants or their family members may be able to get TennCare. There are also other options. Read more about the questions that immigrants and their families often ask about health care in Tennessee. En Español: preguntas que immigrantes y sus familias preguntan sobre cuiado médico.
How do I apply for TennCare?
Right now, the only way to apply for TennCare is through the federal Marketplace. You can go to healthcare.gov, or call them at 1-800-318-2596. To learn more about how to apply for insurance on the Marketplace, look at our FAQs.
If you have questions about TennCare, you need to report any changes to your address, income or household, call the Tennessee Health Connection at 1-855-259-0701.
There are a few categories of TennCare that do not go through the Marketplace:
- To apply for CHOICES, the long-term services program, call your local Area Agency on Aging and Disability office.
- To apply for Medicare Savings Programs, fill out this form and mail it in. Or, call Tennessee Health Connections at 1-855-259-0701 and ask them to send you an application.
- To apply for the DIDD waiver, call your local DIDD office.
- To apply for CoverKids, you can go on healthcare.gov, but it may be faster to apply directly at www.covertn.gov. (Note: CoverKids is not the same as TennCare, but it is a way for children with higher income to get insurance.)
If you are not the parent of a child, but have Power of Attorney, take a look at our advocacy tips sheet for how to apply for children when you have POA. And to make sure a newborn gets covered quickly, look at our newborn cheat sheet.
What if I’m not eligible for TennCare?
If you are not eligible for TennCare, you may be able to get affordable insurance on the Marketplace if your income is above the poverty line. You can find more information the Marketplace here.
If you cannot get TennCare or affordable insurance, then you fall into what is called the “coverage gap.” If you are in the gap:
- You still have a legal right to get hospital care for an emergency or childbirth. They can’t turn you away until a doctor has examined you. An emergency room card can help you get care. Find out more about how to get emergency room care.
- You can get help paying for prescription medicines through a program called CoverRx. This is a program that is free to sign up for, and you can get a large discount on some prescription medicines. To find more information and to apply, go here.
- You can call Health Assist Tennessee (1-800-269-4038) for help finding other options for health care in your area.
- Visit our Coverage Gap page, and learn how to advocate for yourself, your family, and your neighbors.
TennCare won’t pay for the care I need. What do I do?
If you or your child is not getting the care they need, you have the right to appeal. Find out more about how to appeal here. Remember, kids on TennCare have a right to all the health care they need!
I have applied for TennCare, but I haven’t gotten my TennCare card. What do I do?
If you applied for TennCare more than 45 days ago, but you still have not heard back from TennCare, then you have the right to appeal. Find out how to appeal here. You can also learn more about the current court case that says that you have the right to appeal.
You also might have TennCare, but don’t have your card yet. If this is true, then you can call Tennessee Health Connections (855-259-0701) and ask them who your Managed Care Organization (MCO) is. They will tell you if it is United Health Care, BlueCare, or Amerigroup. Then, you can call your MCO and ask them to send you your TennCare card.
In January of 2014, the Affordable Care Act came into full swing. The ACA has enabled thousands of Tennesseans to buy affordable health insurance, many for the very first time. But, it can be a little overwhelming for the first time. Read below for some commonly asked questions. The open enrollment period lasts from November 1, 2015 until January 31, 2016. If you want help signing up and choosing a plan, see how you can get in-person help enrolling.
What is the Marketplace?
The Marketplace is a new way to buy health insurance for 2014. In fact, it is the only place where you can apply for insurance and get financial help. The Marketplace is an online store where you will be able to shop, qualify for, and buy new health insurance programs. You can get insurance on the Marketplace by going to www.healthcare.gov. Or you can call 1-800-318-2596 to apply for insurance. You can go online or call 7 days a week, 24 hours a day.
I bought insurance on the Marketplace last year. What do I need to do now?
To make sure you stay covered in a plan you like, with the right financial help, follow the 5 steps to the right! Log in to your healthcare.gov account and update your information: your income, your family size, or anything else that might have changed from last year. Then you can look at new plans that are on the Marketplace. You can either keep your old plan, or choose a new one that fits you better. Click here for more information on renewals.
How do I apply for Marketplace coverage, and what do I need?
First, you will need to set up an account. You will choose a username, password, and security questions. Use this username and password every time you go to the Marketplace.
Then, you will be asked to provide basic information about yourself and/or your family, including your income, household size, and current health coverage. You will need the following:
- Your social security number
- Documentation if you are a legal immigrant
- Income information: W-2 Forms from last year and pay stubs or payroll information
- Employer’s name and address
- Policy numbers for any current health insurance. Have your employer fill this out.
The information you provide about your income is very important. It determines how much financial assistance you receive each month. The lower your income, the higher the financial help you will receive each month. In addition, it is important that you accurately estimate your 2015 income for tax reasons. At the end of 2015, the IRS is going to compare the number you provide with the income you report on your 2015 income tax return.
When can I apply for health insurance on the Marketplace?
Open enrollment for the Marketplace for coverage in 2016 was between November 15, 2015 – January 31, 2016. You may also be able to get a plan outside of these dates if you lose your job, or there are significant changes such as a birth, divorce, or death. To see situations where you might be able to get a Special Enrollment Period, go here.
Can I be denied health insurance?
No, you can’t be denied coverage. Starting in 2014, insurance companies can’t turn you down or charge you more because of a pre-existing condition or other health status.
