Tennessee health insurance marketplace: history and
news of the state’s exchange

BCBS of Tennessee and Bright Health offering plans for 2018; cost of CSR added to silver premiums,making other
metal levels particularly affordable

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Louise Norris
Individual health insurance and health reform authority; broker
March 22, 2018

More Tennessee coverage

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    Insurance Guide
    • A guide to health insurance in
      your state.
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    • Your state’s Medicaid expansion,
      eligibilty, contacts
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    • Insurance for those over 64

Highlights and updates

  • 2018 enrollment down 4.6% from 2017
  • One insurer in 2017, but Bright Health joined in 2018
  • Average rate increase 15.6%, including added premiums to cover CSR cost
  • Cost of CSR added to silver exchange, other metal levels particularly cheap for some
  • 2018 rates and new insurer indicate death spiral no longer a danger

Tennessee exchange overview

Tennessee was one of the states that voted against Medicaid expansion. Tennessee also allows non-ACA-compliant Farm Bureau plans to continue to be sold to healthy residents. Market premiums are decreasing in 2019 but heath insurance rates are increasing for Humana (44%), Cigna (46%), and Blue Cross Blue Shield (62%). Blue Cross Blue Shield left three major metro areas but rejoined in the Knoxville area combined Humana’s departure would have left 14 counties with no insurance options. Furthermore, 2018 average premiums increased by 28.5%. As for 2019, Bright Health and Celtic are joining the open exchange and Oscar and Cigna are expanding their coverage. For the upcoming year, rate increase will decrease by 12%.

The state’s uninsured rate has dropped from 13.9% to 9.5% in the past five years. The national average is at 8.7%.

Qualified Health Plans

The Kaiser Family Foundation estimated that 645,000 residents in Tennessee could use the exchange to buy qualified health plans and 387,000 would be eligible for premium subsidies. As for 2017, 234,125 people enrolled in private plans through the open exchange. This was a 13% decrease than the previous year. The state saw another decrease for the 2018 year in which only 209,499 residents enrolled. Of those enrollees, 90% were receiving premium subsidies of $791 per month whereas the national average is only $520 a month. The states that have no expanded Medicaid tend to see higher premium subsidies.

Tennessee and Obamacare

22 states participated in the Consumer Oriented and Operated Plan under the Affordable Care Act. In Tennessee, Community Health Alliance Mutual Insurance Company received $73,306,700. The Community Health Alliance ended operations at the end of 2015.

Medicaid Enrollment

Tennessee is one of the 19 states that have not expanded Medicaid, leaving an estimated 163,000 residents in the coverage gap. Exchange subsidies are not available for those residents earning less than poverty level and non-disabled childless adults are not eligible for Medicaid. In just five years, Tennessee’s Medicaid enrollment grew by 23%. In 2018, enrollment was only 10% whereas the national average was 28%. In 2018, Tennessee enacted a legislation that directs the state to seek federal approval for a Medicaid work requirement.



In 2018, there were 1.3 million Tennessee residents enrolled in Medicare. That equates to about 19% of the state’s population. 80% of enrollees qualify on age while 20% for a disability. Tennessee spends about $9,176 per enrollee each year. Medicare offers a Medicare Advantage plan in which 36% of Tennessee Medicare recipients opt for. Furthermore 44% of enrollees opt for the Medicare Part D plan which covers prescription drug plans.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.