Tennessee Has Not Accepted Federal Medicaid Expansion
- 1,675,954 Number of Tennesseeans covered by Medicaid/CHIP as of November 2021
- 339,000 Number of additional Tennessee residents who would be covered if the state accepted expansion
- 118,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
- $2.1 billion Federal money Tennessee is leaving on the table in 2022 by not expanding Medicaid
Medicaid Coverage And Eligibility
Medicaid is also a government-sponsored healthcare program that provides inpatient and outpatient services to patients, but unlike Medicare, it is also run on the state level. Residents of Tennessee may recognize it as TennCare.
Medicaid is issued to residents of each individual state on a needs basis. If a person meets a certain income level and overall asset value, they may be eligible to receive Medicaid. Being a recipient of Medicare does not prevent a person from receiving Medicaid benefits and vice versa, and many people are eligible to receive both.
Unlike Medicare, Medicaid is very broad in its coverage of health-related expenses. Doctor and hospital visits are mostly paid for by Medicaid, leaving the patient responsible for a small co-payment. Many prescription drugs are also included in Medicaids coverage as well.
Medicaid Covers Us In Tennessee
Medicaid is a vital health insurance plan that helps Tennesseans stay healthy, go to work and care for their families. Read and watch the stories below to hear from Tennesseans across the state who are able to use TennCare/Medicaid to access the health coverage they need, as well as from Tennesseans who are unable to get the care they need because they dont currently qualify for Medicaid coverage. You can also watch updated videos from storytellers about how important Medicaid is during the COVID-19 pandemic.
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How Do I Know If I Should Be Dual Eligible
Beneficiaries can find out if theyre eligible for Medicaid by contacting their Medicaid office. An Internet search for Medicaid offices in a beneficiarys state should provide the number to call but beneficiaries should make sure they are contacting a government office before sharing any personal information.
The Centers for Medicare and Medicaid Services also maintains a list of state agencies that oversee Medicaid. Beneficiaries can see if they already have Medicaid by contacting 1-800-MEDICARE and asking whether they receive Extra Help with their prescription drug costs .
Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
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Dual Special Needs Plans
Tennesseans on a UnitedHealthcare Dual Special Needs Plan get many extra benefits beyond those you get with either Original Medicare or Tennessee Medicaid.
OTC+Healthy Food monthly credits on a prepaid card for OTC products and covered groceries in-store or online
Prescription drug coverage $0 copay on covered generic and brand-name prescriptions including home delivery
Dental coverage A given amount for covered types of preventive and comprehensive dental services
How Do I Enroll In Medicaid In Tennessee
If you are eligible for Medicaid in Tennessee, you can enroll in several ways. Applications are available online through the self-service portal that allows you to create an account, apply for benefits, check your status and report changes.
Collect all your documents and information before starting the online application. You will be prompted to give the following:
- Current address, phone number and email address
- Social security number and dates of birth for everyone applying
- Income from jobs and other work sources
- Citizenship and immigration status
- The value of your vehicles and property
- Other health insurance and medical coverage information
If you need help with your application, or if you prefer to apply by phone, Medicaid offices in Tennessee can be reached at 259-0701.
In-person assistance is available at any Department of Human Services office in Tennessee. More than 350 trained staffers can help you apply and answer any questions for you. Applicants can also get help by logging onto an online private group or by calling 475-7879.
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Tennessee Receives Cms Approval For Block Grant Medicaid Funding
In January 2021, just days before the end of President Trumps presidency, CMS announced that Tennessees Medicaid block grant waiver proposal had been approved. The waiver approval, which is valid for ten years , will allow Tennessee to be the first state in the nation that utilizes a block grant approach to federal Medicaid funding, although Puerto Rico has long used a block grant funding model for Medicaid, which has led to significant funding shortfalls in the territorys Medicaid program.
The Biden administration may make changes to the approved waiver, but they would have to go through a review process. Its noteworthy that law professor Nicholas Bagley pointed out in 2019 that Tennessees proposal was likely not legal under the existing rules for Medicaid and the constraints of what can and cant be changed with 1115 waivers.
In May 2019, Tennessee Governor Bill Lee signed H.B.1280 into law. The legislation directed the state to seek federal permission to convert the states current federal Medicaid matching funds into a block grant, indexed for inflation and population growth. The Trump administration had expressed willingness to consider such proposals, but Tennessee was the first state in the nation to enact legislation to get the ball rolling on it .
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Medicaid Eligibility In Tennessee
To date, the US government Medicaid program provides free or affordable healthcare coverage to more than 60 million citizens and immigrants nationwide. The Medicaid program was designed to help low-income families and individuals obtain affordable healthcare coverage. Funded both by the state and federal government, each city has their own set of guidelines for eligibility. If you or your family are looking to apply for affordable health benefits, continue reading for state-specific information for Tennessee.
