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TennCare, the primary Tennessee Medicaid plan, helps thousands of Tennesseans access medical services. This government-funded health insurance coverage primarily assists low-income individuals who are pregnant, currently support dependents, have a disability, or are senior adults. As of September 2023, 1,729,475 Tennesseans were enrolled in Medicaid.
Although TennCare covers most major health services and procedures, you need to know TennCare’s coverage limitations and eligibility requirements.
Medicaid is a federally funded, state-provided program that offers healthcare coverage to low-income or disabled individuals and families. If you qualify, you can receive coverage for doctor’s visits, certain prescription drug costs, medical procedures, dental exams, and more.
This guide will cover various Medicaid topics, including how to apply, eligibility requirements, and what services are offered. Once you know what TennCare covers and if you qualify, you might want to explore acquiring supplemental insurance coverage from a third-party provider. This extended coverage can help fill any coverage gaps in Tennessee Medicaid — or cover you if you don’t qualify for Medicaid — and give you peace of mind that high medical costs won’t catch you off guard. To prevent shouldering the debt of unexpected medical expenses, many Floridians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
TennCare is the state of Tennessee’s Medicaid program available to qualifying Tennessee residents. Eligible residents may access free or at a low cost, depending on their household incomes. Like most Medicaid programs, the federal government funds Tennessee’s Medicaid plans.
Some other commonly asked questions include:
The Tennessee Medicaid card identifies you as a person who qualifies for and can access the program’s benefits. Medicaid cards have a unique number ID printed on them. Once TennCare accepts your application, take your card with you to any Medicaid appointments. Your doctor will use that number to confirm your coverage and bill Medicaid for your care.
(Please note that the card image shown may differ from the one you receive depending on the carrier you choose.)
You can apply for TennCare using the following methods:
Applying for TennCare is a fairly straightforward process. Once TennCare officials receive your application, they may take up to 45 days to fully process it. You’ll receive a letter of approval or denial in the mail.
Who and what TennCare covers mostly depends on your current health condition and the number of dependants you care for. Unlike many other states, Tennessee restricts its eligibility to the following demographics of people:
Because of these restrictive requirements, you may not qualify for TennCare. You can seek coverage from other affordable third-party providers in the insurance marketplaces to supplement your Tennessee Medicaid coverage.
If TennCare administrators accept your application, they will mail an official acceptance letter to your address. The Tennessee Medicaid card will arrive in the same envelope as the acceptance letter. This card allows care providers to access pertinent details about your TennCare coverage and health history.
You must renew your TennCare coverage annually. TennCare associates will reexamine your income, family, or disability details to determine whether you still qualify for coverage. In many cases, your TennCare coverage will renew automatically if you still have dependent children or meet the other requirements.
Otherwise, you’ll receive a packet of renewal forms in the mail. These forms will contain information about your renewal date and coverage expiration date. Complete the packet before the date and mail the forms to TennCare Connect at:
TennCare Connect
P.O. Box 305240
Nashville, TN 37230-5240
You can also call 855-259-0701 to renew your coverage over the phone. Alternatively, book an appointment at your nearest DHS office to renew your coverage in person.
Who and what does TennCare cover? Many states provide the base level of coverage that the federal government requires. However, Tennessee Medicaid has expanded coverage options that affect what services the plan covers.
Previously, adult Medicaid enrollees had limited access to dental services. Without third-party coverage, they risked their overall oral health.
As of January 2023, all adults who qualify for TennCare can access various dental benefits. These comprehensive benefits include crowns, fillings, cleanings, and exams. People under the age of 21 can access dental benefits through the Children’s Health Insurance Program (CHIP) program.
While TennCare dental coverage is comprehensive, it will only cover up to $2000/year. For those requiring more trips to the dentist, investing in private dental plans in Tennessee is advisable.
TennCare covers up to two brand-name or five generic prescription medications per month for adults. These limits do not apply to children under the age of 21 or adults who receive long-term care and assistance. Eligible TennCare enrollees can access prescription assistance through the following programs:
Senior adults or individuals with certain health conditions who do not receive long-term support may benefit from supplemental coverage from a third-party provider. Marketplace plans can assist with purchasing medications exceeding Tennessee’s prescription limit.
TennCare provides extended benefits to individuals who need long-term services and support (LTSS). These services assist aging or disabled individuals who cannot perform essential daily tasks like getting dressed, eating, or bathing. Some LTSS programs include CHOICES and PACE.
