Tennessee Health Insurance Rates – Compare Individual And Senior Plans

Health insurance rates in Tennessee are extremely affordable. Review individual or family medical coverage, and see which plans save you the most money, and provide the coverage you need most.  We  also calculate the federal subsidy that could reduce your prices and substantially lower your TN premium.  Regardless of your income, medical conditions or size of family, there are many low-cost policies that include comprehensive benefits. Typically, rates in the Volunteer State are among the lowest in the US. Medigap coverage is also widely available.

We help you compare the policies that give you the best medical coverage for the lowest cost, and apply and enroll for coverage. During Open Enrollment (which began November 1st for 2018 effective dates), you may qualify for financial assistance that reduces your premium by 60% or more. Any pre-existing conditions you have will be covered. It only takes about 20-25 minutes to enroll in an Exchange policy. Occasionally, your entire premium is paid by the subsidy.

Seniors can review Medicare Supplement and Advantage plan options. Medigap plans can potentially save thousands of dollars in out-of-pocket costs. A separate Open Enrollment period is used for applying or changing policies.  This OE period begins on October 15th and ends on December 7th. However, a 7-month window that surrounds your 65th birthday can also be used to choose supplemental coverage. Prescription drug coverage is offered through Part D contracts and many Advantage plans.

Any policy can be terminated by yourself at any time and for any reason. There are no cancellation penalties. For example, if you simply can not afford to pay premiums, become eligible for Medicare (or Medicaid), or obtain group coverage through your employer, discontinuing  the policy may be the best choice.  If you can not afford the cost of coverage, you are not legally obligated to pay the premium.  Of course, if you are not replacing the coverage, it’s important to understand the risk of being uninsured, and the tax penalty of 2.5% of household income. Beginning in 2019, the penalty will be eliminated.

 

Your Free Quote

Once you provide your zip code at the top of the page, within minutes, you can view the best options. The average cost of a policy (including subsidies) is now less than $100 per month, a reduction of about 70% compared to previous years. About 80% of residents qualify for financial aid, which fuels most of the savings. However, you can select a non-Obamacare plan that may not be compliant, or an off-Exchange plan that meets ACA requirements, but can not receive financial subsidies. Many policies can be purchased at any time throughout the year.

NOTE: Depending on your household income, you, or another family member may qualify for Medicaid or CHIP. However, you can also choose to decline Medicaid (and CHIP) and purchase an unsubsidized policy from any of the participating companies. You will still receive all mandated and required coverage established by the Affordable Care Act legislation. This includes maternity, mental illness, office visits, prescriptions, and pediatric dental benefits.

Cheapest Medical Plans Tennessee

We Always Provide The Lowest Available Health Insurance Rates In Tennessee

Policies can also be purchased after an Open Enrollment period has ended. Special exception situations (SEP)  allow you to apply without answering medical questions.The most common exemptions occur if you lose your work benefits, get divorced, move to another state, or have a baby. NOTE: Newborns are eligible for the SEP, but not either parent. Children reaching age 26, and covered on a parent’s qualified policy, can also apply.

Short-term plans can also be considered to bridge the gap until the next available period. However, they are not eligible for financial assistance, and are designed to cover larger claims. If you have additional questions about Health Exchange plans, we constantly update a page to bring you the latest information.

 

Tennessee Health Exchange Companies

Five companies offer policies on the 2019 Exchange. They are  Blue Cross Blue Shield (BCBS), Oscar,  Cigna, Bright, and Celtic (Ambetter).  Additional companies offer “off-Exchange” plans. BCBS has the largest market share, covering about 70% of the state. Group plans through employers are widely available, and feature options from many companies that don’t offer Marketplace policies.

Community Health Alliance, a CO-OP, previously closed down their operations. Assurant, a subsidiary of Time Insurance, also stopped writing business  in all states. UnitedHealthcare, Humana, and Aetna pulled out of most states. Depending on future legislation, these three major companies may return to the Marketplace in 2020.

More than 70 different plans are available in the four Metal tiers (Platinum, Gold, Silver and Bronze). Low-cost catastrophic policies are offered to persons under age 30 or other applicants that meet “financial hardship” criteria. However, since catastrophic policies are not eligible for the subsidy, we don’t recommend this type of tier contract for low-income households. Often, Bronze or Silver (with cost-sharing) contracts will offer richer benefits at a rate not significantly higher.

Also, not all policies are available in each area of the state. In the 10 most populated counties in the state, participating carriers are listed below:

Shelby County – Cigna, Ambetter, Bright, and Oscar

Davidson County – Bright, Cigna and Oscar

Knox County – BCBS, Bright, and Cigna

Hamilton County – BCBS and Ambetter

Rutherford County – Cigna, Bright, and Oscar

Williamson County – Cigna, Bright, and Oscar

Montgomery County – Cigna, Bright, and Oscar

Sumner County – Cigna, Bright, and Oscar

Sullivan County – Cigna and BCBS

Wilson County  – BCBS

 

TN Health Insurance Companies

Tennessee Health Insurance Companies By County

 

Pay A Lot Less With The Subsidy

You can potentially save thousands of dollars each year with the subsidy. Here’s how it works: A tax credit subsidy instantly reduces the cost of your healthcare. Thus, if the monthly rate of the policy is $800 and your subsidy is $700, you only pay $100 per month. And certain plans may even be free! Your subsidy is based upon your household income and the number of dependent persons residing in the household. Cost of coverage and amount of financial aid can vary, depending upon your area of residence.

