Tennessee Health Insurance Marketplace
Tennessee is one of 36 federally-facilitated health insurance exchanges that opened in October 2013. As health insurance companies previously made coverage more expensive or unattainable for many residents, the marketplace plans are a great addition to the Tennessee market. Under the Affordable Care Act, all Tennesseans can obtain coverage for a reduced rate. Through this federal law, each state was able to set up a marketplace for insurers to sell robust health plans with the potential for financial assistance. As everyone is required to have a health insurance policy under the ACA, the exchange helps connect people with coverage, and makes sure they can afford it with subsidies.
Through tax credits for premiums and cost sharing, those who shop the marketplace can lower their coverage costs substantially. Many individuals applying for health plans on the Tennessee exchange are eligible for reduced rates and medical expenses, including residents who earn between 100 percent FPL up to 400 percent FPL. In addition to price breaks, the exchange offers a guarantee of covered services in each of the ten categories of essential health benefits. This includes services such as maternity care, prescription drugs, mental health services, and emergency care. Plans are offered by various Tennessee insurers.
The marketplace is an innovative solution for individuals and families as well as small businesses to obtain strong coverage at an affordable cost. For help and guidance with costs and coverage options, contact a licensed agent at 888 803 5917.
Each plan sold through Tennessee for individuals falls under one of four “metallic” coverage tiers: bronze, silver, gold or platinum. These levels indicate how much your plan covers for qualified medical services and how much cost sharing you are responsible for. Bronze and silver plans are also more reasonable in terms of monthly premiums, while gold and platinum plans tend to be higher as they offer more coverage.
Premium Tax Credit
The health insurance marketplace offers financial assistance to those who earn between 100 and 400 percent of poverty. The lower your income, the greater your subsidy amount will be. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Marketplace applicants earning between 100 and 250 percent of FPL also are eligible for a cost sharing tax credit to help pay for coinsurance, copays and deductibles.
Subsidies are calculated by income and household size, and the percentage of annual income the second lowest-cost silver plan in your region would consume. The table below outlines the maximum amount of a mid-level premium you’ll pay as a percentage of income. If you qualify for a tax credit, it will pay the remaining portion of your premium.
The exchange is served by only four insurers throughout the entire state. Plan availability varies based on location, including PPO and HMO policies with smaller networks than these companies offer outside of the marketplace. One of the ways insurers can afford to sell reasonably priced coverage on the exchange is to reduce the size of provider networks, but still cover a wide range of services. If you find that a fair compromise, you will appreciate your future plan from one of the following Tennessee health insurers.
- BlueCross BlueShield of Tennessee
- Cigna Health and Life Insurance Company
- Community Health Alliance
- Humana Insurance Co.
To make the process of shopping for coverage easier, Tennessee exchange plans all offer a basic set of benefits. While specific costs and services may vary between insurers, under the ACA, each qualified health plan must cover ten categories of services called essential health benefits. Some services, such as prevention, can be obtained at no cost to you, while others are subject to deductibles, coinsurance or a copay.
The ten categories of covered services include:
- Prescription drugs
- Preventive, wellness, and chronic disease management services
- Maternity and newborn care
- Office visits
- Pediatric care, including dental and vision
- Mental health and substance abuse services, including behavioral health care
- Emergency care
- Laboratory tests
- Rehabilitative and habilitative services and devices
Small Business Health Options Program
While the above information mostly applies to individual and family coverage, the Small Business Health Options Program (SHOP) is another equally important part of the exchange. Small business owners across the state can insure their workers for less than plans the traditional small group market if they qualify for a subsidy. The Small Business Health Care Tax Credit is optimal for very small businesses, but if you have up to 49 workers you may qualify for a SHOP plan, and up to 25 employees qualifies you for a subsidy. To qualify, you must have 25 or fewer full-time equivalent employees (at least 30 hours per week) who earn $50,000 per year or less each. The largest tax credit an employer can receive covers half of their premium contribution, which is given to companies with 10 or fewer workers with annual income up to $25,000 each.
How to Apply
You can apply for marketplace plans on the federal website at HealthCare.gov, in person with a certified application counselor at facilities throughout the state, or through a licensed insurance agent at 888.803.5917. East Coast Health Insurance is not only licensed to sell non-marketplace individual health plans throughout the state, but our agents have also been certified to enroll Tennesseans in subsidized marketplace policies. Regardless of how you apply, it is important to know your options for affordable coverage and get connected to a good policy from a reliable carrier.
Compare Tennessee Marketplace Plans
Below is a cost comparison tool designed to give you an idea of what to expect on the exchange in your area. These rates are estimates based on the averages released by Tennessee insurers on the exchange. This tool does not provide an option to purchase plans. For a more accurate idea of coverage costs and subsidy eligibility, or to sign up for a plan in your area, call a licensed agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.