The residents who qualify for these programs may use in-home or community-based options for their care program. If you live in a nursing home and earn less than $2,742 per month, you likely qualify for coverage through TennCare. You or your dependent might access additional state-supported resources to enhance your long-term care plan.
Also, TennCare will provide those eligible with service and equipment support should they become permanently or temporarily disabled. However the program does not provide financial assistance should the need arise. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
TennCare may cover out-of-state emergencies under the following circumstances:
However, TennCare does not cover non-emergency health services in a different state.
Different states have varying Medicaid coverage provisions and eligibility requirements. Therefore, you cannot intentionally travel for care and expect Tennessee Medicaid to cover the cost of the treatment. Most state governments keep their Medicaid programs specific to the state beyond emergencies.
This means you may not use Tennessee Medicaid outside of the United States of America. If you are traveling and want the peace of mind of knowing that any unexpected health costs will be covered, purchase a proper travel insurance plan in addition to TennCare coverage.
If you are a college student, you might wonder about your healthcare options. TennCare may cover your needs through your parents’ existing enrollment if you are 21 or younger. Once you age out of this coverage, you must meet Tennessee’s eligibility requirements to access Medicaid coverage as an adult.
Do your parents hold a policy from an independent or third-party provider? If so, you have coverage as a dependent under their plan until you turn 26.
If you attend college outside of Tennessee, you will need either institution-backed coverage or another third-party insurance option. TennCare only assists with emergency services in out-of-state situations. You cannot access regular check-ups and other non-emergency assistance with Medicaid coverage.
Senior adults over 65 years of age can access full TennCare coverage. You may also qualify for other Tennessee Medicaid programs, including:
Many states provide extended coverage options for certain subgroups. Residents may pair Medicaid coverage with another government-provided coverage to secure a broader range of healthcare options. Take a look at what Tennessee Medicaid covers for some subgroups.
Native Americans with qualified proof of tribal affiliation may qualify for TennCare assistance. This coverage applies to Native Americans born outside of the United States.
If you are a military veteran who qualifies for TennCare, you may use it along with your TriCare coverage. Most states design their Medicaid programs to cover any costs that TriCare won’t cover. Although the Tennessee state government doesn’t offer specific programs for veterans, the federal government’s Department of Veterans Affairs does.
If you are an active-duty military member or a veteran, make an appointment at your nearest state or veteran resource center to learn more about your options. An associate can inform you about how military or veteran benefits could work with eligible state benefits.
TennCare may restrict access to certain services or products, especially for people over the age of 21. Below, you’ll find some examples of services or products that your TennCare plan may not cover.
Tennessee Medicaid will not cover more than two brand-name prescriptions or five generic ones per month.
Most state Medicaid plans do not offer coverage beyond state borders.
TennCare does not cover braces or other orthodontic treatments unless you have a severe issue with your teeth that affects your ability to speak and eat.
If you have an injury or condition requiring a long-term stay at a rehabilitation facility, you need to fund these services without your TennCare coverage.
TennCare only covers medically necessary organ transplants and similar surgeries.
Even if you receive a prescription for an over-the-counter medication, you cannot use your Tennessee Medicaid to cover it.
TennCare limits covered eye health services to treatment of diagnosed conditions and diseases. Routine exams, prescription glasses, and other services require out-of-pocket payments or supplemental coverage.
Tennessee Medicaid will not fund items like diapers and therapeutic medical equipment. Since some exemptions apply, you should speak to a TennCare associate or your primary healthcare provider about any equipment or product benefits you may use.
Although TennCare offers much-needed assistance to many people, many low-income adults do not qualify if they don’t have a diagnosed disability or an eligible dependent. Qualifying adults may still not have coverage for certain health services at an affordable price. Affordable healthcare plans from third-party providers are great options in these cases to get the care and coverage you need.
Also, Tennessee Medicaid will only put forth a very small dollar amount towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
When you enroll in TennCare, what services can you access while using the coverage?
