TennCare is Medicaid, run by Tennessee

TennCare is Tennessee's version of Medicaid. It is not Medicare, and it is not a separate program. When you hear "TennCare," you are hearing the name Tennessee gave to its Medicaid system. The federal government funds Medicaid, but each state runs its own program under its own name and rules. Tennessee chose the name TennCare.

This matters because Medicare and Medicaid are completely different programs with different rules, different income limits, and different coverage. Medicare is federal health insurance for people 65 and older, or for some younger people with disabilities or end-stage renal disease. Medicaid is joint federal-state insurance for people with low income. TennCare is Tennessee's Medicaid program, so it follows Medicaid rules but with Tennessee-specific details.

You cannot have "TennCare Medicare." You can have both TennCare (Medicaid) and Medicare at the same time — this is called being "dual may be able to access" — but they are two separate programs with two separate enrollment processes and two separate coverage rules.

Key Takeaways

  • TennCare is the name Tennessee uses for its Medicaid program; it is not Medicare and not a separate program.
  • Medicaid covers people with low income; Medicare covers people 65 and older or with certain disabilities, regardless of income.
  • You can be enrolled in both TennCare and Medicare at the same time, but they are two different programs with different rules.
  • TennCare is run by the Tennessee Department of Finance and Administration, Division of TennCare, not by a federal office.
  • Income limits and covered services under TennCare differ from other states' Medicaid programs because each state sets its own rules within federal guidelines.

How TennCare differs from Medicare

Medicare is a federal program. Everyone who qualifies gets the same basic coverage no matter where they live. You pay into Medicare through payroll taxes during your working years, and you become may be able to access at 65. TennCare is a state program. Tennessee sets the income limits, decides which services to cover, and chooses how much to pay providers. Your may be able to access depends on Tennessee's rules, not federal rules alone.

Medicare does not ask about income. TennCare does. To be covered by TennCare, your household income must fall below a threshold set by Tennessee. That threshold is lower than in some other states and higher than in others. Medicare asks about age, work history, and disability status. TennCare asks about income, household size, and sometimes immigration status.

The two programs also cover different things. Medicare covers hospital stays, doctor visits, and prescription drugs (with a separate Part D plan). TennCare covers those things too, but Tennessee decides the details — which doctors participate, which drugs are covered, how much you pay out of pocket. If you have both, Medicare is your primary payer for most services, and TennCare fills in gaps.

Who runs TennCare and how to contact them

TennCare is run by the Tennessee Department of Finance and Administration, Division of TennCare. This is the state agency that processes enrollment, handles questions about coverage, and manages the program day to day. You do not apply through Medicare or through a federal office. You apply through TennCare directly.

You can reach TennCare by phone at 1-800-342-3145. You can also apply online through the TennCare website or through the federal healthcare marketplace at healthcare.gov, which will route your application to TennCare. If you need help in person, TennCare has local offices throughout the state, and you can find the one nearest you on the TennCare website.

TennCare coverage types and how they work

TennCare offers several different coverage types, and which one you are in depends on your income, age, disability status, and family situation. The main groups are TennCare Standard (for low-income adults and families), TennCare Medicaid Expansion (for adults earning up to 138% of the federal poverty level), and TennCare for people who are aged, blind, or disabled.

Each coverage type has different income limits and different cost-sharing rules. Some cover dental and vision; others do not. Some require you to choose a managed care plan; others let you see any provider who accepts TennCare. When you apply, TennCare will tell you which coverage type you may have access to for and what it covers. The coverage you get depends on Tennessee's rules, not on what Medicare covers.

What happens if you have both TennCare and Medicare

If you are 65 or older and have low income, you may have both Medicare and TennCare. This is called being dual may be able to access. Medicare is your primary insurance, meaning it pays first. TennCare pays second, covering costs Medicare does not pay — copayments, coinsurance, and sometimes services Medicare does not cover at all.

You enroll in Medicare through Social Security or the federal government. You enroll in TennCare through the Tennessee Division of TennCare. The two enrollments are separate. You need to do both. If you are already on Medicare and your income drops, you can apply for TennCare. If you are on TennCare and turn 65, you should enroll in Medicare Part A and Part B even if you have no premium, because TennCare works better when Medicare is primary.

Income limits and how they change

TennCare income limits change each year because they are tied to the federal poverty level, which the government updates annually. For 2024, the income limit for TennCare Medicaid Expansion is 138% of the federal poverty level. For a single person, that is roughly $1,800 per month; for a family of four, roughly $3,700 per month. These numbers change every January.

Other TennCare coverage types have different limits. TennCare Standard, which covers some low-income adults without children, has a lower limit. TennCare for aged, blind, or disabled people has its own rules. The exact limit for your situation depends on which group you fall into. When you apply, TennCare will tell you whether your income qualifies.

Income limits also vary by state because each state's Medicaid program is different. Tennessee's limit is not the same as Kentucky's or Georgia's. If you move to another state, you will need to apply for that state's Medicaid program and learn its rules.

How to apply for TennCare

You can apply for TennCare online, by mail, by phone, or in person. The online application is at the TennCare website. You can also apply through healthcare.gov, which will send your application to TennCare. By phone, call 1-800-342-3145. By mail, send your application to the address listed on the TennCare website. In person, visit a local TennCare office.

You will need to provide proof of income (pay stubs, tax returns, or a letter from your employer), proof of Tennessee residency (a utility bill or lease), and proof of citizenship or legal residency (a birth certificate, passport, or immigration documents). TennCare will tell you exactly what documents to send when you apply. Processing usually takes 30 to 45 days, though it can be faster if you apply online and upload documents right away.

Frequently Asked Questions

Is TennCare the same as Medicare?

No. TennCare is Medicaid, which covers people with low income. Medicare covers people 65 and older or with certain disabilities, regardless of income. They are two separate programs with different rules and different enrollment processes.

Can I have both TennCare and Medicare at the same time?

Yes. If you are 65 or older and have low income, you can be enrolled in both. Medicare is your primary insurance and pays first; TennCare pays second and covers costs Medicare does not pay. You enroll in each program separately.

What is the income limit for TennCare in Tennessee?

The income limit depends on which TennCare coverage type you may have access to for. TennCare Medicaid Expansion covers people earning up to 138% of the federal poverty level, which is roughly $1,800 per month for a single person. Other coverage types have different limits. Call 1-800-342-3145 to find out the exact limit for your situation.

How do I apply for TennCare?

You can apply online at the TennCare website, through healthcare.gov, by phone at 1-800-342-3145, by mail, or in person at a local TennCare office. You will need proof of income, proof of Tennessee residency, and proof of citizenship or legal residency. Processing usually takes 30 to 45 days.

What does TennCare cover?

TennCare covers doctor visits, hospital stays, prescription drugs, and other services. The exact coverage depends on which TennCare coverage type you are in. Some types cover dental and vision; others do not. When you enroll, TennCare will send you a handbook explaining what your coverage includes.