Understanding TennCare - American Exchange

Understanding TennCare

TennCare is a complicated system.

One can spend hours on TennCare’s website. It is a wild goose chase of flipping through several pages trying to gather the proper information. It is easy to get confused in the process.

Writing about Tennessee’s Medicaid entity is difficult as well. I haven’t been successful in posting an article about TennCare yet because there is so much information. I have discarded at least three drafts in attempting to write on the subject.

The system is complicated–that’s for sure. There is a lot to know. But you might be able to understand the program if you understand common themes.

Financial Need and TennCare

TennCare is offered to those with financial need.

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Income is an important consideration for TennCare eligibility.

Financial need for TennCare is determined by the Federal Poverty Level or FPL. This is a table showing the minimum incomes needed to afford basic necessities–food, shelter, clothing, etc. The table organizes income from 100% to 400% where 100% of FPL is the lower limit.

If you are wondering if you qualify for TennCare, the best place to start is by estimating your income. How much are you making per month? per year?

Once you have a ball park figure, ask yourself how many people are in your family. Are you married? Do you have kids? How many kids?

FPL minimum income values increase as family size increases. The table shows different values for different family sizes. Simply see if your income is at or below the FPL value for minimum income.

Most Tennesseans with incomes ranging from under 100% to 255% of FPL qualify for some type of health insurance benefits.

For more information of the Federal Poverty Level, click this link. Click here for a FPL calculator.

TennCare: Four Key Demographics

Determining financial need is the first step. Once you evaluate your financial need, you increase your chances of qualifying for coverage by asking yourself if you fit into one of the following demographics.

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Pregnant women with low incomes often qualify for TennCare

Ask yourself: Am I pregnant? Do I suffer from a disability? Does my child need coverage? Are you an adult needing health coverage?

Children, adults, persons with disabilities, and pregnant women are common demographics that qualify for health insurance.

Tennessee’s Medicaid program offers several health benefits to disabled residents. For example, if an adult resident has a disability that began before the age of 22, then the adult qualifies for health insurance as a Disabled Adult Child. Elderly people needing help with daily activities of living generally qualify for health care through CHOICES.

The list of qualifiers is long. It helps if you access this flow chart to help determine your eligibility.

TennCare Takeaways

TennCare is a complex system.

If you want to apply, first determine you or your family’s total income (before taxes). If your income is less than 100% up to 255% of FPL, then you have a good chance of qualifying for some form of health insurance.

Next, TennCare offers health insurance to children, adults, children with disabilities, and pregnant women. If you fall into one of these key demographics, you stand an even better chance of qualifing for TennCare coverage.


Philip StrangĀ is an insurance agent and on-the-side copywriter. He enjoys helping others make sense of the complicated health insurance industry.