Your eligibility and amount of money you receive,  is also determined by the type of policy selected. Catastrophic plans are not eligible for subsidies. If your income is between 100% and 400% of the Federal Poverty Level (133% in states with Medicaid expansion), you qualify. A few examples are listed below. We’re assuming a household of two adult married persons (ages 45) in the Nashville area (Davidson County).  Amounts shown below are your monthly instant tax-credit.

$35,000 household income – $894 subsidy

$45,000 household income – $759 subsidy

$55,000 household income – $647 subsidy

$60,000 household income – $606 subsidy

These subsidies are directly applied to the premium. So you do not have to wait or apply to receive the discounts. The amount of subsidy will vary depending on where you live, the size of your family and the modified adjusted gross income (MAGI) you report on your tax return. If your household income substantially changes, a re-calculation of the subsidy is recommended.

For example, if you live in the Nashville area (Shelby County), the amounts  increase. Other counties that would provide larger subsidies include Smith, Cumberland, Hawkins, Warren, Madison and Clay. Also, the addition of children in the household will increase financial aid. One extra dependent could make a difference of up to $4,000 per year. NOTE: Eligibility for Medicaid or CHIP may occur in larger families with lower incomes.

 

Cheapest Health Plans In Tennessee

Not including subsidies, there are many low-cost policies that can be purchased for individuals and families. Some of the least expensive options are listed below. Specific plans may not be offered in all areas.

 

Catastrophic Tier

Oscar Simple Secure – $7,350 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. First three pcp office visits are not subject to copay or deductible.

Bright Health Catastrophic – $7,90 deductible with maximum out-of-pocket expenses of $7,900 and 0% coinsurance. First three pcp office visits are not subject to only a $50 copay.

 

Bronze Tier

BCBS Bronze B07S – $5,650 deductible with maximum out-of-pocket expenses of $6,650 and 50% coinsurance.

Cigna Connect 7000 – $7,000 deductible with $7,900 maximum out-of-pocket expenses and 50% coinsurance.

Cigna Connect 6650 – $6,650 deductible with $7,900 maximum out-of-pocket expenses and 50% coinsurance. Pcp office visit copay is $40 for first three visits and Urgent Care copay is $50.

Bright Health Bronze – $7,900 deductible with $7,900 maximum out-of-pocket expenses and 50% coinsurance. Pcp office visit copay is $40 for first three visits and Urgent Care copay is $75.  The generic drug copay is $25.

Bright Health Bronze Perks – $5,900 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. Pcp office visit copay is $30 for first two visits and Urgent Care copay is $75.  The generic drug copay is $25.

Oscar Simple Bronze – $7,900 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance. Urgent Care copay is $75.

Oscar Classic Bronze – $4,500 deductible with $7,900 maximum out-of-pocket expenses and 50% coinsurance. Urgent Care copay is $75.

Ambetter Essential Care 1 – $7,900 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance.

 

Silver Tier

BCBS Of Tennessee Silver S04S – $2,500 deductible with maximum out-of-pocket expenses of $7,700 and 50% coinsurance. All non-preventative expenses are subject to 50% coinsurance.

BCBS Of Tennessee Silver S01S – Similar to previous plan, but a $500 deductible with maximum out-of-pocket expenses of $7,000 and 50% coinsurance. All non-preventative expenses are subject to 50% coinsurance.

Cigna Connect 4750 – $4,750 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. $35 pcp office visit copay and $45 Urgent Care copay. Preferred, non-preferred generic, and preferred brand drug copays are $10, $25, and $75. 90-day mail order copays are $30, $75, and $225.

Cigna Connect 5000 – $5,000 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. $30 pcp office visit copay and $45 Urgent Care copay. Preferred generic and generic drug copays are $10 and $25. 90-day mail order copays are $30 and $75. Preferred brand drug copays are $75 and $225.

Cigna Connect 3500 – $2,000 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. $30 pcp office visit copay and $35 Urgent Care copay. Preferred generic and generic drug copays are $10 and $25. 90-day mail order copays are $30 and $75.

Oscar Backup Silver – $3,000 deductible with $6,500 maximum out-of-pocket expenses and 30% coinsurance.

Oscar Classic Silver – $5,000 deductible with $7,350 maximum out-of-pocket expenses and 50% coinsurance. Office visit copays are $50 and $100, and the Urgent Care copay is $100. Generic and preferred brand drug copays are $25 and $50 ($75 and $150 for 90-day mail order).

Oscar Simple Silver – $7,350 deductible with $7,350 maximum out-of-pocket expenses and 0% coinsurance. Office visit copays are $25 and $75, and the Urgent Care copay is $100. Generic and preferred brand drug copays are $25 and $50 ($75 and $150 for 90-day mail order).

