Insurance Questions? We Have Straight Answers.
Insurance is confusing — and that's by design. We're changing that. Here are honest, plain-English answers to the questions our clients ask most.
What Tennesseans Ask Us Most
No — Tennessee is one of ten states that did not expand Medicaid under the ACA. TennCare primarily covers pregnant women, children, seniors, and adults with disabilities. Working adults earning below the federal poverty line typically don't qualify for either TennCare or standard ACA subsidies, creating Tennessee's well-known 'coverage gap.' We specialize in finding short-term, off-marketplace, and hospital-indemnity options that protect households stuck in this gap.
TennCare eligibility in Tennessee is income- and category-based. Pregnant women up to 195% of FPL, children up to 252% of FPL (through CoverKids), parents/caretakers with low income, and adults with qualifying disabilities are the primary categories. Childless adults rarely qualify regardless of income. Our advisors will run your household through the TennCare and CoverKids screening before recommending any private plan.
It depends entirely on your county, your doctors, and your medications. BlueCross BlueShield of Tennessee has the broadest network footprint, especially in Middle Tennessee and East Tennessee. Ambetter (Centene/Celtic) is often the cheapest premium in Memphis and parts of West TN. Oscar focuses on Nashville and a few urban markets with strong telehealth features. We pull live quotes from all three and check your providers against each network.
ACA subsidies are based on projected annual household income. For variable-income Tennesseans — musicians, session players, 1099 contractors — we work from your last two years of Schedule C plus current-year estimates. If you under-estimate, you may owe back at tax time. If you over-estimate, you'll get the difference back. Many Nashville creatives miss subsidies entirely because they assume they won't qualify. Most do.
Rural Tennessee counties typically have 2–4 carriers active on the marketplace, with BCBS Tennessee usually offering the widest network including regional hospitals like Vanderbilt Tullahoma-Harton, Jackson-Madison County, and Erlanger Bledsoe. Network adequacy is a real issue in some Appalachian counties — we'll tell you honestly which networks include the nearest hospital and primary care.
Tennessee follows the federal Open Enrollment window: November 1 to January 15 for coverage beginning the following year. Outside that window, you need a qualifying life event to trigger a 60-day Special Enrollment Period: losing TennCare or employer coverage, moving to a new TN county, marriage, divorce, birth or adoption, becoming a citizen, or aging off a parent's plan at 26.
Yes. CoverKids is Tennessee's CHIP program and covers children up to age 19 in households earning up to 252% of the federal poverty level — even when the parents earn too much for TennCare. For a family of four, that's roughly $78,000 in annual income. CoverKids is no-cost or low-cost and covers doctor visits, prescriptions, dental, vision, and hospital care. We routinely build household coverage plans where the kids go on CoverKids and the parents pick an ACA marketplace plan.