Are you having trouble getting the health coverage you need in Tennessee? No matter what your questions are, we have answers. We have dozens of health insurance experts who have dedicated considerable time and resources to putting together this informational website. We can help you evaluate all of the pros and cons of major medical insurance, short-term health insurance, Health share plans, and more in Tennessee. You may even be able to pick a plan and get yourself and your loved ones covered by the time you finish reading this.
Major Medical Insurance in Tennessee
The history of major medical insurance in Tennessee is closely linked to the passage of the Patient Protection and Affordable Care Act back in 2010. The passage of this law established two very important things: the federal Health Insurance Marketplace, and the rules which insurance companies have to obey in order to sell major medical insurance coverage on that Marketplace Exchange. When you hear people talk about ACA insurance or the Exchange, they’re talking about the federal Health Insurance Marketplace.
Tennessee does not have its own state Exchange, so you will need to visit HealthCare.gov if you want to apply for major medical coverage. You should try to do this during the Open Enrollment period every year which starts on November 1st. That usually ends on December 15th, but that date is subject to change based on demand and availability. There are also special enrollment periods you may qualify for if you suffer an extenuating circumstance or experienced a major life change, like having a child. There are many different circumstances that could qualify you for a special enrollment period, so don’t hesitate to visit HealthCare.gov to check and see if you’re trying to apply for coverage outside of the open enrollment.
For people who aren’t currently getting their health insurance through their employer, major medical is a highly attractive option. It gives people the opportunity to purchase guaranteed-issue health insurance, which means that they are not allowed to be rejected for coverage or price-discriminated against if they have a pre-existing condition. In fact, the only things that can make a difference on how much they are charged for their monthly premiums are either one or a combination of the factors below:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another reason millions of people register every year for major medical coverage is due to the guaranteed Essential Health Benefits. This list of 10 health benefits help ensure that people get comprehensive and preventative care they need to be optimally healthy and reduce their total medical costs over the course of their lifetime:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
For better or worse, most insurance companies do have to raise their rates in order to provide guaranteed issue coverage with all of these Essential Health Benefits. But that doesn’t mean you’ll be saddled with the total cost of these higher bills. Most hard-working Americans can actually qualify for premium tax credit which automatically lowers their monthly premiums buy hundreds of dollars, saving them thousands each year. The chart below will tell you whether or not you make enough money to qualify for a premium tax credit, whether you fall below the maximum income limit to qualify for Medicaid, or whether you fall into the Medicaid expansion gap in Tennessee:
|Annual Income (138% of FPL)
|Annual Income (100% of FPL)
For those who don’t know, the Medicaid expansion gap only exists in a few states, and Tennessee is one of them. It exists because lawmakers have refused to accept free federal money which could be used to expand Medicaid to needy families who fall into this income gap. Until the lawmakers change their minds, this is going to be a conundrum which makes healthcare prohibitively expensive for thousands of Tennessee families for the foreseeable future. In the meantime, people who fall into this income gap may want to take a closer look at short-term health insurance or a Christian health plan. For people who are low-income enough to qualify for Medicaid, there is an application process at the Tennessee Medicaid website that you need to go through in order to get coverage. But Tennessee requires a lot of its Medicaid applicants before you can officially receive Medicaid benefits, including a mandatory work requirement. Visit the Medicaid website for more information.
Short Term Health Insurance in Tennessee
State legislators in Tennessee have not proposed any strict regulations on short-term health insurance plans, so they default to the federal rules. Federal rules state that you can purchase short-term health insurance for a maximum of 12 months and you can only renew them for a total plan duration of 36 months. Whether you’re patiently waiting for the next Open Enrollment period, or you’re going through some sort of temporary hardship, short-term health insurance can cost up to 33% less compared to the monthly premiums for an unsubsidized ACA plan. They can also give you most of the Essential Health Benefits that you would get with major medical, and you’ll get consumer protections so that you can take your insurance company to court if they try to unjustly deny you your benefits.
That’s the good news about short-term health insurance in Tennessee. But there are some caveats. There’s no such thing as a guaranteed issue short-term health insurance policy, which means you will be subjected to medical underwriting and could be rejected for coverage or could be charged exorbitant monthly premiums for having a pre-existing condition. Many short-term health insurance plans come with deductibles in the thousands of dollars which you will be financially responsible for before your benefits kick in. They also come with annual and lifetime benefit caps, but no such guarantee on caps for your out-of-pocket expenses. Still, it’s better to have at least some type of coverage than no coverage at all – especially if you are relatively healthy now and suffer a major medical emergency while you wait for an opportunity for major medical coverage.