Ambetter Balanced Care 11 – $6,000 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. Office visit copays are $30 and $60, and the Urgent Care copay is $100. Generic and preferred brand drug copays are $20 and $50 ($60 and $150 for 90-day mail order).

Ambetter Balanced Care 5 – $7,350 deductible with $7,350 maximum out-of-pocket expenses and 0% coinsurance. Office visit copays are $40 and $80, and the Urgent Care copay is $100. Generic and preferred brand drug copays are $20 and $60 ($60 and $180 for 90-day mail order).

Bright Health Silver – $5,000 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. Office visit copays are $40 and $75, and the Urgent Care copay is $75. Generic and preferred brand drug copays are $25 and $100 ($75 and $150 for 90-day mail order).

Bright Health Silver Perks – $3,000 deductible with $6,500 maximum out-of-pocket expenses and 40% coinsurance. Office visit copays are $30 and $60, and the Urgent Care copay is $75. Generic and preferred brand drug copays are $20 and $75 ($75 and $150 for 90-day mail order).

 

Gold Tier

BCBS Of Tennessee Gold G06S – $1,500 deductible with maximum out-of-pocket expenses of $6,350 and 20% coinsurance. Office visits copays are $35 and $50. Urgent Care copay is $50. Prescription drug copays are $8 (generic), $35 (preferred brand), $60 (non-preferred brand), and $120 (specialty).

Cigna Connect 1200 – $1,200 deductible with $7,000 maximum out-of-pocket expenses and 20% coinsurance. $15 and $60 office visit copays with $35 Urgent Care copay. Preferred, non-preferred generic, and preferred brand drug copays are $8, $15, and $35. 90-day mail order copays are $24, $45, and $105.

Oscar Classic Gold – $1,500 deductible with $7,350 maximum out-of-pocket expenses and 20% coinsurance. Office visit copays are $25 and $50, and the Urgent Care copay is $100. Generic and preferred brand drug copays are $10 and $50 ($30 and $150 for 90-day mail order).

 

Chattanooga Rates Are Among The Lowest In The US

Yes…Chattanooga medical plan prices are incredibly low, along with many other ares in the eastern part of the state. You can thank Blue Cross Blue Shield who negotiates lower pricing with a local hospital system. The result has been prices for coverage that are extremely attractive. Although Oscar and Cigna do not offer coverage in this area, and the number of available plans is limited, prices remain competitive.

Although Hamilton County has its share of smokers, high blood pressure,  obese persons, and serious medical issues, the Erlanger Health System network is able to provide enough doctors and hospitals to treat everyone. And whether it’s an MRI or an ER visit, the cost of treatment is not breaking the bank. Blue Cross identifies its networks with letter designations. For example, the “E” network has the least number of providers (including only one local hospital). “S” policies have two available hospitals in the area while “P” plans allow access to three.

Shown below are monthly Chattanooga rates for a married couple (both age 40) with household income of $40,000:

BCBS Bronze B07S Network S PPO – $0

Silver S04S Network S PPO – $11

Silver S01S Network S PPO – $398

 

Nonprofit Cooperatives No Longer Available

Although not very popular and relatively new, nonprofit cooperatives were available in several states including Tennessee. The advantage (sometimes) was price, although the network provider list was typically very shallow. Community Health Alliance enrolled less than 400 persons during the initial Open Enrollment period, far short than original expectations. The following year was better but not enough to keep the struggling CO-OP operating.

More than 25,000 policyholders were forced to find other plans before the end of 2015. Even though a 44% rate increase was approved, the risk of failure was too large to allow operations to continue. Created by a bipartisan group of Congress, “Cooperatives” were intended to give consumers another option for purchasing low-cost medical coverage. All profits are dispersed back into the organization with the main focus on patient-care. It’s possible that they could return after 2018, depending upon new legislative guidelines.

 

Knoxville Makes List Of Most Affordable Cities

The widely respected Kaiser News Department recently published the 10 areas of the US with the best healthcare bargains. As expected, Western Pennsylvania, Hawaii and parts of Minnesota made the list. But so did Knoxville, checking in at Number eight! One of the reasons may be that Blue Cross and Blue Shield was able to negotiate an agreement with a single hospital system.

Also, Knoxville has several highly-rated hospitals that effectively service the community, and their close proximity may play a role in keeping rates affordable. These hospitals include Turkey Creek Medical Center, Est TN Children’s, Fort Sanders Regional Medical Center, Parkwest, Physician’s Regional, North Knoxville Medical Center, and the UT Medical Center.

 

What About Nashville?

The Nashville area (including Davidson County) also offers low rates. We have listed below some examples of the most competitive 2018 policy options for that area. Our assumption is based on a 45-year old couple with total income of $50,000 per year, resulting in an annual subsidy of more than $10,000. Prices shown below are monthly, and the federal subsidy has been applied to the premium. Also, “cost-sharing” applies to Silver-tier plans.