Do I have to buy health insurance?
If you do not buy health insurance and you file taxes, you might have to pay a penalty.
There are some people who do not have to buy health insurance. These exempted groups include:
- People with low incomes who do not file tax returns. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).
- Certain religious groups
- Incarcerated people
- Someone who lives outside US for 11 months out of the year
- Undocumented residents
- People who go without coverage for less than 3 months
- People who do not have an affordable offer of coverage. This means that if your monthly premium for your only offer of coverage is more than 8% of your monthly household income, the coverage is not affordable.
What if I already have health insurance?
People who have health coverage through private insurance, from an employer, TennCare, or Medicare don’t have to buy on the Marketplace.
If you have insurance through your employer, but you don’t like it, you can buy a more preferable plan on the Marketplace. However, you might not qualify for financial assistance paying your premiums and other health care costs. If your employer’s offer of coverage is considered “affordable” and meets “minimum value,” then you will not be able to get financial help. Your employer is supposed to give you tell you if the insurance at work is “affordable” and meets “minimum value.” Have them fill out this form.
How can I get financial help to pay for health insurance?
The available financial help depends on income levels. There are two ways that you can get financial help: “premium tax credits” and “cost-sharing reductions.”
Premium tax credits lower your monthly insurance premiums. Persons and families between 100%-400% of poverty line may be eligible for premium tax credits. For example, if you are a family of four with income of between $23,850 and $95,400, you may be eligible for premium tax credits that will lower your monthly costs. Premium tax credits stay the same no matter which healthcare plan you choose. See what tax credits you would be eligible for using the Kaiser calculator here. When you apply on the Marketplace, you will be asked about your income and then you will be told the amount of your premium tax credit.
If you’re eligible, there are three ways to use premium tax credits.
- You can have the government pay a portion of your monthly premium directly to the insurance company every month. You will pay the remainder of what the government does not pay.
- You can pay the full premium, and get paid back for the amount that the government will pay at the end of the year, when you file your taxes.
- You can do a combination of the two: you can have the government use some of the premium tax credits to pay for your monthly premium every month, and then save the rest of it to get back when you file your taxes.
Cost-sharing reductions lower your out-of-pocket costs, like your deductible, your out-of-pocket max, and your co-pays. If you are between 100%-250% of the federal poverty line, you maybe be eligible for cost-sharing reductions. These are only available on Silver plans (see the next question to learn what this is). When you apply on the Marketplace, these cost-sharing reductions will automatically be calculated when you look at Silver plans.
What are the basic health insurance plans?
There are 4 basic plans: platinum, gold, silver, and bronze. The plans will include the same essential benefits. The amount consumers pay for deductibles, co-payments, and other services will differ between the plans.
What benefits do Marketplace insurance plans cover?
All insurance sold on the Marketplace must include 10 essential health benefits:
- Maternity & Newborn care
- Rehabilitative & Habilitative Care
- Pediatric Services
- Mental Health & Substance Use Disorder Service (Behavior Health Treatment included)
- Preventative & Wellness Services & Chronic Disease Management
- Laboratory Services
- Prescription Drugs
- Ambulatory Patient Services
- Emergency Services.
Can I choose my own doctor?
Most health insurance plans have networks of hospitals, doctors, specialists, pharmacies, and other health care providers. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing plans in the Marketplace, you will see a link to a list of providers in each plan’s network. If staying with your current doctors is important to you, check to see if they are included before choosing a plan.
Can I get dental insurance?
Dental insurance is different for adults than it is for children under 18.
For adults, dental is not considered an essential health benefit. This means insurers do not have to offer dental care to adults. Some plans offer dental insurance and some do not. If you want dental coverage, you can buy a separate plan for dental.
For children, dental coverage is an essential health benefit. This means insurers have to offer dental care to children 18 and under as part of the health plan or as a stand-alone plan. Read your health plan carefully to make sure you know what is included.
To read more, click this link.
What happens if I do not pay my premium?
If you miss several payments, the insurance company will send you a notice of cancellation. You have the chance to appeal the notice. If you do not appeal or pay your fees, the insurance company can cancel your insurance coverage 30 days after notice is distributed.
How do I pay on the Marketplace?
You can pay by personal check or cashier’s checks, money orders, pre-paid debit cards, electronic fund transfers from a bank account, and an automatic deduction from a debit/credit card. You cannot pay with cash.
Note: Your enrollment is not complete and your coverage is not effective until the insurance company receives your first premium payment.
How do I protect myself from fraud and scams?
Never give out your social security number, bank account number, or email address to anyone over the phone unless you made the call. If someone calls you asking for your personal information, do not give him any information. Ask for a number to call back. If you receive an email from someone claiming to need your personal information, do not respond.
Also, there are fake enrollment sites. Remember that the only place Tennesseans can buy the new insurance AND get tax credits is at the Marketplace, www.healthcare.gov.
What do I do if I have Medicare?
If you already have Medicare, you do not need to do anything. Your Medicare will stay the same, with a few beneficial changes: there will be more preventative care services provided, and the doughnut hole—a gap in coverage where there is a temporary limit on what the plan will pay for drugs—will be closed.
Versión en español: “Inmigrantes y la Ley Cuidado de Salud a Bajo Precio (ACA)”