Christian Health Plans/Health-Sharing Plans in Tennessee
If you can’t get ACA insurance in Tennessee, what could possibly compete with short-term health insurance as your next alternative option? Well, a Christian health plan might. Christian health plans were a lot more popular in Tennessee back when the individual mandate was still federal law. It gave people an exemption to the individual mandate based on the religious status of these organizations without forcing them to purchase health insurance that was as expensive as the ACA. This saved people a lot of money while connecting them to health share organizations that gave them at least some semblance of medical coverage, even if they couldn’t get high quality major medical coverage through the ACA.
Christian health plans and short-term health insurance actually have a lot in common. The most important similarities that these two plants share are:
- These plans are NOT guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Can cost as much as 33% less than an unsubsidized ACA plan
But as many things as they have in common, they still have enough differences between them to make a significant impact on how you get your medical care. For starters, there are the membership guidelines which will be imposed and that you must follow in order to get your benefits paid out. Usually, this isn’t anything to major; you might have to declare a specific religious faith, promise to go to church a certain number of times per year, or make changes to your lifestyle, like ceasing tobacco use for your health. You have consumer protections with short-term health insurance because the state is legally allowed to regulate these companies by law. The state of Tennessee is not allowed to regulate Christian health plan providers, so if there is ever a dispute between you and your provider, you can’t take them to court; their decision on the matter is final in most cases. The payment structure for Christian health plans is a little different, too. You don’t pay a monthly premium, you pay a monthly share amount. Likewise, you don’t pay deductibles, co-pays, or coinsurance. But you will be asked to pay either uninsured amounts or personal responsibility amounts which function in much the same way as coinsurance, co-pays, and deductibles.
Fixed Indemnity Plans in Tennessee
Technically, short-term health insurance and health share plans are the closest you can get to replacing major medical coverage without legally qualifying as major medical coverage. Fixed indemnity plans, however, are much farther behind those two options if your goal is to replace major medical coverage With something outside of the Marketplace. On the other hand, fixed indemnity plans are great if you have major medical, short-term health insurance, or the like and need something to reduce your out-of-pocket costs. Most major medical plans or similar products pay a fixed percentage of your total medical costs, whereas fixed indemnity plans payout a fixed amount of money per day, per week, per month, per incident, or per visit. Look at it this way: would you rather have an insurance plan that pays out 60% of the bill from your doctor visit, or $60 per doctor visit? That’s basically the difference between fixed indemnity and more comprehensive coverage.
But fixed indemnity plans can give you the flexibility to visit medical providers outside of your network so that you can get the care you need at a better price. Fixed indemnity plans can also at least provide you a little bit of financial cushioning if you don’t have health insurance but you are relatively healthy and don’t anticipate but still want to protect against unexpected medical bills. But when it comes to things like medical underwriting, caps on annual and lifetime benefits, and no caps on your total out-of-pocket costs, fixed indemnity plans aren’t your best bet for replacing major medical coverage.
Discount Cards in Tennessee
It can be hard to find a medical discount card that’s right for you these days. There’s a big difference between the higher-quality medical discount cards that actually save you a good deal of money and the scams out there. When trying to avoid scams, make sure you avoid any company that advertises their medical discount card as replacement coverage for major medical insurance. They do not work the same way as regular insurance does. You also need to avoid companies that advertise an extremely long list of participating providers or discounts that sound too good to be true. But it’s not difficult to call ahead and double-check to make sure that the participating providers actually offer the discounts that the medical discount card company advertises.
If you find a medical discount card that looks legitimate, the next step is to make sure that the fee you pay for your membership is smaller than the amount of money you save on your discounts. If not, then you’re essentially wasting money just for the privilege of using coupons. But if so, then taking a bite out of your out-of-pocket medical costs is as simple as paying a monthly or annual membership fee and waiting for your card in the mail. Once you get it, you can present it whenever you purchase prescription drugs, visit certain doctors, or pay for other medical services where your discount applies. And you can save money right there at the register.