The state of Tennessee offers Medicaid benefits to its residents. Known as TennCare, the state provides opportunities for eligible applicants to receive vital medical services that can include emergency or intensive care, dental care, lab work, eye care, doctors visits, and more.
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Vision Dental And Hearing Care
Make sure sight, teeth and hearing are the best they can be. Benefits include:
Vision: Covered with limits, not covered for pregnant women age 19 and older
For children under age 19, vision services are limited to:
- 1 vision exam per calendar year
- 1 set of lenses per calendar year
- 1 set of eyeglass frames every 2 calendar years
For pregnant women age 19 and older, vision services are limited to:
- Medical evaluation and management of abnormal conditions and disorders of the eye
- The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered
Dental: For children under age 19 only, not covered for pregnant women age 19 and older
Hearing: Annual hearing screening, hearing aids are limited to 1 per ear per calendar year up to age 5, then 1 per ear every 2 years thereafter
The Parts Of Medicare
Medicare is split into four distinct plans, with each providing different amounts and aspects of coverage.
Part A, also known as hospital insurance, pays for overnight hospitalization and most other fees that may be incurred during the course of treatment. Part A often comes into play when a patient requires surgery or must be admitted to the hospital following an accident or serious illness. Part A is provided at no extra cost to anyone who is eligible for Medicare.
Part B, also known as medical insurance, is an optional form of coverage that pays for routine outpatient treatment, such as x-rays, laboratory work, immunizations, and emergency care. Part B also provides coverage for medical equipment that patients might require, including wheelchairs, oxygen tanks, and prosthetics. Patients who enroll in Part B will be required to pay a separate monthly premium to receive benefits.
Part C is known as Medicare Advantage and is a combination of Parts A and B. It also has the flexibility to allow patients to enroll in Part D as well. Medicare Advantage has a lower monthly premium than other plans, but co-payments after receiving treatment are typically higher.
On the other side of the coin, is Medicaid.
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See Why Tennesseans Choose Unitedhealthcare
Whatever plan you choose, UnitedHealthcare will help you get the care you need.
- Large variety of network providers
- Low- or no-cost prescription drugs
- Well visits, routine shots
Its your health. Its your choice.
Everyone deserves affordable health care, including you.
Working adults, people with disabilities, pregnant women, and children who qualify for Medicaid should check out UnitedHealthcare Community Plan.
We have the Medicaid benefits and extras that can make a real difference in your life. All at no cost to you.
- Preventive checkups, shots and lab tests
- Routine shots that help protect against illness
- Transportation to and from doctor appointments for adults
- 24/7 NurseLine to answer your health questions
Sometimes, you might need a little extra help. Get extras not covered by Medicaid.
- Earn rewards for keeping you and your baby healthy
- Coaches, supplies and medications to help you quit using tobacco
- Earn gift cards for getting preventive services
- Support and treatment to reach a healthy weight
We also offer resources to help you make the most of your plan. Including:
- Mental health services
Visit tn dot gov slash tenncare for more information.
Helping you live a healthier life.
We are here for you, Tennessee
Remember to choose UnitedHealthcare Community Plan.
And get the Plan that gets you more.
To learn more about UnitedHealthcare Community Plan, visit UHCCommunityPlan.com forward slash TN.
What Does Tenncare Cover
If you qualify, TennCare usually covers:
- Medicare Part B premiums, deductibles, and coinsurance
- Inpatient hospital services with limitations and deductibles
- Outpatient hospital and rural health clinic services
- Nursing home care
- Long-term care alternatives, such as personal care services
- X-ray and lab services
- Medical supplies and equipment in limited situations
- Physical therapy and
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Is Medicare The Same Thing As Medicaid
Medicaid is designed for people that fall into a certain income bracket while Medicare is for people over the age of 65 or for those that have been on disability for two years, explains Grant Dodge, a broker at Health Benefits Associates Inc., in Reno, Nevada.
Medicaid doesnt have an age requirement, so adults of all ages and dependent children can enroll. In 2021, there were 75.4 million people covered with Medicaid. Medicaid plans are administered by the states but funded jointly by the state and federal government. Medicare is a federal program managed by the United States Centers for Medicare and Medicaid Services . The U.S. Social Security Administration handles Medicare enrollment and premium payments. It has an age requirement unless youve been on disability for 24 months or have specific medical conditions. Once you have both parts of Medicare from the federal government , you can sign up for additional coverage with private insurance carriers to fill in the gaps of Medicare, explains Dodge.
