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Tennessee Health Insurance

Tennessee Medical Insurance Overview

In terms of general health when compared to the rest of the country, there is plenty of room for improvement in the state of Tennessee.  Although Tennessee’s rank did rise gradually between 2012 and 2014, it still ranks quite low in a wide range of health factors.  Many improvements are needed in several areas if there is to be any growth in the healthcare of the state’s residents.

With the passage of the Affordable Care Act in 2010, many hoped that it would improve the overall health status of those individuals and families in the state of Tennessee.  The intention of the legislation was to mandate health benefits marketplaces so that more nationwide consumers could find and compare affordable health insurance options.

Provisions were also in place to ensure that the population of uninsured Americans decreased dramatically between its inception and the year 2020.  Following the enactment of the ACA, as many as 82 percent of Tennessee residents see tax credits of $213 per month on the marketplace.

Tennessee’s Health Care Issues
Annual data provided by America’s Health Rankings showed that the state of Tennessee came in 43rd place when it came to the health status of the state’s residents.  Because it ranks so low in comparison to other states, the state exhibits many areas of which it can improve.  Despite that, the state has its share of both strong and weak points as listed below.

Strengths include its high rate of students who have graduated high school, its low prevalence for excessive drinking and its low disparity in health status by level of education.  The state’s weaknesses include its low rate of vaccinations for young women against HPV, its many poor mental health days and its high prevalence of residents who smoke.

The health of Tennessee’s residents is improving thanks to the provisions under the Affordable Care Act.

Understanding Tennessee’s Uninsured Population
A study that surveyed residents of Tennessee in 2012 revealed that many residents did not have health insurance because they felt that having insurance would be out of their budgets.  However, this has since been proven to be incorrect.  This particular study also showed data reflecting a drop in uninsured residents in the four years subsequent to 2008.  In addition, it analyzed the results of TennCare and shown that most participants in this program were satisfied with the outcome.

The following data reveals more insight regarding the uninsured population of residents in the state of Tennessee.  According to the Kaiser Family Foundation, ten percent of the uninsured population had no coverage since 2014.  In addition, six percent of the non-elderly uninsured population of the state was without health insurance.  Lastly, data shows that even though there are households earning over 400 percent of the poverty line, the members of these households were still uninsured.

Group Health Plans
Individuals enrolling into a group health plan can typically obtain the best cost and coverage options that are available.  This is the best plan of action for workers in the state because some of the alternatives are more expensive and offer less medical coverage as a whole.

Fifty percent of the state’s population has coverage under a group health plan through their place of employment.  If you work in the state of Tennessee, you should ask whether or not your employer offers such health insurance benefits.  If your employer does not provide group health coverage, you may seek to get similar coverage through a trade union.  In the state of Tennessee, the Department of Commerce and Insurance is responsible for regulated private insurance companies.

Signing Up
Enrollment is usually only possible during an employer’s designated enrollment period.  The human resources department of the workplace is usually in charge of this process and notifies employees as to when these periods occur.  However, finding the right health insurance isn’t always straight-forward and easy to accomplish.  Anyone who is considering joining an employer-sponsored group health plan would be wise to consider other possibilities also, just to be sure that the group plan is the best available option.

Here are some things which should be considered before joining a new health insurance plan:

Premiums: You will likely be required to pay some monetary contribution to the costs of your monthly premiums.  If this is the case, you will want to be sure that the premiums are something that fits into your budget.  These payments are usually withdrawn from your paycheck every pay period.
Coverage Options: Many employers have more than two or three plan options available to workers.  You should consider if any of the offered plans contain enough coverage for your medical needs and future medical situation.
Dependents: Are you responsible for covering your dependents or spouse under this group health plan?  If so, you should be aware that adding others onto your policy will cause your monthly rates to increase.  You should also ensure that your new plan can offer your family members with adequate coverage if needed.

Pre-Existing Condition Exclusion Periods
A person who has a pre-existing medical condition may be forced to wait through a year-long exclusionary period.  During this time, coverage under the group health plan is not available.  Insurance companies are prevented by HIPAA from excluding dependents from coverage who are under 19-years-old, regardless of whether or not they have a pre-existing condition.

Affiliation or Waiting Periods
Where a HMO is concerned, new enrollees must go through an affiliation or waiting period before their health insurance policy comes into effect.  The only way that this period of time can be longer than two months is if the applicant enrolled late.  In this case, the applicant may be required to wait up to three months.  However, both exclusionary and waiting periods occur simultaneously instead of having one pick up where the other ends.

Continuation Coverage
Anyone previously covered under a group plan and who has recently lost coverage because of a job loss or divorce can get temporary insurance coverage under COBRA.  Newly uninsured people can receive up to 18 months of insurance coverage and eligibility is based on the size of the employer who originally offered the insurance package.  Typically, the employer must have 20 workers in the company for COBRA coverage to be available.  When applicable, information will be sent to those COBRA affects so the determination can be made as to whether or not the person wishes to enroll into the plan.
COBRA coverage is a more expensive option for continuation coverage because the employer is no longer paying their share of the monthly premium costs.

Individual Health Plans
Certain situations, such as unemployment or self-employment, may require a person to seek out individual health insurance.  Approximately five percent of Tennessee’s residents are covered through an individual health insurance plan.  Although these plans tend to be more costly than group health plans, it has been estimated by the Foundation for Health Coverage Education that individual plans for a young and healthy resident of Tennessee can be found for as little as $50 per month.

