Tennessee is one of the most influential Southern states in our country for music, culture, politics, and industry. Home of both Memphis and Nashville, its cities have produced many famous musicians, recording studios, and broadcasting networks, as well as major corporations. Tennessee is also populated by the most caves in the nation, and its landscape is intersected by the Appalachian, Smoky, and Blue Ridge Mountain ranges, making the state a prime location for outdoor activities and tourism.
Residents of Tennessee have access to several health insurance companies for individual and family coverage, including Aetna, Blue Cross Blue Shield of Tennessee, Celtic, Cigna, Humana, IHC Group, and UnitedHealthOne. For more information on these plans and pricing details for your specific region,enter your zip code below and get a quote. If you require further assistance with selecting a plan or have any questions about health insurance, please call us at 888 803 5917.
The residents of Tennessee are improving in health according to an annual survey from the UnitedHealth Foundation, which placed them at 39th in the country. While the state has never been exceedingly healthy, it has received the most positive outcome in 2011 from the past ten years. Smoking has decreased among the population, now just over 20 percent of all adults continue to smoke in Tennessee. There is also a high level of immunization coverage in the state, and the least amount of binge drinking in the country.
The number of obese adults has grown to 31.7 percent, affecting more than 1.5 million individuals in Tennessee. Diabetes is also an increasing issue in the state, now over 11 percent of all adults have the illness. Health insurance is also in need among Tennesseans, as it has a fairly large uninsured population at 15 percent of all individuals. The state is seeing some of the best health statistics it has seen in a long time, and it is essential to stay healthy and treat necessary conditions in order to continue experiencing an improvement. Look into public programs if health insurance is too costly, and get a health plan if you are able to afford it.
Health Insurance Plans
- PPO plans give you access to Aetna’s preferred network of providers, as well as the freedom of using non-network providers. Plans come in deductibles of $1,500, $2,500, $5,000, and $7,500 (with an unlimited number of doctors office visits and dental coverage) for individuals in-network. Value plans have deductible of $5,000 or $10,000, and offer the most affordable premium rates in exchange for higher cost sharing. For most medical services, you will pay a percentage of coinsurance which varies based on the type of care. Office visits with a primary care or specialist physician and prescription drugs are covered for a copay before meeting the deductible.
- PPO High Deductible plans are available with either a $3,000 or $5,000 annual deductible for individuals (double for families), and the capability to open a health savings account. Using funds from a health savings account helps you gain a better sense of control over your medical bills, and also give you tax advantages. These plans have a high level of coverage, with just about every type of medical service available for no cost after you have met the deductible. Preventive care such as immunizations, well-child care and physical exams can be obtained at any time after your plan starts, covered in full with network providers.
- Preventive and Hospital Care plans cover a limited number of benefits for those who do not need a large amount to choose from right away. For a deductible of $3,000 for individuals and $6,000 for families, you can receive in-network preventive services as soon as your plan starts for no cost. After the deductible is met, you have access to a handful of major medical services, such as inpatient hospitalization, outpatient surgery, home health care and skilled nursing for 20% coinsurance. These plans are also HSA-compatible for use with a tax-advantaged savings fund.
Blue Cross Blue Shield of Tennesssee
- PersonalBlue plans are traditional PPOs, offering individual and family coverage for deductibles ranging from $1,000 to $7,500. These plans give members the option of using in-network or out-of-network medical care, though the network will provide immediate benefits and discounts. Office visits and prescription drugs are available as soon as your plan begins for a copay, and you can choose your level of cost sharing. These plans also give the option of additional benefits including maternity, dental, or life.
- High Deductible Health Plans through Blue Cross Blue Shield of Tennessee are qualified for use with a health savings account (HSA), and offer low monthly premiums. These plans provide comprehensive coverage on hospital and physician care with 100% coverage after you meet the deductible on all covered services. Tax-advantaged funds help individuals meet their deductible sooner or save for the future.