$0 – Cigna Connect 7000

$4 – Oscar Simple Bronze

$4 – Oscar Classic Bronze

$4 – Oscar Backup Bronze

$326 – Cigna Connect 4750

$404 – Oscar Backup Silver

$417 – Oscar Classic Silver

$483 – Oscar Simple Silver

 

What If I Don’t Qualify For The Subsidy?

If your income is too high to qualify for the federal subsidy, affordable plans are still available. For example, based on the most current Federal Poverty Guidelines, if your income exceeds the amounts listed below (courtesy of Heritage), you would become ineligible for subsidies.  The maximum household amounts are  $12,140 for one person, $16,460 for two persons, $20,780 for three persons, and $25,100 for four persons. Click the graph to enlarge.

Federal Poverty Level Guidelines 2016

Tennessee Federal Poverty Level Guidelines For Marketplace Plans

 

When applying and purchasing coverage with no Obamacare subsidy, the government website is not involved (off-Exchange). Admittedly, the process is sometimes quicker, with very few glitches, delays, or frustration. We help you compare plans, evaluate what impact your medical conditions (if you have any) have on your potential out-of-pocket expenses, and finally select the best option.

Often, when off-Exchange (off-Marketplace) policies are purchased, your network provider list is larger, and discounts on services are greater. This difference started to appear when carriers realized that creating thinner networks were the only way to remain competitive while offering guarantee-issue (non-underwriting) plans.

Since Open Enrollment (OE) occurs every year in Tennessee and all other states, you are never locked into a choice.  For example, if you select a cheap high-deductible policy with large out-of-pocket costs, and realize you will have major medical expenses the following year, you can change to a lower out-of-pocket cost plan. Typically, OE occurs at the end of the calendar year (November 1-December 15). If coverage needs to be purchased outside of these dates, other plans are available. In 2019, new low-cost options may be introduced that provide plans without several of the 10 “essential health benefits.” Senior Medicare plan Open Enrollment begins in October.

Cheap Tennessee health insurance plans are available and our job is to help you find them. With the help of expert advice, federal subsidies and comprehensive comparisons, we make it easy to find the most affordable policies. If you are currently being treated for chronic medical conditions, many comprehensive options are offered.

 

Tennessee Medicare Supplement  Plans For Seniors

More than 1 million Volunteer State residents receive Medicare benefits, and about one fourth also qualify for Medicaid. Additional assistance is provided the State Government. They are the Commission on Aging And Disability, Medicare Assistance, and Department of Human Services.

Medigap/Supplement plans pay many of the out-of-pocket costs that standard Medicare coverage does not cover. Some of the most common expenses are Part A coinsurance and hospital costs, Part B coinsurance and co-payments, Part A and B deductibles, Part B excess charges, skilled nursing facility care coinsurance, blood, and other costs. Policies are issued individually, so it is possible for each spouse to enroll in a different plan. The Department of Insurance (DOI) helps to verify the financial safety of companies conducting business in the state.

Listed below are current estimated monthly rates (Female Age 65) for various popular plans:

 

Shelby, Fayette, Hardeman, Tipton, Dyer, And Lake Counties

 

Plan A

$78 – AARP-UnitedHealthcare

$89 – New Era Life

$93 – Transamerica

$93 – Companion Life

$97 – Western United Life

$98 – Thrivent

$100 – Equitable National Life

$101 – Liberty Bankers Life

$104 – Shenandoah Life

$105 – CSI Life

$105 – Mutual Of Omaha

$110 – Pekin Life

$110 – United American

$112 – Aetna

$115 – Equitable

$115 – Medico

$117 – Combined Insurance

$118 – Individual Assurance

$130 – American Retirement Life

$130 – Humana

$131 – Oxford Life

$160 – Gerber

 

Plan C

$121 – Western United Life

$135 – New Era Life

$140 – AARP-UnitedHealthcare

$145 – Transamerica

$172 – Humana

$207 – United American

 

Plan F (HD)

$23 – United American

$35 – New Era Life

$46 – Mutual Of Omaha

$50 – Humana

$58 – Aetna

 

Plan F

$118 – New Era Life

$122 – Western United Life

$123 – Thrivent

$124 – Equitable National Life

$125 – Liberty Bankers Life

$127 – Pekin Life

$130 – Guarantee Trust Life

$132 – Companion Life

$141 – AARP-UnitedHealthcare

$141 – Mutual Of Omaha

$144 – Aetna

$144 – Shenandoah Life

$145 – Combined Insurance

$145 – Transamerica

$150 – Individual Assurance

$151 – Medico

$136 – Aetna

$138 – UnitedHealthcare

$139 – Manhattan Life

$141 – Mutual Of Omaha

$144 – Oxford Life

$144 – Shenandoah Life

$150 – Central States

$151 – Medico

$171 – Equitable

$171 – American Retirement Life

$172 – CSI Life

$172 – Oxford Life

$176 – Humana

$216 – United American

$229 – Gerber

 

