Tennessee was a state, which willingly volunteer for military service during the war of 1812, so it is nicknamed as The Volunteer State. However, currently people associate this state with the Country Music Hall of Fame along with the honky-tonks and dance halls in Nashville. The Volunteer state lies in the bottom as far as health rankings are concerned and certainly there is room for improvement throughout the Tennessee state. Thus, residents of Tennessee should take well care of their health by enrolling in the right health plan available in their state. To ensure that residents of Tennessee avail health insurance it was mandated for the residents to have insurance coverage or face a penalty at the time of paying tax. This individual mandate was created after the Affordable Care Act or Obamacare was passed. However, after the backlash mainly from the non-supporter of President Obama and after president Trump taking the charge of the office, he eliminated the individual mandate. Residents of Tennessee can shop for health insurance plans offered to individuals and their families by private insurance companies or from participating private insurance companies through HealthCare.gov, the federal exchange. The state operates a federally facilitated healthcare exchange and its residents can enroll through HealthCare.gov.
Highlights & Updates
- Open enrollment for 2020 health plans has ended in Tennessee but residents with qualifying events will be able to enroll and they can also make changes in their coverage for 2020.
- For health plans effective in 2021, the open enrollment period will begin November 1, 2020.
- Short-term health plans are available in Tennessee with initial plan terms of up to 364 days.
- For the 2019 health plans coverage, around 221,000 Tennessee residents enrolled through the state exchange.
- Residents of Tennessee can enroll through HealthCare.gov, as the state operates a federally run exchange.
- For the 2020 coverage, five insurance companies are operating in Tennessee’s individual market.
- There are over 1.3 million Medicare beneficiaries in Tennessee, as of 2019.
Individuals and Family Health Insurance Plans in Tennessee
Individuals residing in Tennessee, who don’t have employer sponsored health plans and who don’t qualify for government health plans can obtain health insurance for themselves and their families through private insurance carriers. With the rising cost of healthcare, individuals simply can’t afford to take any chances and therefore need to carefully select a right health plan that will protect them during medical emergencies. Some of the individuals and family health plans available in Tennessee include:
HMO – HMO or Health Maintenance Organization plans available in Tennessee come with a wide range of healthcare services. The HMO plans are offered through a network of providers who agree to render healthcare services to members of the plans. Enrollees of the HMO plans are likely to have a broader range of preventive healthcare services compared to another type of plan. HMO plan members are required to choose a primary care physician, who take care of their healthcare need and also provide them referral before seeing a specialist. Members of HMO plans generally have lower out-of-pocket expenses and they may not be required to pay a deductible before the start of their coverage and their copayments are also likely to be minimal. Individuals enrolled in this plan don’t require to submit their own claims to the insurance company. Enrollees should keep in mind that they will not be covered for services rendered by out-of-network providers or for medical services that are received without a proper referral from their primary Care Provider.
PPO – Individuals and family health market in Tennessee showcases a wide range of health plans among which Preferred Provider Organization is the most popular plan for individuals who wish to have utmost freedom to choose any healthcare provider or medical facility for their healthcare needs. Members of PPO plans are free to visit in-network physician or healthcare provider of their choice without requiring a referral from a primary care physician. Individuals enrolled in PPO plans are encouraged to use the insurance company’s network of preferred doctors. Though, individuals are free to choose a healthcare provider but they should keep in mind that in-network healthcare services are covered at a higher benefit level compared to out-of-network services. Thus, to receive the highest level of benefit coverage, individuals should check that whether their provider accepts their health plan or not. Members of the plan also have to pay annual deductible before insurance companies start covering.
Fee For Service Plans – Fee-for-Service or Indemnity plans are designed especially for those individuals who are looking for utmost freedom while choosing a choice of your doctor and hospital. Under this plan insured are free to visit doctor or specialist of their choice without requiring any referral. In the fee-for-service plans, members are required to pay upfront for services and later on submit a claim to the insurance company for reimbursement. Members are suppose to pay annual deductible before receiving coverage from the insurance company. Once the deductibles are met by the members of the plans, the insurance company usually pay the amount, which the healthcare provider of their area would typically charge for the given healthcare service. The remaining amount has to be paid by the insured itself.
Point-of-Service or POS Plans – A POS plan has qualities of both HMO and PPO plans and the benefits of this plan depend whether the members have received care in or out of the health insurance company’s network of providers. Members of the plan are required to select a primary care physician who will beside provide healthcare will also provide referral to visit specialist when needed. Just like a PPO plan members of this plan may also receive healthcare from non-network providers but they will have to bear greater out-of-pocket costs. They are also responsible to pay copayments, coinsurance and an annual deductible.