Limitations on coverage may apply to persons suffering from pre-existing medical conditions in this state.  Insurance providers of individual plans are able to do extensive underwriting with regard to plans of this nature, so it can prove to be expensive.  Despite that, insurance companies can use their own discretion when determining whether or not to cover medical conditions that are pre-existing and can exclude individuals from coverage for a period of two years.

Tennessee Health Benefits Exchange
In 2012, it was announced by the state’s Governor that the insurance marketplace would be facilitated and managed by the federal government.  The state received a federal grant of $1 million for exchange planning, but later opted to not create a state-run marketplace for residents.

While there was a great deal of support for the health benefits exchange, the state chose not to move forward with the initiative.  In 2014, control over the exchange was assumed on a federal level.  As such, residents may use in order to obtain resources, compare options and purchase health insurance coverage.  The Henry J. Kaiser Family Foundation’s website has a wealth of information regarding the benefits exchange planning for the state of Tennessee.

Tennessee State Insurance Programs
Nearly 38 percent of people residing in Tennessee have coverage thanks to a state-sponsored program.  Many of these programs aim to help women, infants, children and individuals who have low or moderately low incomes.  The programs listed offer benefits plans that aid in acquiring medically necessary and primary care services.  Determining factors for eligibility are sometimes based solely on the applicant’s income level, but other factors can include gender, health condition and age.

AccessTN is a way of offering affordable health insurance benefits to residents of Tennessee with a pre-existing medical condition.  There is a wide range of plans to choose from depending on the situation and applicants must have been without coverage for at least six months.  Additionally, applicants must have also been denied coverage for an individual health plan by at least two insurance providers.

Pre-Existing Condition Insurance Plan (PCIP)
PCIP is specifically targeted to those who haven’t been able to obtain health insurance in the past because of pre-existing medical conditions.  There is a wide range of benefits offered by PCIP including hospital care, prescription medication, and primary and specialty care.  Those who can supply evidence that they have been denied coverage because of a pre-existing condition are eligible for PCIP.

TennCare caters to families and individuals who earn low incomes.  TennCare covers services including inpatient and outpatient hospital care, family planning, prenatal care, vaccines for children, home health care, rural health clinic care and more.

TennCare Standard
Whereas the coverage of this program is similar to that offered through TennCare, TennCare Standard is primarily aimed at covering children who are uninsured.  Eligibility is based on income level or a pre-existing condition.

Aimed at children under the age of 21 who have already been granted benefits through TennCare, TENNderCare provides check-ups, lab testing, immunizations, developmental and behavioral screening, vision and hearing screening and much more to uninsured children.

Providing benefits to pregnant women and uninsured children in Tennessee, eligibility for the CoverKids program is determined by household income level.  Monthly premiums can be free or cost as much as $341 per month for each covered child.

Breast & Cervical Cancer Screening Program (BCCSP)
In order to be eligible for BCCSP, women need to earn 250% or less than the Federal Poverty Level.  The program provides coverage to women in need of cancer screening services with services covered including breast examinations, mammograms and pap tests.  There is no monthly premium for these early detection measures.

Indian Health Services (IHS)
In Tennessee, there is an IHS office in Nashville which provides a service to American Indians originating from Southern and Eastern parts of the country.  Anyone of Indian descent or any woman who is pregnant with the child of an eligible Indian, may be eligible to receive health coverage through IHS.  Depending on circumstances, there may be a minimal portion to pay towards health care costs or no monthly cost at all.

Medicare and the Medicare Prescription Drug Program
Medicare consists of several parts (A, B, C, D) which offer various coverage options depending on the needs and eligibility of an individual.  Available to individuals who are aged 65 or over or those that have a disability or end-stage renal disease, Medicare coverage benefits include dental, prescription and vision services.

Health Coverage Tax Credit
Covering services such as inpatient and outpatient care, doctor visits, preventive and major medical care and durable medical equipment, the Health Coverage Tax Credit helps trade-dislocated workers to enjoy health benefits.

VA Medical Benefits Package
The VA Medical Benefits Package offers preventive and primary care to veterans, including those with pre-existing conditions.  Medical coverage is offered to those who have served in any branch of the U.S. armed forces and were honorably discharged.  To qualify for comprehensive coverage, the veteran must have served at least 24 months of consecutive service.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance program helps to connect individuals with 475 programs which helps them in meeting the cost of prescription medications.  Those who lack prescription coverage may be able to find benefits through the Partnership for Prescription Assistance program.

Women-Infants-Children (WIC)
Run by the USDA Food and Nutrition Service, WIC aims to improve the overall health of women, infants and children who earn a low income.  The program provides breastfeeding support to mothers and nutritional assistance to children up to five years of age. Immunization benefits can also be obtained through the WIC program.  Costs associated with participation are either free or minimal, depending on the earnings of the covered pregnant woman or new mother.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a government service which connects people with volunteers who have a working knowledge of health services and treatments available to those who suffer with mental illness.  Anyone looking for resources and assistance regarding mental health can use the NAMI helpline, including family members of those dealing with mental illness.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA introduced more stringent regulations for private health insurance providers to follow in addition to regulations already in place for the handling and use of private medical data.  This is a significant development for the health care status of the United States, but it is not a foolproof piece of legislation.
Continuation coverage is available through HIPAA once COBRA coverage has been exhausted.  In addition, HIPAA regulates how insurance companies can deal with pre-existing medical conditions depending on the plan type.