- CeltiCare Preferred plans are PPOs with deductible options of $2,500 or $5,000 for individuals, and cover in-network services at 80 percent after you meet the deductible. Covered care includes emergency room visits and various hospital services. Before you meet your deductible, the first two doctor’s office visits have a $15 copay, and generic prescriptions have a $10 copay. Preferred plan members also qualify for value-added benefits for participating in healthy lifestyle programs, as well as quitting smoking.
- Celtic Basic plans also connect you to the Celtic Physician & Hospital PPO network with either 30 or 20 percent coinsurance after meeting the deductible. Basic plans offer generic only coverage for a $15 copay with the deductible waived. Physician’s visits are $30 for the first two visits (before deductible) and subject to coinsurance afterwards. Preventive care is covered in full when using in-network providers as soon as your plan starts.
- CelticSaver HSA plans have two different coverage options, including a $2,600 deductible with 80 percent coverage after deductible, or $5,000 with 100 percent coverage after deductible. Both plans offer doctor’s office visits, diagnostic services, prescriptions, and hospital care at the selected coinsurance level after deductible. These plans have the capacity to connect a health savings account to help pay for qualified medical costs and receive tax benefits.
- Open Access plans are available in many deductible options, with the option of 80 or 100 percent coverage after deductible. Open Access plans offer both major medical services after deductible for a low rate in-network, as well as immediate benefits for a copay. Covered services include surgery, inpatient stays, physician services, lab work, ultrasounds, physical therapy and more. Prescription drug coverage is also included with these plans, offering copayments and lowered rates for both home-delivery and retail pharmacy.
- Open Access Value plans have deductibles ranging from $1,500 to $10,000, and 70 percent coverage after you meet the deductible. Primary care and specialist office visits are offered as soon as your plan begins for many of these plans, though higher deductible options offer such services for a percentage of coinsurance after deductible. Preventive care is no cost in-network and includes immunizations, well-child care, screenings for cancer, and more. Services available once you have met the deductible include inpatient hospitalization, surgery, allergy testing, lab and X-ray, and diagnostic testing.
- Health Savings plans come in three deductible options: $1,500, $3,000 and $5,000 for individuals in-network. Each of these plans has an extensive level of coverage, offering all major medical services for no charge in network once you meet the deductible. Covered services include doctor’s office visits, specialist visits, lab work, short-term rehabilitative therapy, outpatient surgery, and inpatient stays. With your health savings account, you can save for future use, or pay for medical costs to meet your deductible.
- Copay plans from HumanaOne offer the convenience of using set prices for certain medical costs, such as doctor’s office visits and prescription drugs. These plans are available in Enhanced Copay 80 and Copay 80. Enhanced Copay 80 plans cover a larger number of doctors office visits and every tier or prescription drugs. Copay 80 plans offer the same 80 percent coverage after deductible, but have limited office visits and generic coverage only. Preventive care is covered in full from the day your plan starts with both plan types.
- HSA plans offer 100 percent coverage of your medical costs after deductible, and the option of using a health savings account with your plan. These plans are available in Enhanced HSA and HSA types in Tennessee, and cover all in-network services at no cost, and out-of-network services as well. Enhanced HSA plans have prescription drug coverage, while the HSA 100 plan does not, though a discount card is available. The only benefits offered before meeting your deductible are preventive care services which will cost nothing when using in-network providers.
- Freedom Choice plans offer the choice between 70 or 80 percent coverage for in-network services after you meet the deductible, which range from $1,500 to $20,000. All Freedom Choice plans have a $50 copay for office visits with a primary care doctor or specialist, and prescription coverage subject to a separate deductible. Once the deductible is met, you can receive coverage on hospital stays, chiropractic, surgery, outpatient services, emergency care and more.
- Freedom HDHP plans are eligible for use with a health savings account and come in a variety of high deductibles. Based on the deductible to select, your coinsurance will be either 20 percent or no cost for in-network care after deductible. Preventive care is available at no cost when using in-network providers as soon as your plan starts. Individual deductible options range from $2,000 to $10,000. All of these plans cover prescription drugs, and also give you the option of using out-of-network care.