Health Savings Account – Health Savings Account is a federally insured savings account, which is generally paired with an HAS-qualified health plan and allows individuals to make tax-free contributions. HSA-qualified health plans cost less compared to traditional plans and the saved money can be deposited into HSA. The interest earn on this account is tax-free and the amount may be used to pay for the qualified medical expenses. The entire amount saved in this account rolls over each year. This account acts just like personal savings account with the only difference that the amount in this account can only be used to pay for qualified healthcare expenses. In order to be eligible to open this account, individuals need to be enrolled in high deductible health plans. Qualified healthcare expenses include a wide range of medical, dental and mental health services.
Short-term Health Plans in Tennessee
Tennessee has not impose strict regulations for short-term health plans and follows the federal laws on plan duration and renewals. Therefore, short term health insurance plans are available in the state for initial terms of up to 364 days that can be renewed for up to 36 months. Individuals shopping for this plan need to understand that short-terms plans offer temporary coverage and are not like typical ACA-compliant coverage. People are generally attracted toward this plan mainly due to its affordability. Short-term benefits are generally related to emergency care, which means that these plans do not work for individuals who require regular medical care like frequent visit to the doctor or expensive prescriptions. Though, these plans do not provide benefits just like major medical health insurance but still provide coverage that is affordable for many people. Individuals purchasing short-term health plans in Tennessee will not be eligible for any guaranteed issue individual health plans like HIPAA plans or COBRA plan, if they have recently lost coverage from a group health plan. Individuals shopping for the short-term plans should also keep in mind that these plans do not cover pre-existing medical conditions or benefits like comprehensive plans and these plans also do not guarantee renewal. So, if individuals develop any condition while being on a short-term plan then they may be excluded from their policy or may prevented from renewing at the time of renewal.
Dental Insurance Plans in Tennessee
Individuals looking to shop for best and affordable dental insurance plans in Tennessee are sure to find some good plans. Though, dental insurance plans in Tennessee vary as per issuing insurance company but majority of the dental plans provide coverage for some common procedures such as cleanings, routine checkups, x-rays, crowns, fillings, root-canals, extractions as well as oral surgery. Individuals looking for basic coverage will find many options ranging from some preventive dental care to basic procedures like cleaning and fillings. Individuals can select dental plan depending upon the dental care which they may need in the future. Individuals who do not expect to get a oral surgery or root canal should opt for basic coverage plan. Most of the dental insurance plans in Tennessee do not cover certain procedures like orthodontia, cosmetic dentistry and major preexisting conditions. There are generally two types of dental insurance:
Dental Preferred Provider Organization – PPO plan comes with dental network that offer discounted prices on dental treatments, when members visit an in-network provider and they pay a coinsurance based on their plan. However, if they go to an out-of-network dentist their benefits are reduced. Members of PPO plans have the options to visit any dentist of their choice and they also neither need to a choose a primary care dentist nor they need to obtain a referral to visit a specialist. These dental plans also have deductibles and waiting periods which the members should meet before availing their insurance benefits. These plans also limit the amount of benefits which members can receive each year.
Dental Health Maintenance Organization – In the dental health maintenance organization plans, the insurance companies maintain a network of dentists to whom they pay a set amount each month, depending upon the number of people enrolled in the plan. Members enrolled in this plan need to choose a primary dentist to obtain dental care and to receive a referral for visiting a specialist. Members are required to pay a fixed copay for the availed dental services and some of the DHMO plans also have annual maximums while some do not have any annual maximum. Members receiving dental treatments from out-of-the-network dentist are unlikely to be covered and they would pay entire treatment cost of the dental care from their own pocket.
Vision Plans in Tennessee
Affordable vision insurance plans offered in the Tennessee include annual eye exams, glasses, contacts and other eye care services allowing individuals to have extra savings for all their eye care needs. Vision care plans in Tennessee are designed with the aim to promote the significance of annual eye exams for maintaining eye health and overall wellness among the residents. Individuals enrolled in vision plan are eligible for an eye exam once in every calendar year ann can also get standard lenses or contacts once in a year and frames once in every two calendar years.
Insurance Carriers in Tennessee
In Tennessee five insurance carriers are offering health plans coverage in 2020 through Healthcare exchange and these companies include:
Blue Cross Blue Shield of Tennessee