Plan G

$93 – Western United Life

$97 – Thrivent

$97 – New Era Life

$97 – Equitable National Life

$99 – Liberty Bankers Life

$100 – Pekin Life

$101 – American Retirement Life

$101 – Aetna

$105 – Mutual Of Omaha

$106 – Central States

$107 – Guarantee Trust Life

$109 – Shenandoah Life

$112 – Combined Insurance

$114 – Companion Life

$115 – CSI Life

$116 – Oxford Life

$118 – AARP-UnitedHealthcare

$129 – CSI Life

$134 – Transamerica

$168 – United American

$192 – Gerber

 

Plan N

$81 – Western United Life

$82 – Thrivent

$82 – Equitable National Life

$82 – Pekin Life

$85 – Liberty Bankers Life

$88 – Guarantee Trust Life

$88 – Shenandoah Life

$91 – Aetna

$92 – New Era Life

$92 – Individual Assurance

$93 – Mutual Of Omaha

$97 – CSI Life

$97 – Central States

$99 – AARP-UnitedHealthcare

$104 – American Retirement Life

$104 – Medico

$106 – Equitable Life

$109 – Oxford Life

$115 – Transamerica

$116 – Humana

$123 – Combined Insurance

$147 – United American

 

Davidson County

 

Plan A

$78 – AARP-UnitedHealthcare

$81 – Humana

$93 – Transamerica

$93 – Companion Life

$97 – Western United Life

$99 – New Era Life

$101 – National Guardian Life

$104 – Shenandoah Life

$105 – Liberty Bankers Life

$105 – CSI Life

$105 – Mutual Of Omaha

$106 – Guarantee Trust Life

$108 – Medico

$109 – Prosperity Life

$111 – Thrivent

$112 – Aetna

$112 – United American

$113 – Equitable National Life

$117 – Combined Insurance

$119 – Pekin Life

$131 – Oxford Life

$145 – Individual Assurance

$159 – Gerber

 

Plan C

$121 – Western United Life

$140 – AARP-UnitedHealthcare

$144 – Transamerica

$157 – New Era Life

$163 – Central States

$173 – Humana

$207 – United American

 

Plan F (HD)

$23 – United American

$39 – New Era Life

$46 – Mutual Of Omaha

$50 – Humana

$57 – Aetna

 

Plan F

$122 – Western United Life

$130 – Guarantee Trust Life

$130 – New Era Life

$131 – Liberty Bankers Life

$132 – Companion Life

$139 – Pekin Life

$139 – Thrivent

$141 – AARP-UnitedHealthcare

$141 – Medico

$141 – Mutual Of Omaha

$143 – Aetna

$144 – Shenandoah Life

$145 – Combined Insurance

$145 – Transamerica

$168 – Central States

$171 – CSI Life

$171 – Individual Assurance

$172 – Oxford Life

$176 – Humana

$194 – American Retirement Life

$216 – United American

$229 – Gerber

 

Plan N

$81 – Western United Life

$88 – Guarantee Trust Life

$89 – Shenandoah Life

$89 – Liberty Bankers Life

$89 – Pekin Life

$91 – Aetna

$93 – Thrivent

$93 – Equitable National Life

$93 – Mutual Of Omaha

$97 – Medico

$97 – CSI Life

$99 – AARP-UnitedHealthcare

$105 – Individual Assurance

$107 – New Era Life

$109 – Oxford Life

$115 – Transamerica

$116 – Humana

$117 – Equitable Life

$117 – American Retirement Life

$124 – Combined Insurance

$147 – United American

 

TN Senior Health Insurance Options

Tennessee Medicare Advantage Plans Are Very Popular

 

Tennessee Medicare Advantage Plans For Seniors

Medicare Advantage plans in Tennessee are also popular because of low premiums and comprehensive benefits (including prescription coverage). Several popular plan options are listed below.

Note: Each county features several similar or identical options. However, copays, deductibles, and maximum out-of-pocket expenses can vary, along with the network provider list. Also, most participating insurers do not offer contracts in all areas of the state, and rates may differ from one county to another.  Most benefits described below are for in-network treatment. A full comprehensive list of benefits is available for each plan.

 

AARP MedicareComplete Plus Plan 1 – $60 deductible with maximum out-of-pocket expenses of $4,500. Inpatient hospital copay is $295 for first six days. Outpatient hospital copay is $295 per visit. Office visit copays are $10 and $35, while the Urgent Care and ER copays are $30-$40 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0 copay. Outpatient mental health therapy visits are subject to $15 copay (group) or $25 copay (individual). Foot, dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $2 (Tier 1), $8 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 31% (Tier 5).

AARP MedicareComplete Plus Plan 2 – $0 deductible with maximum out-of-pocket expenses of $3,400. Inpatient hospital copay is $175 for first seven days. Outpatient hospital copay is $160 per visit. Office visit copays are $0 and $25, while the Urgent Care and ER copays are $25-$40 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$14 copay. Outpatient mental health therapy visits are subject to $15 copay (group) or $25 copay (individual). Foot, dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $2 (Tier 1), $8 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 33% (Tier 5).

BlueAdvantage Sapphire – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $325 per visit. Office visit copays are $10 and $35, while the Urgent Care and ER copays are $45 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$100 copay. Outpatient mental health therapy visits are subject to $30 copay (group and individual). Foot, dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $1 (Tier 1), $10 (Tier 2), $42 (Tier 3), $90 (Tier 4), and 33% (Tier 5).

