Medicaid Costs and Coverage in Tennessee

How much is Medicaid in Tennessee? The question is often asked by Medicaid coverage applicants and recipients after enrolling in the government program. However, the Tennessee Medicaid program, known as TennCare Medicaid, does not require most participants to pay premiums or copayments for covered services. However, the Tennessee Medicaid program does hold most adult recipients responsible for small copayments for covered prescription drugs. In addition, all TennCare participants may be required to pay out of pocket for any medical services not covered by their TennCare plan or for any services or drugs that are not considered medically necessary. What services are covered by Medicaid in Tennessee may depend on your health plan or Managed Care Organization (MCO). However, most types of Medicaid insurance plans or MCOs cover the same fundamental medical services and health products, including physician services, inpatient and outpatient hospital visits, mental health and substance abuse treatment and many more. It is important to find how much does Medicaid cost with your unique MCO plan and circumstances, as you will be responsible for any expenses incurred for services rendered if applicable. To learn more about Medicaid cost estimates, continue reading the sections below.

How does Medicaid coverage in Tennessee or TennCare Work?

In Tennessee, Medicaid coverage is provided through TennCare, a state-run Medicaid program. TennCare Medicaid insurance offers health care to qualifying participants, including low-income families, pregnant women, disabled individuals and the elderly. Tennessee TennCare administers Medicaid health coverage exclusively through Managed Care Organizations. MCOs or Medicaid health plans are made up of a network of medical professionals and agencies that cooperate to optimize health care services for members. Although many other states offer MCO enrollment options, TennCare is the only Medicaid program in the nation that requires all participants to enroll in an MCO. Download our national Medicaid guide for more details about the government health care insurance program including the eligibility requirements that can influence coverage options.

Types of Medicaid Insurance in Tennessee

There are three primary types of Medicaid insurance or Managed Care Organizations in Tennessee. TennCare works with three Medicaid coverage providers including AmeriGroup, BlueCare and TennCare Select and UnitedHealthcare Community Plan. In addition, TennCare offers pharmacy services through Magellan Health and dental care for recipients younger than 21 years of age through DentalQuest. Instead of the fee-for-service Medicaid programs offered by many other states, Tennessee relies exclusively on MCO programs to manage the health care of participants. After completing the Medicaid application process in TN, applicants will find out which MCO they may be eligible to enroll in.

What services are covered by Medicaid in Tennessee?

The services covered by Medicaid may depend on the participant’s type of recipient group, such as children or elderly participants, or Medicaid eligibility. To find out what services are covered by Medicaid in your unique circumstances, look at your MCO health plan card. Your card may have a letter that determines what kinds of benefits are included in your plan. Most Medicaid coverage plans include fundamental medical services and prescriptions, including the following:

  • Physician visits and pharmacy services
  • Lab and X-ray services
  • Inpatient and outpatient hospital visits, plus emergency air and ground ambulance rides
  • Mental health and substance abuse treatment
  • Branded and generic prescription drugs that do not exceed Medicaid coverage limits

Download our comprehensive Medicaid guide for details about services that must be covered.

What services are covered by Medicaid CHOICES in Tennessee?

In addition to standard Medicaid covered services, the TennCare CHOICES program includes additional long-term care services, including in-home and nursing home care. TennCare CHOICES services covered by Medicaid are intended for seniors and disabled adults who may require a nursing home level of care. Examples of services included in Medicaid CHOICES in Tennessee include the following:

  • Brief home visits for personal care activities like bathing, dressing and feeding
  • Home modifications and assistive equipment, such as ramps and grabbers
  • Personal emergency response assistance through a call button system
  • Short-term stays at assisted living or nursing facilities
  • Supervised adult day care enrollment

What does Medicaid not cover in Tennessee?

Medicaid covered services and products may be different for different categories of recipients, such as children or participants in CHOICES. However, most types of Medicaid insurance in Tennessee explicitly exclude certain services and products. Information about Medicaid non-covered services generally includes any treatment or supply not considered medically necessary. This can include agents promoting fertility, hair growth, weight loss or cough and cold relief, as non-prescription drugs and most vitamin and mineral items are not listed as covered medication. Likewise, body enhancement, tattoo removal, hair transplants or other cosmetic services will not be covered by the government program. Cosmetic dentistry, oral services or orthodontic services are also not medically necessary and will not be covered. Medicaid coverage also does not extend to alternative therapies such as animal, art or carbon dioxide therapy.

Services excluded from Medicaid in Tennessee must be paid for out of pocket. Similarly, TennCare Medicaid coverage will not cover medical services and products that exceed coverage maximums. For examples, most adults are limited to a certain number of prescription medications and refills per month and additional prescriptions and refills may need to be purchased out of pocket.

How much is Medicaid in Tennessee?

In regards to how much does Medicaid cost, adults and children enrolled in Tennessee TennCare do not have copayment or cost-sharing responsibilities for coverage or services. As a Medicaid coverage recipient, you do not have to pay for monthly or annual premiums or covered services.

However, adults receiving Medicaid insurance are responsible for small copayments to obtain prescription drugs and refills. The cost for Medicaid prescriptions is nominal for branded and generic medications. Most adult Medicaid participants are limited to a certain number of prescriptions or refills per month. This Medicaid information is valuable to know, as beneficiaries will be responsible for the cost of prescription drugs obtained after reaching their limit. Children younger than 21 years of age are not required to provide copayments for covered prescription medications.