With the passage of the 2010 Patient Protection and Affordable Care Act, state insurance regulatory agencies were tasked with reviewing existing policies to come into compliance with federal law. A significant change already in effect is the prohibition against excluding children from coverage due to the presence of a pre-existing condition. Additionally, children may continue to be listed on their parents’ health policies up to age 26, regardless of their status as students or even if they have married.
Adults who have a pre-existing condition may currently seek coverage through temporary high-risk insurance pools. This arrangement will be replaced by the federally mandated health insurance exchanges on January 1, 2014.
General Insurance Regulations
All insurance policies in Tennessee must have guaranteed renewability. Currently, insurers can exclude for a pre-existing condition for up to two years, although if there is no gap in the applicant’s coverage history, this exclusion can be avoided.
Health status can be used as a basis to deny coverage, and both health condition and age may be used as the determining rate factor. An existing policy, however, may not be cancelled due to illness.
Health Care Exchanges
Tennessee is currently studying options for the implementation of the health care exchange mandated under the Affordable Care Act, however, a measure did become law on May 5, 2010 prohibiting any health plans sold by an exchange in the state from offering coverage for abortions. If the state has not created an exchange by January 1, 2013, the U.S. Department of Health and Human Services will assume responsibility for the process.
Medicare benefits are distributed according to income as a percentage of the Federal Poverty Level. In Tennessee, infants under one year of age qualify at 185% FPL, ages 1-5 at 133%, and ages 6-19 at 100%.
Pregnant women are eligible for Medicaid at 250% FPL, parents at 137%, and disabled Social Security recipients at 74%.
Approximately 16% of Tennessee residents receive Medicare benefits, with more than 1,007,000 accessing coverage for prescription medications. On average, more than $7000 is spent per Medicare enrollee in the state.
Additional prescription medication assistance is possible through the TennCare Pharmacy program, run by SXC Health Solutions, and Medicare recipients can access counseling and education seminars through the Senior Health Insurance Program (SHIP).