BlueAdvantage Garnet – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $325 per visit. Office visit copays are $10 and $35, while the Urgent Care and ER copays are $45 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$100 copay. Outpatient mental health therapy visits are subject to $30 copay (group and individual). Foot, dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $1 (Tier 1), $10 (Tier 2), $42 (Tier 3), $90 (Tier 4), and 33% (Tier 5). Benefits are identical to Sapphire plan.

Cigna-HealthSpring Advantage – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $0-$100 per visit. Office visit copays are $15 and $30, while the Urgent Care and ER copays are $30 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$100 copay. Outpatient mental health therapy visits are subject to $30 copay (group and individual). Foot, hearing, and vision exams are covered, subject to policy limits. No prescription drug benefits are included.

Cigna-HealthSpring Preferred – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $0-$300 per visit. Office visit copays are $0 and $40, while the Urgent Care and ER copays are $40 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$270 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Foot, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 27% (Tier 5).

Cigna-HealthSpring Premier – $200 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $0-$300 per visit. Office visit copays are $0 and $30, while the Urgent Care and ER copays are $30 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$225 copay. Outpatient mental health therapy visits are subject to $30 copay (group and individual). Foot, hearing, dental, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 29% (Tier 5).

HumanaChoice R7315-001 Regional PPO – $500 deductible with maximum out-of-pocket expenses of $3,400. Inpatient hospital copay is $550 per stay. Outpatient hospital copay is $95 per visit. Office visit copays are $10 and $30, while the Urgent Care and ER copays are $10-$30 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$150 copay. Outpatient mental health therapy visits are subject to $30 copay (group and individual). Dental and vision exams are covered, subject to policy limits. No prescription drug benefits are included.

Humana Gold Plus – $150 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $345 for the first five days. Outpatient hospital copay is $325 per visit. Office visit copays are $15 and $45, while the Urgent Care and ER copays are $15-$45 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$50 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $5 (Tier 1), $15 (Tier 2), $47 (Tier 3), $97 (Tier 4), and 30% (Tier 5).

Aetna Medicare Premier Plan – $0 deductible with maximum out-of-pocket expenses of $5,950. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $45-$250 per visit. Office visit copays are $5 and $55, while the Urgent Care and ER copays are $5-$45 and $80. Diagnostic tests, and procedures have a $25 copay,  outpatient x-rays have a $15 copay, and lab tests have a $10 copay. Outpatient mental health therapy visits are subject to $40 copay (group) or $55 copay (individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $2 (Tier 1), $5 (Tier 2), $42 (Tier 3), $100 (Tier 4), and 33% (Tier 5).

Aetna Medicare Value Plan – $0 deductible with maximum out-of-pocket expenses of $5,300. Inpatient hospital copay is $300 for first five days. Outpatient hospital copay is $40-$295 per visit. Office visit copays are $5 and $55, while the Urgent Care and ER copays are $5-$45 and $80. Diagnostic tests, and procedures have a $40 copay, outpatient x-rays have a $15 copay, and lab tests have a $10 copay. Outpatient mental health therapy visits are subject to $40 copay (group) or $55 copay (individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $2 (Tier 1), $5 (Tier 2), $42 (Tier 3), $100 (Tier 4), and 33% (Tier 5).

Amerivantage Classic – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $350 for first five days. Outpatient hospital copay is $150 per visit. Office visit copays are $15 and $50, while the Urgent Care and ER copays are $45 and $80. Diagnostic tests, and procedures have a $0-$150 copay,  outpatient x-rays have a $90-$110 copay, and lab tests have a $0-$10 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $4 (Tier 1), $10 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5).

Amerivantage Plus – $0 deductible with maximum out-of-pocket expenses of $5,100. Inpatient hospital copay is $295 for first five days. Outpatient hospital copay is $0-$275 per visit. Office visit copays are $0 and $$0- 40, while the Urgent Care and ER copays are $35 and $80. Diagnostic tests, and procedures have a $0-$150 copay,  outpatient x-rays have a $90-$110 copay, and lab tests have a $0-$10 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $2 (Tier 1), $10 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5).

WellCare Advance – $0 deductible with maximum out-of-pocket expenses of $4,500. Inpatient hospital copay is $325 for first five days. Outpatient hospital copay is $0-$100 per visit. Office visit copays are $5 and $35, while the Urgent Care and ER copays are $35 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$150 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Dental, hearing, and vision exams are covered, subject to policy limits. No prescription drug benefits are included.

WellCare Dividend – $0 deductible with maximum out-of-pocket expenses of $6,700. Inpatient hospital copay is $1,450 per stay. Outpatient hospital copay is $350. Office visit copays are $10 and $50, while the Urgent Care and ER copays are $35 and $80. Diagnostic tests, procedures, outpatient x-rays, and lab tests have a $0-$50 copay. Outpatient mental health therapy visits are subject to $40 copay (group and individual). Dental, hearing, and vision exams are covered, subject to policy limits. 30-day prescription drug cost-sharing copays are $6 (Tier 1), $20 (Tier 2), $47 (Tier 3), $99 (Tier 4), and 33% (Tier 5).

