In Tennessee, TennCare and the Marketplace are two different doors, and the right one depends on who in your household you are applying for. TennCare is Tennessee’s Medicaid program, and you apply through TennCare Connect. Marketplace plans, with premium tax credits for those who qualify, are on HealthCare.gov. Many families use both. This works the same in Memphis, Jackson, Clarksville, Nashville, Murfreesboro, Cookeville, Chattanooga, Knoxville, and the Tri-Cities.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in Tennessee. We are not TennCare, HealthCare.gov, CMS, the State of Tennessee, or an insurance company. TennCare decides who qualifies for TennCare, and the Marketplace decides who qualifies for savings. We do not quote prices or name plans here.
The short answer
- TennCare is designed for certain groups. Tennessee says it is designed to provide health care coverage to low-income children, pregnant women, parents or caretakers of minor children, the elderly, and people with disabilities.
- If you don’t qualify for TennCare, Tennessee points you to the Health Insurance Marketplace at HealthCare.gov.
- When in doubt, apply. HealthCare.gov says you can apply for Medicaid any time of year, and that even if you don’t think you’ll qualify based on income, you should apply, especially if you have children, are pregnant, or have a disability.
Who TennCare is for
TennCare says you must fit into a TennCare category to qualify. Its categories include children, pregnant women, parents or caretaker relatives of a minor child, people who get Supplemental Security Income, and several others. Income limits and other rules apply, and TennCare makes the decision. Rather than guess from a chart, apply and let TennCare tell you. TennCare’s Do I qualify? page explains the kinds of TennCare.
CoverKids is a separate Tennessee program for children. TennCare describes it as covering children under 19 whose income is below 250% of the federal poverty level and who do not have other insurance, and TennCare lists it as help for pregnant women too. Ask TennCare Connect about CoverKids when you apply.
How to apply for TennCare
TennCare lists three ways to apply:
- Online at TennCare Connect, where you can also check your status, report changes, and read letters.
- By phone at 855-259-0701.
- On paper, with the English or Spanish application from TennCare’s how to apply page.
TennCare says you can also get help at a Department of Human Services office in any of Tennessee’s 95 counties, or from your local health department. Have Social Security numbers and birth dates for everyone applying, income information, citizenship and immigration information, and details on any other health insurance ready.
How to apply on HealthCare.gov
If you start on HealthCare.gov instead, that’s fine. HealthCare.gov says that if it looks like anyone in your household qualifies for Medicaid or CHIP, it securely sends their information to your state agency, and the state contacts you. If the state denies Medicaid or CHIP, it sends your information back to the Marketplace. See HealthCare.gov’s Medicaid and CHIP page.
Marketplace dates: open enrollment on HealthCare.gov starts November 1 and ends January 15. Enroll by December 15 for coverage that starts January 1. For the full step by step, read our Tennessee open enrollment guide.
One household, two kinds of coverage
It is common for children to be on TennCare or CoverKids while a parent shops for a Marketplace plan. When you compare Marketplace plans, keep these in mind:
- Your savings are based on what you expect to earn next year, not last year. A careful estimate helps you avoid a surprise at tax time.
- If your income goes up during the year, report it right away. There’s no longer a cap on how much extra premium credit you may have to pay back.
- Premium tax credits are generally available to households earning between 100% and 400% of the federal poverty level. Above 400%, the credit generally isn’t available.
- Extra savings on deductibles and copays (cost-sharing reductions) are available only on Silver plans, for incomes up to 250% of the poverty level.
If your TennCare is ending
TennCare says coverage can end for reasons like moving out of state, not renewing, an income increase, or no longer fitting a TennCare group. Before it ends:
- Answer the letter. If you no longer qualify in your current category, TennCare sends a notice with questions to see whether you qualify in another one. Complete it.
- You can appeal. If you don’t qualify for any TennCare coverage, TennCare says you’ll get a notice and the chance to appeal.
- Ask about temporary coverage. TennCare describes Transitional Medicaid and Extended Medicaid, which can give 12 months of coverage in certain situations, and says children under 19 may keep TennCare for 12 months even if income goes up, with some exceptions.
- Move to the Marketplace if you need to. HealthCare.gov says that if you lost Medicaid or CHIP in the past 90 days, you may qualify for a Special Enrollment Period, so you don’t have to wait for November.
See TennCare’s Losing TennCare? page for details.
Have Medicare?
TennCare says you can apply for a Medicare Savings Program, which may help pay Medicare premiums and cost-sharing, the same three ways. For help applying, TennCare points to TN SHIP at 1-877-801-0044.
Live near a state line?
Medicaid follows the state where you live. If you live across the line in Kentucky, Virginia, North Carolina, Georgia, Alabama, Mississippi, Arkansas, or Missouri, apply in that state. Our agent is not licensed in those states.
Protect your application
When you work with an agent, you’ll get a text or email asking you to approve that agent. Only approve someone you chose. Never share your HealthCare.gov login. A licensed agent doesn’t need it.
How we help
We help Tennessee families by phone and online, in English or Spanish. Learn more on our Tennessee health insurance help page. If TennCare is the right door, we point you to TennCare Connect. If the Marketplace is, we go through your income estimate, doctors, and prescriptions and help you with the HealthCare.gov application. If it’s both, we help you keep the pieces straight.
Ready when you are
Have your household’s income estimate, any TennCare letters, and your doctor list handy, and we will take it one step at a time.
Call (321) 315-0054 | agent@inshh.com
You may qualify after tax credits. Eligibility varies.
Featured photo: Meadow in the Smoky Mountains by Rhododendrites, CC BY-SA 4.0, cropped with text added.
