With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Tennessee, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Tennessee
Tennessee ranked 45th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a low prevalence of binge drinking, a low incidence of pertussis infections, and high immunization coverage among children. Tennessee’s health challenges are a high prevalence of smoking, a high violent crime rate, and a high prevalence of low birthweight and high infant mortality rate. In the past 10 years, violent crime decreased 16 percent; however, the state remains 50th in the rankings for violent crime.
Tennessee individual and family health insurance
The state of Tennessee opted to default to a federally facilitated health insurance exchange. As such, its residents use the federal Health Insurance Marketplace website to shop and apply for qualified health plans that are eligible fir income-based premium tax credits and cost-sharing subsidies.
Those who go without health insurance may face a tax penalty known as the shared responsibility payment. However, individuals and families are not limited to Tennessee’s federally facilitated exchange. The private marketplace offers many qualified health plan options at websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Tennessee’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 151,352 individuals in Tennessee selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Tennessee enrolled in a marketplace plan increased to 231,440 during the open enrollment period.3
|Tennessee’s health insurance exchange:||healthcare.gov|
|Tennessee department of insurance:||state.tn.us/commerce|
Tennessee small group health insurance plans
Small business owners with 50 or fewer employees may purchase group health insurance plans through Tennessee’s federally facilitated Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Tennessee’s federally facilitated exchange.
Tennessee state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Tennessee’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All group sizes|
|Maximum continuation period – standard||The fractional policy month remaining at termination, plus 3 months|
|Maximum continuation period – Special||Divorce or death of insured spouse: fractional policy month, plus 15 months
Termination of benefits during pregnancy: Up to 6 months following the end of the pregnancy
|Maximum premium||100 percent|
|State legislation reference||Tenn. Code Ann. § 56-7-2312 (2014)|
|Additional notes||Must have been previously insured under the group policy for three continuous months prior to termination|
Tennessee high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Tennessee opted not to expand Medicaid in 2014.7 As a result, there is currently a coverage gap that includes adults who do not qualify for Medicaid under current Tennessee guidelines but do not earn enough to receive federal premium tax credits subsidies when shopping the federally facilitated health insurance exchange—you must earn between 100 and 400 percent of the federal poverty level to qualify for premium tax credits. Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Tennessee’s Medicaid program, TennCare:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||State of Tennessee|
|Where to apply||healthcare.gov / Options for applying in person or over the phone: tn.gov/tenncare/members.shtml|
|Open-enrollment period||Year-round in all states|
|Eligibility||Based on income in relation to the federal poverty level and specific program eligibility guidelines|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Tennessee’s health insurance program for low-income children:
|Where to apply||866-620-8864|
|Eligibility8||Uninsured and without access to state-sponsored health insurance or TennCare; U.S. residents and qualified non-residents; Tennessee residents; under age 19 at the date of application; household income within 250 percent of the federal poverty level|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Tennessee Code Annotated. § 56-7-2312 (2014). http://www.lexisnexis.com/hottopics/tncode/.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Tennessee.”http://www.medicaid.gov/medicaid-chip-program-information/by-state/tennessee.html.
8 CoverKids. “CoverKids Eligibility.” http://www.coverkids.com/WebForms/Eligible.aspx.