Having Both Medicare And Medicaid
If you meet the income eligibility requirements for TennCare and are also over the age of 65 or diagnosed with either ALS or ESRD, you can have both Medicare and Medicaid. This means that you can qualify for a dual-eligible Medicare Advantage plan and make the most of your available benefits. To get help selecting a dual eligible plan, contact our partners at Medicare Plan Finder. They can send a licensed agent to your home to help you select a plan from the hundreds of options available in Tennessee, with no bias and no purchase required.
*This post was originally published on December 5, 2013, by Ashley McNurlan, and updated on November 21, 2018, by Anastasia Iliou.
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Tennessee Medicaid: What Seniors Should Know About
- TennCare is Tennesseeâs Medicaid program . TennCareâs goal is to pay medical bills for people who cannot afford to pay their own. TennCare covers about 20% of the Tennessee population, which includes 1.4 million people with a 12 million dollar budget.
What Is The Difference Between Medicare And Medicaid
Medicare is a federal medical benefits program paid for by the Social Security system. Medicare is primarily for the elderly but covers some disabled people. Medicare is not means-tested and is available for all seniors, regardless of their income or assets. People on Medicare usually pay premiums and copays just like people on private insurance.
Medicaid is a public assistance program for poor adults and children. Medicaid is a means-tested program, meaning you must have low income and few assets to qualify.
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Can I Select An Insurance Plan For My Medicare And Medicaid Benefits
If you are dual eligible, you are can enroll in a dual eligible special needs plan that covers both Medicare and Medicaid benefits. These plans may also pay for expenses that Medicare and Medicaid dont over individually, including over-the-counter items, hearing aids, and vision or dental care.
Read more about the Medicaid benefits available to Medicare enrollees.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including at Sachs Policy Group, where he worked with insurer, hospital and technology clients.
Income Requirements For Tennessee Medicaid
Income requirements differ based on your needs. These are the 2018 requirements for senior groups :
If your monthly income and assets are at or below the following limits either before or after health expenses, you may qualify:
- Family of 1 $241 income, $2,000 assets
- Family of 2 $258 income, $3,000 assets
- Family of 3 $317 income
- Family of 4 $325 income
Those who are disabled and receive social security supplemental income qualify with the following monthly income and asset limits:
- Family of 1 $750 income, $2,000 assets
- Family of 2 $1,125 income, $3,000 assets
If you require nursing facility care or if you receive home and community-based services, you may qualify with the following monthly income and asset limits:
- $2,205 income, $2,000 assets
Women who have been screened through an approved Breast and Cervical Cancer Early Detection Program and require treatment can receive TennCare coverage if financially necessary. To qualify, you cannot have Medicare or another form of insurance that covers breast and cervical cancer treatment and you must be below 250% of the federal poverty level.
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How Much Does Medicare Cost In Tennessee
Eligible beneficiaries in Tennessee receive coverage through Medicare Part A at no cost if they have met eligibility requirements. If you dont meet requirements, then you will need to buy Part A at a cost of $422 per month if you paid Medicare taxes for less than 30 quarters. If you paid Medicare taxes for 30-39 quarters, then the standard premium will be $232.
The standard Part B premium amount is $134 but could be higher depending on a beneficiaries income. Part B deductible and coinsurance is $183 per year. After a deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services , outpatient therapy, and durable medical equipment.
Medicare Part C, also known as Medicare Advantage, offers a different way to receive Medicare Part A and Part B benefits. Private Medicare providers cover required services and oftentimes offer enhanced coverage in exchange for a beneficiary paying a premium for the added coverage.
Part D coverage pays for prescription drugs and is also offered by Tennessee Medicare-approved insurance providers at an additional premium.
Part C and Part D coverage will vary by location and provider and will also be based in part on the level of coverage. Higher income consumers may pay more in premiums as well.
For more details on Medicare costs for 2018, go here.
Gop Lawmakers Wanted To Use Tanf Money To Impose Work Requirement
H.B.1551 was amended by the House in March 2018, adding a section to the bill to require the state to also seek federal approval to use TANF funding or other federal funding to implement the work requirement. The state initially estimated that implementing the work requirement would cost more than $18 million per year in state funds, and Republican lawmakers wanted to use TANF money designated to provide assistance to very low-income families to cover the cost of imposing a work requirement that was designed to strip health coverage away from several thousand impoverished Tennessee residents.
Lawmakers noted in 2018 that TANF had $400 million in reserves in Tennessee, but one analysis clarifies that the surplus is due to the paltry level of support that TANF provides in Tennessee: a maximum of $185/month in benefits for a family of three.
H.B.1551 passed in the Tennessee House in March, on a 72-23 party-line vote. The text of the amended legislation that passed in the House clarifies that if the federal government does not approve the use of TANF funding to implement the work requirement, the state wont move forward with seeking a waiver to impose a Medicaid work requirement.
House Democrats tried in vain to add several other amendments to the bill, including:
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