Remember, Medicaid programs may change yearly. Stay updated about the Tennessee Medicaid legislature to make informed healthcare decisions.
| Dental | |
|---|---|
| TennCare covers medically necessary dental services for children and adults. Those services include the following: | |
| Routine services | Access regular cleanings, exams, and other routine treatments. |
| Diagnostic services | Diagnostic services may include more extensive exams and X-rays. |
| Restorative treatments | Fillings and crowns can restore your teeth and prevent further issues. |
| Preventative services | Prevent infections or decay from spreading and causing pain with services such as tooth extractions. | You can review a full list of covered dental services. |
| Vision | Children 21 and younger can access most routine, diagnostic, and prescription services as long as they are medically necessary. Adults can access the following services: |
|---|---|
| Management and treatment of diagnosed abnormal conditions or diseases | You must have a qualified diagnosis for an eye issue to receive consistent eye care. Otherwise, TennCare does not cover most vision services. You might have to pay for the diagnostic services out of your pocket. |
| A single pair of glasses for cataract treatment following surgery | If you receive a diagnosis for cataracts, you can receive cataract treatments like surgery and one pair of prescription glasses. | Many adult residents who want access to affordable eye care must purchase a supplemental plan to afford additional routine services in Tennessee. The state’s Medicaid coverage does not assist with any diagnostic or routine eye services for adults. If you don’t hold a policy for vision insurance, you must purchase glasses, contacts, and other services at full price out-of-pocket. |
| Surgery | As a TennCare enrollee, you may qualify for the following surgical procedures if your doctor deems them medically necessary: |
|---|---|
| Bariatric surgery for weight loss | TennCare covers surgical procedures to help with weight loss if you have a qualifying medical condition. |
| Reconstructive breast surgery | If you underwent a mastectomy for breast cancer or a similar degenerative breast condition, you can rely on Tennessee Medicaid to reimburse reconstructive surgeries following the treatments. |
| Surgery to assist with malformed body parts, birth defects, or reconstruction following previous qualifying surgical procedures | While some states do not cover treatments for cosmetic deformities, TennCare may. Speak with your doctor about eligibility requirements. | Speak with your primary care physician to learn more about which surgical procedures fall under TennCare’s definition of medically necessary. Your Tennessee Medicaid plan should cover any associated inpatient stays and prescriptions. |
| Hospital | TennCare will cover emergency room visits and scheduled hospital appointments. Some covered services include the following that are medically necessary: |
|---|---|
| Outpatient hospital services | Yes, if medically necessary. |
| Inpatient hospital stays | Yes, if medically necessary. |
| Ambulance transportation | Yes, if medically necessary. |
| Transportation to non-emergency care appointments | Yes, if medically necessary. |
| Out-of-state emergencies | Yes, if medically necessary. | You can also schedule free non-emergency transportation within 72 hours of your scheduled appointment. |
TennCare will cover various mental and behavioral health services such as:
However, the overarching Medicaid plans do not cover some of these services. If you qualify for certain Medicare programs beyond TennCare, you may need assistance from an independent insurance provider to access much-needed mental and behavioral health treatments.
| Sexual Health | TennCare can assist you in your family planning efforts with comprehensive pregnancy and post-birth services. It can also help you protect yourself from various sexually transmitted infections. |
|---|---|
| Prenatal care | Yes |
| Postnatal care | Yes, up to a year following childbirth. |
| Childbirth | Yes, up to three epidurals. |
| Long-acting contraceptives | Yes |
| Oral contraceptives | Yes |
| STD prevention and treatment programs | Yes | TennCare does not count prescription contraceptives in your overall pharmaceutical limit. The program may cover the costs in full. You can still access two branded or five generic prescriptions beyond birth control medications. |
| Specialist Services | Under TennCare, you may access medical services from a variety of specialists. Such services may include the following: |
|---|---|
| Chiropractic treatment | Yes |
| Outpatient occupational and physical therapy | Yes |
| Psychiatric treatment | Yes |
| Speech therapy | Yes |
| Diagnostic services | Yes, such as lab work and X-rays. | Work with your primary care physician to determine if a specialist service is medically necessary. TennCare only covers medically necessary treatments and services. |
TennCare primarily covers the following low-income demographics:
Low-income adults without dependents or qualifying conditions may struggle to access the healthcare they need. Whether you have Medicaid coverage or not, you can find supplemental or full coverage from a third-party insurer through Insurdinary. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.We’ll help you compare affordable plans to extend your healthcare, including:
If you currently have TennCare, you can further improve your healthcare access with policies for vision health, prescription medications, and extended specialist services. While Tennessee Medicaid helps almost two million Tennessee residents, it still greatly limits who can access it and what they can access.
Access better options and comprehensive coverage through Insurdinary. We prioritize the most affordable premiums for your budget. Then, you can choose the best supplemental or inclusive packages.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
