Tennessee Health Insurance

 

Health insurance in Tennessee

● Tennessee operates a federally managed exchange with registration through HealthCare.gov.

● Open enrollment for Tennessee 2021 health insurance plans is November 1 to December 15, 2020. Residents with qualifying events can sign up outside that window.

● Short-term health insurance plans can be sold in Tennessee with initial plan terms of up to 364 days.

● Six insurers will offer medical insurance in the Tennessee market for 2021, including newcomer UnitedHealthcare.

● More than 200,000 Tennessee residents enrolled in 2020 coverage through Tennessee's health insurance market, 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 grant for Medicaid funding.

● As of December 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 will find information about the many types of health insurance coverage available. You can find the basics of Tennessee's health insurance market and the next open enrollment period; a brief overview of Medicaid in Tennessee, which has refused to implement the Medicaid ACA expansion; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; and a collection of Montana health insurance resources for residents.

Tennessee health insurance marketplace defined by state resistance to ACA reforms

Tennessee can be counted among the states with higher uninsured rates and persistent resistance to the Affordable Care Act. As such, it has opted for a more hands-off approach with a federally facilitated exchange and has not yet expanded Medicaid.

The state has also allowed farm bureau plans that do not comply with the ACA to continue to be sold to healthy residents, result in an ACA-compliant risk pool that is simpler than in most states.

Tennessee uses HealthCare.gov as an exchange. The exchange gives Tennessee individuals and families the opportunity to enroll in self-purchased health plans (as opposed to employer-sponsored health plans). These policies are used by early retirees, the self-employed and anyone employed in a small business that offers no health benefits.

The exchange is also the only place where premium subsidies and cost-sharing reductions are available, based on household income.

Tennessee opens enrollment period and dates

Open enrollment for ACA-compliant 2021 health plans runs from November 1, 2020 to December 15, 2020. During the open enrollment period, new subscribers can request coverage, and current subscribers can renew or change coverage for 2021. It is also an opportunity to update the financial information that the exchange has on file, to ensure that financial assistance for next year is accurate.

The open enrollment period also applies to purchase plans outside the exchange. People who sign up 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 the Tennessee exchange during the open enrollment period for 2020 coverage. Enrollment peaked in 2016 (as in most states that use HealthCare.gov), when 268,867 people signed up. Since then, enrollment has declined under the Trump administration.

Health insurance premiums in Tennessee's individual insurance market fell for 2019 and fell again for 2020. But this followed two years of sharp increases, in 2017 and 2018. Since then, things have stabilised considerably in recent years; approved rate changes for 2021 range from a decrease of about 6% to an increase of about 10%. And UnitedHealthcare is returning to the Tennessee exchange for 2021. UnitedHealthcare offered plans on the stock exchange in 2016, but left at the end of that year. By 2021, there will be six insurers that will offer stock market sales plans, although with variable service areas (for example, not all plans are available in all areas).

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 funding model for TennCare (the state's Medicaid program), instead of current open federal matching funds. Critics of the legislation note that block grants are likely to result in a reduction in Medicaid funding over time. No Democrats were included in the House committee that worked on the block grant bill, and the legislature was full of tensions on the issue.

The ACA has called for Medicaid to be expanded to cover all Tennessee residents with incomes of up to 138% of poverty. In 2012, however, the Supreme Court ruled that states could give up medicaid expansion, which Tennessee has done so far.

Because Tennessee has not expanded Medicaid, there are about 117,000 impoverished residents in the coverage gap, with no access to financial assistance for their health coverage.

Subsidies for private plans sold in the health insurance market are not available to those earning less than the poverty level, and adults without non-disabled children 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 other non-expansion states use.

Tennessee CO-OP closed in 2015

The ACA included a provision for the creation of consumer-oriented and managed plans (CO-PO). In Tennessee, community health alliance mutual insurance company was a CO-OP created by ACA and was one of five aircraft carriers in Tennessee in 2015. But in October 2015, the Tennessee Department of Commerce and Insurance announced that the Community Health Alliance would stop operations at the end of the year, and enrollees had to select coverage from a different insurer for 2016.