- Copay plans from UnitedHealthOne are convenient and simple for individuals who want to pay a predictable rate for health care services. These plans are similar to group plans from an employer, but you have the freedom to choose in-network or out-of-network care because it is a PPO. As soon as your plan starts, you have the ability to receive preventive care such as cancer screenings, immunizations, well-child care and other exams for no cost. Prescription drugs are available for discounted prices, such as $15 for generics, and $30-40 for brand names through Copay 100 and 80 plans. Once you have met the deductible, you can receive more services through in or out-of-network providers, such as inpatient hospital stays, surgery, outpatient services and more.
- High Deductible plans are available in three types, including Plan 80, Saver 80 and Plan 100. Depending on your plan choice, 80 or 100 percent of your health care costs will be covered after deductible. Plan 100 is the most comprehensive coverage option, with more services available for no cost after you meet your deductible in exchange for higher premiums. Plan 100 and Plan 80 cover physician and specialist visits and prescriptions drugs, while the Saver plan does not, due to its low premiums. High deductible plans all cover preventive care at 100 percent before deductible.
- Health Savings Account plans offer 100 percent after deductible coverage on in-network major medical services. These plans also give members the choice of pairing their plan with an HSA. Monthly premiums are lower due to the high deductible, which can be met using funds from the health savings account. As soon as your plan begins, preventive care is available for no charge with in-network providers. Non-network care is also covered for a higher percentage of coinsurance. Covered services include most types of physician and hospital care, including office visits, testing, lab work, surgery, and inpatient stays.
Public Health Options
Tennessee has a variety of public health programs to serve its low-income and uninsured population. In addition to the state’s Medicaid program, TennCare, the state offers a high-risk pool for those with pre-existing conditions, as well as clinics and preventive care services like children’s immunizations and family planning. For a full outline of services offered through the state of Tennessee, visit the Department of Human Services.
- TennCare: medical insurance coverage for individuals and families with a low income in Tennessee. Pregnant women, elderly, blind, and disabled individuals also qualify for Medicaid coverage.
- Pre-Existing Condition Insurance Plan (PCIP): a temporary high-risk pool for individuals with medical conditions who have been uninsured for over six months and rejected for health coverage.
- CHIP: Children’s Health Insurance Program offered to all uninsured children under age 19 in Tennessee, regardless of health or income.
- Immunization Program: providing vaccines for preventable illnesses to children and adults of all ages in Tennessee.
Health Insurance Laws
The state of Tennessee has many laws currently in place that help health insurance companies to keep their business running smoothly, as well as provide protection for individuals with insurance. Pre-existing conditions are taken very seriously when underwriting in Tennessee, as there is no legal definition for such a medical condition. If the insurer decides you have a qualifying illness or have received treatment for one in any length of time prior to enrolling in a health plan, you are likely to be rejected for coverage.
If the insurance company accepts an individual with a pre-existing condition for a health plan, they will surely raise the premium rates, and they may also issue an exclusion period of up to 24 months. Insurers also have the right to permanently decide against paying for any treatment for the specified condition by pairing your plan with an elimination rider. This offers the possibility of high rejection for individual health insurance in Tennessee, though the state offers an alternative.
The Pre-Existing Condition Insurance Plan is helpful for many individuals who have been turned down by a health insurance company for individual coverage. PCIPs offer health insurance for rates similar to an individual policy for a healthy person, and have no exclusions for any types of care. The Affordable Care Act set up PCIPs as a means to an end with discrimination against people with illnesses and conditions in health insurance. In January 2014, these plans will no longer be available as all insurers will be required to offer unbiased coverage to people with conditions.
Guaranteed renewability is also an important part of state health insurance laws. It protects people who have insurance and makes sure they can keep their coverage by making it illegal for insurers to cancel a plan based on someone becoming sick after their plan’s start date. The same law also requires health insurance companies to ask their policy holders if they wish to renew the same benefits for another term before theirs expires. This helps to maintain continuous coverage and keep people who pay their bills properly insured.