 

Tennessee Prescription Drug (Part D) Plans And Monthly Rates

 

AARP MedicareRx Walgreens – $28.10 per month. $415 deductible with 2,884 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $5 (Tier 2), $30 (Tier 3), 32% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $15 (Tier 2), $90 (Tier 3), 32% (Tier 4), and 25% (Tier 5).

AARP MedicareRx Saver Plus – $30.20 per month. $415 deductible with 2,954 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $5 (Tier 2), $25 (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $15 (Tier 2), $75 (Tier 3), 38% (Tier 4), and 25% (Tier 5).

AARP MedicareRx Preferred – $71.00 per month. $0 deductible with 3,367 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $5 (Tier 1), $10 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $15 (Tier 1), $30 (Tier 2), $120 (Tier 3), 40% (Tier 4), and 33% (Tier 5).

Aetna Medicare Rx Select – $17.10 per month. $365 deductible with 3,737 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $6 (Tier 2), $141 (Tier 3), 40% (Tier 4), and n/a (Tier 5).

Aetna Medicare Rx Saver – $29.10 per month. $295 deductible with 3,283 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $2 (Tier 2), $30 (Tier 3), 35% (Tier 4), and 27% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $6 (Tier 2), $90 (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Aetna Medicare Rx Value – $58.70 per month. $0 deductible with with 3,737 available formulary drugs.  30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $2 (Tier 2), $47 (Tier 3), 45% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $6 (Tier 2), $141 (Tier 3), 45% (Tier 4), and n/a (Tier 5).

BlueRx  Essential– $34.40 per month. $415 deductible with 2,591 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $4 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $12 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 25% (Tier 5).

Cigna-HealthSpring Rx Secure-Extra –  $53.20 per month. $0 deductible with 3,601 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $4 (Tier 1), $10 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $12 (Tier 1), $30 (Tier 2), $126 (Tier 3), 50% (Tier 4), and n/a (Tier 5).

Cigna-HealthSpring Rx Secure –  $54.50 per month. $405 deductible with 3,555 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $6 (Tier 1), $10 (Tier 2), $35 (Tier 3), 39% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $15 (Tier 2), $90 (Tier 3), 39% (Tier 4), and n/a (Tier 5).

EnvisionRxPlus – $45.70 per month. $405 deductible with 3,187 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $3 (Tier 2), 15% (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $9 (Tier 2), 15% (Tier 3), 33% (Tier 4), and n/a (Tier 5).

Express Scripts Medicare Saver – $29.60 per month. $315 deductible with 3,524 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $4 (Tier 2), 18% (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $12 (Tier 2), 18% (Tier 3), n/a (Tier 4), and n/a (Tier 5).

Express Scripts Medicare Value – $27 per month. $405 deductible with 3,153 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $3 (Tier 2), $18 (Tier 3), 48% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $9 (Tier 2), $54 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

Express Scripts Medicare Choice – $85.40 per month. $350 deductible with 3,681 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $2 (Tier 1), $7 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 26% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $6 (Tier 1), $21 (Tier 2), $126 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

Farm Bureau Essential Rx – $46.60 per month. $405 deductible with 3,941 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $5 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $15 (Tier 2), $120 (Tier 3), 40% (Tier 4), and 25% (Tier 5).

First Health Part D Value Plus – $56.20 per month. $0 deductible with 5,342 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $10 (Tier 1), $20 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $30 (Tier 1), $60 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5).

Humana Walmart Rx – $28.80 per month. $415 deductible with 3,055 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $4 (Tier 2), 20% (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $12 (Tier 2), 20% (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Humana Preferred Rx – $29.50 per month. $405 deductible with 3,130 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $1 (Tier 2), 20% (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $3 (Tier 2), 25% (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Magellan Rx Medicare Basic – $57.30 per month. $405 deductible with 3,598 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $4 (Tier 2), 15% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $12 (Tier 2), 15% (Tier 3), 50% (Tier 4), and n/a (Tier 5).

Mutual Of Omaha Rx Value – $28.80 per month. $415 deductible with 2,806 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $4 (Tier 2), 15% (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $12 (Tier 2), 20% (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Silver Script Choice – $25.40 per month. $0 deductible with 3,114 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $13 (Tier 2), $42 (Tier 3), 46% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $7.50 (Tier 1), $32.50 (Tier 2), $105 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

Silver Script Plus – $46.20 per month. $0 deductible with 3,173 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $2 (Tier 1), $8 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $5 (Tier 1), $20 (Tier 2), $100 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

Symphonix ValueRx– $25.80 per month. $405 deductible with 3,191 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $1 (Tier 1), $3 (Tier 2), $38 (Tier 3), 30% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $3 (Tier 1), $9 (Tier 2), $84 (Tier 3), 30% (Tier 4), and 25% (Tier 5).