Tennessee was one of several CO-POs nationwide that closed in late 2015 — largely because the federal government was able to pay only a fraction of the money insurers owed under the risk corridor program.

Short-term health insurance in Tennessee

Tennessee doesn't have state legislation that limits the duration of short-term health insurance plans, so the state doesn't comply with federal rules. These rules allow short-term health insurance plans to have initial terms of up to 364 days and a total duration, including renewals, of up to 36 months.

Did Obamacare help Tennessee?

Despite a general aversion to Obamacare, the people of Tennessee have seen better health insurance coverage under the Health Reform Act. The state's overall uninsured rate fell from 13.9% in 2013 to 9.5% in 2017, although it rose to 10.1% in 2018. Although the uninsured rate is lower than in 2013, it is still above the national average of 8.9%. This is largely due to Tennessee refusing to accept federal funding to expand Medicaid under the ACA.

However, there are more than 186,000 Tennessee residents who are covered by private plans through the tennessee market, all with coverage for the ACA's essential health benefits, regardless of pre-existing conditions or coverage history. And 89% of them receive premium subsidies that make their monthly insurance premiums much cheaper than they would otherwise be. In addition, 52% receive 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 with a promise to repeal and replace the ACA, easily won Tennessee in the 2016 election.

In 2010, Tennessee 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 has 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 chairman in the House, and was then responsible for leading the American Health Care Act (an attempt to repeal the ACA) through the House in 2017. The U.S. House now has only two Democratic representatives from Tennessee and seven Republicans.

Former Governor Bill Haslam, a Republican, worked with the Obama administration to seek approval for his modified version of the Medicaid expansion, and met with then-HHS Secretary Sylvia Matthews Burwell in July 2014 to continue discussions he had with Secretary Sebelius. Haslam said he would like to expand Medicaid to cover another 161,000 low-income Tennessee residents, but wanted higher co-payments than the Obama administration's HHS would allow, and no compromise was reached.

Haslam was limited in time and could not function in 2018. His successor, Bill Lee, also a Republican, won the election by a substantial margin.

The Trump Administration has encouraged states to impose labor requirements on their Medicaid populations, which was not a 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 at the end of 2018 and was still awaiting approval from mid-2020. While the Trump administration has approved labor requirements in many states, courts have blocked the implementation of four of those waivers, and other states have withdrawn their waivers or postponed implementation. There are currently no Medicaid work requirements in place.

Tennessee has allowed ACA-compliant Farm Bureau plans to continue to be sold to healthy Tennessee residents, which has led to a less healthy risk pool for ACA-compliant health insurance plans in Tennessee. The state has long considered farm bureau plans separate from the insurance industry, so they are not governed by state rules that apply to insurance and therefore have lower costs. By opting to continue that practice in 2014 and beyond, Tennessee allowed such plans to continue to be sold to healthy candidates. They were the only state in the country that allowed it 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.

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 across the state.

● HealthCare.gov — The health insurance market 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 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 national service that provides information and assistance with questions related to Medicare.

Health care reform legislation in Tennessee

The Tennessee legislature has been fairly active in health and health care reform, but not all of their legislation has been beneficial to the state's residents.

In 2018, Tennessee enacted a law that directed the state to seek federal approval for a Medicaid work requirement. And in 2019, the state enacted a law directing the state to seek federal approval to pass 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 while treating uninsured patients.

And H.B.1342, which was also issued in 2019, strengthens protections against surprise balance billing by requiring medical facilities to provide patients with written notification - at least three days before a medical procedure - whether they will receive services from an off-network provider at the facility. The state has already requested facilities to provide these notifications to patients, but the legislation adds the provision that disclosure is provided at least three days in advance. Out-of-network doctors who do not provide the necessary information will not be allowed to balance the patient's account.