Medicaid Eligibility in Tennessee

Calendar Icon Updated February 11, 2019
Medicaid

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, doctor’s visits, and  more.

Tennessee’s Requirements for Medicaid Qualification

To qualify for TennCare, applicants need to meet eligibility  requirements that have been set forth both by the state and the federal  government. Factors that play a role in eligibility include income,  health, household size, and age. There are certain groups of applicants  that tend to qualify for TennCare Medicaid. This includes:

  • Children 21 years of age or younger
  • Expectant mothers
  • Parents, guardians, or caretaker of a child
  • Women suffering from breast or ovarian cancer
  • Individuals receiving social security benefits
  • Someone who needs long-term care
  • A senior living in a nursing home with income less than $2,205 a month
  • Interested parties can apply for TennCare anytime.

How to Apply for Medicaid in in Tennessee

Residents of the state of Tennessee can apply for TennCare by visiting www.healthcare.gov or by calling 1-800-318-2596.

Interested parties who prefer to apply by mail can visit the Division of TennCare website and download a paper application in English or Spanish.

If you need assistance with applying for TennCare Medicaid, you can get help in one of three ways:

1.  Visit your local DHS office and ask the staff for assistance.

2.  You can opt to get help from a private group by visiting https://localhelp.healthcare.gov/.

3.  You can also apply for benefits by phone with a Healthcare  Marketplace customer service representative that will walk you through  the entire process.

For those with a disability, you can request someone come to your  home to assist you with the application in person. Contact your local  Agency on Aging and Disability by contacting 1-866-6678.

Tennessee Medicaid Application

To complete the application process, you will need to gather information that includes:

  • Social security numbers and/or immigrant status documents
  • Proof of income for all household earners (pay stubs, W2, or tax returns)
  • Policy information for existing healthcare coverage
  • Information on employer-offered insurance (if applicable)

The completed application is then processed, and a determination letter should be provided to you within 1-2 weeks.

What Does Medicaid Cover in Tennessee?

TennCare has many benefits packages that eligible applicants are able  to choose from. Applicants will receive a benefit indicator or number  on their card labeled A-M. This letter explains what benefits are  covered by TennCare. You can learn more about benefit coverages here, however, potential coverage options include:

  • Mental health services
  • Chiropractic services
  • Nursing home care
  • Dental services
  • Emergency care and ambulance services
  • Home health services
  • Hospice care
  • In or outpatient substance rehab
  • Lab work
  • Medical supplies
  • Occupational therapy
  • Organ transplant/donor
  • Outpatient hospital services
  • Prescriptions
  • Vision services

Income Requirements for Tennessee Medicaid

Every eligible applicant must meet the state’s income limit  requirements to be approved for TennCare. Below, is a brief breakdown of  income limits based on groups of individuals.

Children age 0-19 – low-income families of children age 0-19  has an income limit of 195% of the Federal poverty level. There are  different income limit requirements for children over the age of 19 who  aren’t insured, those who are medically needy, and children who have  illnesses or medical problems that prevent them from being insured other  places.

Families – Parents or caretakers of children that fall into  the above-mentioned categories are eligible for TennCare if they have  monthly income as follows $1,018 (1 member), $1,329 (2 members), $1,611  (3 members), $1,867 (4 members), $2,102 (5 members), $2,320 (6 members),  or $2,524 (7 members)

Women – Women who are expecting must have income that is 195%  below poverty level. Women who are suffering from breast or ovarian  cancer will need an income limit that falls 211% below poverty level.

Aged, Blind, or Disabled – There are separate income limit  requirements for these categories. Seniors receiving SSI or disabled  must fall within these limits: $735 per month (1), $1,103(2). Those who  require long-term care must have a monthly income of $2,205 or less.

How Much Does Medicaid Cost in Tennessee?

The costs of Medicaid in Tennessee will depend greatly upon your  income. Those who come from low-income or no-income households won’t be  required to pay anything towards the premium, nor will they have copays  or out-of-pocket prescription costs.

However, those who make more money may be required to pay for a  portion of the premium and/or copays and prescription costs. For  instance, a single adult with no dependents and low-income may be  required to pay an average of $10 – $30 copay for their medical visits  and services.

Prescription Drugs with Medicaid in Tennessee?

Prescription costs are covered for TennCare policyholders.  Prescriptions can be filled for free or at a very low cost. You can find  a list of preferred and covered medications by clicking here.

Which Medicaid plan is best in Tennessee?

Tennessee has several Managed Care Organizations or healthcare plans  to choose from. Some include AmeriGroup, Blue Care, United Healthcare,  and TennCare Select. You will need to review each option to determine  which provides the best coverage for your medical needs.

To learn more about TennCare, visit https://www.tn.gov/tenncare.

Eligibility Team

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