The birthplace of rock 'n' roll is also home to the 43rd best health care in the nation. That number comes from a study by U.S. News based on quality, access, and public health.
Health insurance options in Tennessee
According to the TN Department of Commerce & Insurance, there are plenty of ways for residents to get health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Tennessee residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 47% | ||
| Individual or family | 6% | ||
| Medicaid | 21% | ||
| Medicare | 15% | ||
| Military | 2% | ||
| Uninsured | 10% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
10 percent of Tennessee residents have no insurance, a percent above the national average. That isn't a good sign for policyholders. The more uninsured people there are, the higher the costs are for insured people.
Tennessee health care insurance costs and rate factors
Tennessee residents spend an average of $7,372 per year on health care expenditures. That's a few hundred less than the national average. What influences your health care costs in Tennessee? Insurance companies price policies on factors that vary from person to person:
Health insurance plan type
The more coverage you want, the more you'll pay in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
So, how much should you expect to pay in Tennessee? These are the average monthly premiums for each plan type for a middle-aged TN resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $351 | $485 | $617 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
A gold plan in Tennessee will cost you almost twice the price of a bronze plan. This price jump is because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent.
The lowest coverage option is a catastrophic plan. You may qualify for if you're under 30 or have certain exemptions. These types of plans have low monthly premiums, but a yearly deductible of $8,150. That high deductible means you may save money with a bronze or silver plan if you need to use your insurance.
Body mass index
According to the CDC, a high body mass can lead to several health conditions. Insurance companies know this and analyze your BMI to assess your risk-level. A high BMI often leads to higher monthly premiums.
In 2018, Tennessee had a 34.4 percent obesity rate, the 12th highest in the country. Of the TN residents who used QuoteWizard to compare health insurance plans, 36 percent have an obese BMI.
Tobacco Use
It's no surprise that smoking causes many diseases and reduces your health. That's why you'll pay more for health insurance as a smoker. About 22.6 percent of Tennessee residents are smokers, the fourth highest rate in the country.
Age
According to HealthCare.gov, older people pay up to three times more for health insurance than younger people. Tennesseans who used QuoteWizard to shop for health insurance are, on average, 41 years old.
Location
One of the main factors in the cost of your health care plan is where you live. Different states have different laws, regulations, and providers surrounding their health care marketplace.
Many health insurance companies use community rating to price policies. That means that rates depend in part on the combined claims that everyone files. So, if your neighbor files a high number of insurance claims, your rates may jump.
Living in a health-conscious state could keep your premiums low. According to America's Health Rankings, TN is the 45th healthiest state in the country.
Tennessee health insurance companies
Where can you get health insurance in Tennessee? These are the top health insurance companies in the state:
- Oscar
- Cigna
- Bright Health
- Blue Cross Blue Shield of Tennessee
- Celtic/Ambetter
- UnitedHealthcare
These companies offer individual and family plans. Check company websites to find out how your zip code could affect your policy.
Tennessee health insurance laws
The Affordable Care Act limits what insurance companies can analyze while determining your rates.
- Pre-existing conditions: Health insurance companies used to look at pre-existing conditions when pricing your health plan. With the ACA, they aren't allowed to factor pre-existing conditions into your prices.
- Gender: A 2004 study stated that women historically pay more for health care. But the ACA mandates that insurance companies cannot charge men and women different prices for the same plan.
- Insurance and medical history: Insurance companies used to bump costs if you had lapses in insurance coverage or medical problems. With the ACA, insurers can't consider these factors
There are limits to how much you can pay out-of-pocket for marketplace plans. The 2018 out-of-pocket maximum is $7,350 for an individual plan and $14,700 for a family plan.
Tennessee state law requires that insurance companies provide at least some coverage for these services:
- Emergency services
- Autism spectrum disorders
- Hearing aids
- Newborn infant and hearing screenings
- Reconstructive breast surgery
- Supplies and services for diabetic patients
- Clinical trials
Medicare and Medicaid in Tennessee
Medicare and Medicaid are both government-funded health care programs. Medicare provides coverage for seniors, and Medicaid aids low-income families and children.
Medicare
Tennessee residents 65 and over qualify for Medicare. There are many options within the program, including parts A, B, C, D, and supplemental coverage plans. As a Tennessee resident, you may qualify for one of these Medicare Savings Programs with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid in Tennessee is called TennCare. These are the state's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,920 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Tennessee Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Julie Mix McPeak
- Insurance Hotline:
- 800-342-4029
- Office Hours:
- Monday - Friday
8:00 am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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