WellCare Classic– $70.60 per month. $0 deductible with 3,100 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $1 (Tier 2), $35 (Tier 3), 42% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $3 (Tier 2), $105 (Tier 3), 42% (Tier 4), and n/a (Tier 5).

WellCare Extra– $30.30 per month. $405 deductible with 3,065 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $0 (Tier 2), $34 (Tier 3), 30% (Tier 4), and 33% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $0 (Tier 2), $102 (Tier 3), 30% (Tier 4), and n/a (Tier 5).

WellCare Value Script– $15.50 per month. $415 deductible with 3,327 available formulary drugs. 30-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-day cost sharing copays at preferred pharmacies are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

 

 

Additional Information:

BlueCross BlueShield dominated the state marketplace, writing almost 90% of all new applications submitted during Open Enrollment this year. That trend will likely continue in 2015 since their relationship with many local hospitals continues to keep prices low. Cigna, a large national carrier, is the only company that is likely to squeeze some of the BCBS market share away. Most applicants will continue to qualify for federal subsidies.

Kaiser Foundation (a reputable and trusted resource) predicts that Tennessee prices will again be among the lowest of any states for 2015 plans. Although Nashville premiums are expected to rise about 9%, the “narrow network” concept (smaller number of network doctors and hospitals) keeps most of the state stable.

BlueCross Blue Shield, however, may increase 2015 rates as much as 15%-20% because of a sicker-than-expected population that led to higher claims. The TN. Department of Insurance has accepted the proposed price hike.

The NCQA has once again awarded CIGNA as having the best HMO and PPO plans in the state. The ratings are determined by customer surveys surveys conducted by professional organizations such as CAHPS (Consumer Assessment of Healthcare Providers and Systems.

More than $1 million is being spent by the federal government to help Tennessee consumers purchase medical coverage during Open Enrollment. There is, however, a big problem. Seedco, the recipient of the money, has been sued in the past by…Are you ready for this? The federal government!

But there were other problems with Seedco. In 2013, the Tennessee Comptrollers office reported that almost $30,000 of fictitious claims were paid to a company that did not perform the work they stated. Workers routinely did never showed up at their place of employment.

This situation illustrates why experienced brokers or reputable websites are the most reliable resources for assisting  consumers with their TN  healthcare needs.

A special legislative session in February will attempt to provide a Medicaid-alternative to about 200,000 residents of the state. Governor Bill Haslam is hoping that  “Insure Tennessee”  will be widely accepted because of its emphasis on preventive treatment, no  extra cost to consumers, and rewarding of personal responsibility and wise choices. Until after 2016, the federal government will pay for the entire cost of the program.

Two plans have emerged from the Medicaid-alternative discussions. “Healthy Incentives” and “Volunteer”  are the tiers of benefits to be offered.

“Healthy Incentives” will be offered to consumers who do not have an option to purchase coverage through an employer. It closely resembles the TennCare option or individual coverage you can buy from the major carriers. Premiums are typically $20 per month if your income falls between 100% and 138% of the Federal Poverty Level guidelines. Households that earn under $10,000 per yer will benefit the most.

The “Volunteer” plan mandates that companies must pay at least 50% of their employee’s premiums. The balance will be paid by “vouchers, although the specifics have not yet been determined. It’s expected that the vouchers would pay most or all of the group plan costs.

BlueCross BlueShield of Tennessee has requested an average increase of 36% for its 2016 Marketplace plans. Humana  has requested a 15.8% increase while Cigna is only asking for a .4% rate hike. Community Health Alliance offered some of the least expensive options in 2015, but they have requested a whopping 32.6% increase. Some of their policies could rise by as much as 65%.

Due to excessive enrollment, Community Health Alliance stopped offering new policies in mid-January. Many other co-ops across the country suffered unexpected financial losses because of the uncertainty of projected claims. Insurance Commissioner Julie  Mix McPeak  stated that although rate increases will be allowed, they will unlikely be as much as the carriers are requesting. NOTE: last year, TN medical premiums were among the lowest in the US.

Community Heath Alliance promptly ceased offering 2015 Exchange policies in January after fearing that too many enrollments would impact its ability to pay all claims. Rates were cheap and the number of applicants was much higher than anticipated.

However, it now appears that despite a proposed rate increase of more than 32%,  there is a chance that new 2016 plans will not be available.  The price hike was formally requested two months ago, but the TN Insurance Department is concerned that the increase may not be enough to sustain a proper business model. The deadline for approving rate changes is the end of August.

No more grandfathered plans from BlueCross BlueShield of Tennessee. Previously, policies issued before March 23, 2010 could be kept, despite not offering 10 required “essential health benefits” or meeting other ACA Legislation guidelines. President Obama, of course, also proclaimed that consumers could “keep their policies.”

These types of plans, while quite affordable, typically don’t include maternity benefits and place a deductible on preventative coverage.  Also, mental illness and depression treatment is often limited or excluded. However, many residents preferred keeping these policies since they were customized to fit within their budget.

BCBST  has notified policyholders that as of December 31, the policies will end, and new coverage must be selected. About 25,000 people are impacted and will need to choose alternative Marketplace contracts.