Tennessee health insurance Marketplace guide

To qualify for health coverage through the Tennessee Marketplace, you must:²

• Live in Tennessee
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable employer-sponsored health insurance. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.³
• Not be able to be claimed by someone else as a tax dependent.⁴
• If you’re married, you must file a joint tax return with your spouse.⁵ (with very limited exceptions)⁶

In Tennessee, the open enrollment period for individual/family health coverage runs from November 1 to January 15.⁷ 

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁸ 

Outside of open enrollment, a special enrollment period (typically triggered by a specific qualifying life event) is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Tennessee, you can: 

• Visit HealthCare.gov to access Tennessee’s health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans. 

• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁹

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

Tennessee uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

Ninety-six percent of the people who purchased health plans through the Tennessee Marketplace in 2024 were eligible for advance premium tax credits (APTC), also known as premium subsidies. The APTC amounted to an average savings of $581/month and reduced the average enrollee’s premium to about $66/month.¹⁰

Marketplace enrollees with household incomes of no more than 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that will result in lower deductibles and out-of-pocket expenses for Silver plans (these cost-sharing reductions are not available on plans at other metal levels).¹¹ Between the premium subsidies and cost-sharing reductions, you may find that a Tennessee Marketplace health insurance plan provides the best value.

Source: CMS.gov¹²

Tennessee has a coverage gap because the state has refused to expand Medicaid under the Affordable Care Act. Childless adults without disabilities are ineligible for Tennessee Medicaid regardless of how low their income is. Because the ACA’s premium tax credits (subsidies) aren’t available to applicants with income below the poverty level (because the law called for them to have expanded Medicaid instead), these applicants fall into what’s come to be known as a coverage gap. They are ineligible for Medicaid and also ineligible for premium tax credits to make private coverage more affordable.

There are an estimated 95,000 Tennessee residents in the coverage gap.¹³

For 2025 coverage, six insurers offer individual/family health plans through the exchange/Marketplace in Tennessee.¹

The number of participating insurers is unchanged from 2024, but there is one new insurer (Alliant Health Plans),¹ and one carrier that is exiting the market at the end of 2024 (Ascension/US Health & Life).¹⁴ Tennessee residents enrolled in Ascension plans in 2024 will need to pick new coverage during the open enrollment period for 2025, which began November 1, 2024. As long as these enrollees select a replacement plan by December 31, it will take effect on January 1, 2025.

Plan availability varies from one part of the state to another, but all areas of Tennessee have at least three participating exchange-based health insurers offering plans for 2025.¹⁵

For 2025, the following average rate changes were approved for Tennessee’s individual/family insurers (before subsidies are applied):¹

Source: Tennessee Department of Commerce and Insurance¹

Tennessee no longer has an effective rate review program, so the federal government (CMS) reviews the rates that are filed in Tennessee.¹⁶

The average approved rate changes listed above are calculated before any subsidies are applied. The majority of Tennessee’s Marketplace enrollees do receive subsidies, which change each year to keep pace with the cost of the second-lowest-cost Silver plan in each area.

For perspective, here’s an overview of how full-price (unsubsidized) average premiums have changed in Tennessee over the years:

• 2015: Average increase of 9%.¹⁷
• 2016: Average increase of 28.2%.¹⁸
• 2017: Average increase of 56%.¹⁹
• 2018: Average increase of 28.5%.²⁰
• 2019: Average decrease of 12.4%.²¹
• 2020: Average decrease of 1.1%.²²
• 2021: Average increase of 8.2%²³
• 2022: Average increase of 4.4%.²⁴
• 2023: Average increase of 8.5%.²⁵
• 2024: Average increase of 4.8%.²⁶

A significant record-high of more than 555,000 people enrolled in private health coverage through the Tennessee exchange during the open enrollment period for 2024 coverage.²⁷ The previous record high had been fewer than 350,000 people, set the year before.²⁸ (See chart below for a summary of enrollment by year.)

The surge in enrollment in recent years is due in part to the American Rescue Plan (ARP) making ACA’s premium subsidies more substantial. Under the ARP’s subsidy enhancement rules – now extended through 2025 by the Inflation Reduction Act – subsidies are larger and more widely available than they used to be.²⁸

The enrollment growth for 2024 was also due in part to the “unwinding” of the COVID-related Medicaid continuous coverage rule (people were not disenrolled from Medicaid for three years during the pandemic, but that ended in the spring of 2023). By April 2024, nearly 124,000 Tennessee residents had transitioned from Medicaid or CHIP to a private Marketplace plan.²⁹

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023,³⁹ 2024⁴⁰

HealthCare.gov
800-318-2596

State Exchange Profile: Tennessee
The Henry J. Kaiser Family Foundation overview of Tennessee’s progress toward creating a state health insurance exchange.