Obamacare in Tennessee

Health Insurance Marketplace in Tennessee

If you live in Tennessee, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Specific plans and prices are available now and coverage can start as soon as January 1, 2014.

Spanish language speakers can contact cuidadodesalud.gov.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Tennessee has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Tennessee’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP in Tennessee:

Community Health Alliance Mutual Insurance Company

Who can help you (the Navigators)

Get local help

Structured Employment Economic Development Corporation

Seedco, a national organization, helping low-income households and communities move toward economic prosperity since 1987, will act as lead agency for a consortium of partners in each state and oversee all aspects of the proposed program, providing technical assistance, financial oversight, compliance protocols, and partner facilitation. Seedco and its partners will support the activities of Navigators in Georgia and Tennessee, many of whom will be roving.

Tennessee Primary Care Association

The Tennessee Primary Care Association (TPCA) is a community-focused non-profit that aims to improve access to primary health care through leadership, advocacy and support of community health centers. TPCA will leverage health centers’ existing relationships to conduct outreach and enrollment efforts, and reach beyond its member CHC efforts to fill gaps in geographic coverage in the 13 counties not served by community health centers.

Who you can contact for more help

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know  with the form below and we’ll get right back to you.

[contact-form-7 id=”73″ title=”Contact form 1″]

Subscribe to the Obamacare-enrollment newsletter

Accountable Care Organizations in Tennessee

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

 The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Tennessee

On December 10, 2012, Governor Bill Haslam (R) announced Tennessee would default to a federally-facilitated health insurance exchange.1

Prior to the announcement that the state would not operate its own exchange, the Tennessee Department of Finance and Administration established the Insurance Exchange Planning Initiative to advise the Governor and Legislature on exchange implementation. The Initiative worked closely with a variety of stakeholders and content experts, including agents, brokers, underwriters, actuaries, providers, and advocates.2,3 Stakeholder feedback was compiled into a white paper released in October 2011; findings indicated overwhelming preference for a state-run, rather than a federally-operated, exchange.4

A measure restricting health plans in the exchange from offering abortion coverage, with no exceptions, became law on May 5, 2010, without former Governor Phil Bredesen’s (D) signature (HB 2681/SB 2686).5

Contracting with Plans:
 In September 2012, the Exchange Planning Initiative released a Request for Information for qualified health plans in the individual exchange market.6 In 2012, the state convened a new Technical Assistance Group (TAG) of actuaries to provide expertise on reinsurance and risk adjustment.7

Small Business Health Options Program (SHOP) Exchange: In March 2012, the state released a Request for Information on information technology services for the Small Employer Health Options Program exchange.8 The Department of Finance and Administration had solicited subcontractors to conduct multiple analyses related to the establishment of an exchange, including an analysis of the merger of the individual and small group markets.9

Information Technology (IT): The state released a Request for Proposals (RFP) soliciting subcontractors to implement a significant Medicaid eligibility system upgrade to seamlessly integrate with the Children’s Health Insurance Program (CHIP) and interface with an exchange. Tennessee also participated in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.10

Tennessee Bridge Option: Tennessee developed the Bridge Option proposal as is an alternative to the Affordable Care Act’s (ACA) Basic Health Program.11 Both options aim to improve the affordability of coverage for individuals with incomes above the Medicaid eligibility threshold and up to 200% of the poverty level. The Bridge Option would enable individuals moving from Medicaid to subsidized coverage in the Exchange to remain in lower-cost Medicaid managed care plans, or bridge plans. This approach would also allow all members of a nuclear family to hold coverage through a common insurer and provider network regardless of their eligibility status. The Department of Health and Human Services has indicated that states will be allowed to offer bridge plans through their exchanges, though it is not clear whether these plans will be offered in the federal exchange.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Tennessee has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Tennessee PPO.

Exchange Funding

The Tennessee State Department of Finance and Administration received a $1 million federal Exchange Planning grant in September 2010. The Department has since received three federal Level One Establishment grants: $1.5 million in November 2011, $2.2 million in February 2012, and $4.3 million in May 2012. The grants are for continued exchange planning including for the procurement of technical expertise, funding staffing needs, planning for a health plan management system, marketing and outreach, and consumer assistance.12

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Tennessee is considering purchasing private coverage for the uninsured as a form of Medicaid expansion.

Next Steps

The federal government will assume responsibility for running a health insurance exchange in Tennessee beginning in 2014.

Additional planning documents for Tennessee’s health insurance exchange can be found at:http://www.tn.gov/nationalhealthreform/exchange.html


1. ‘Haslam Announces State Will Not Run Health-Care Exchange.’ December 10, 2012.https://news.tn.gov/node/10017
2. Insurance Exchanges: What Makes Sense for Tennesssee? Powerpoint presentation. Tennessee Healthcare Financial Management Association. May 24, 2011. http://www.tn.gov/nationalhealthreform/forms/HC21.pdf
3. Press Release. State Insurance Exchange Planning Initiative TAG members.http://www.tn.gov/nationalhealthreform/forms/exhange110810.pdf
4.Best Alternatives to a Federal Exchange in Tennessee: A Summary of Stakeholder Feedback. October 21, 2011. State of Tennessee Insurance Exchange Planning Initiative.http://www.tn.gov/nationalhealthreform/forms/fulldocument.pdf
5. House Bill 2681/ Senate Bill 2686. http://www.capitol.tn.gov/Bills/106/Bill/SB2686.pdf
6. Request for Information. Insurance Exchange Planning Initiative. State of Tennessee.http://tn.gov/generalserv/purchasing/ocr/documents/RFI31865-00709.pdf
7. Tennessee Transitional Reinsurance Program: 3Rs Actuarial TAG. DRAFT. April 10, 2012. Gorman Actuarial, LLC. http://www.tn.gov/nationalhealthreform/forms/rrtagpresentation041012.pdf
8. Request for Information. State of Tennessee- Insurance Exchange Planning Initiative. March 15, 2012.http://tn.gov/generalserv/purchasing/ocr/documents/RFI31865-00707.pdf
9. Exchange Planning Grant Second Quarter Report. May 2, 2011.http://www.tn.gov/nationalhealthreform/forms/planninggrant2ndqtr.pdf
10. Enroll UX 2014 website. http://www.ux2014.org/
11. Bridge Option: One Family, One Card Across Time. Tennessee Insurance Exchange Planning Initiative. November 21, 2011. http://www.tn.gov/nationalhealthreform/forms/onefamily.pdf
12. Tennessee Level One Establishment grant. Department of Finance and Administration. September 30, 2011.http://www.statecoverage.org/files/TN_level1establishmentgrant.pdf

Also of interest

Provided by the Henry J. Kaiser Family Foundation