Are You Eligible for TennCare? | HealthTN.com

Are You Eligible for TennCare?

HealthTN TennCare 4 Comments

Are You Eligible for TennCare?

What is TennCare?

TennCare is the state Medicaid program in Tennessee administered jointly by the federal government and the Tennessee state government. TennCare was established in 1994 under a federal waiver that authorized states to come up with their own Medicaid rules. TennCare serves low-income families, individuals, and children who need help paying their medical bills.

What are the TennCare eligibility requirements?

Income requirements are different based on your needs. In 2018, the limits are as follows:

If you receive SSI (Supplemental Security Income):

  • Family of one cannot exceed $750 in monthly income and $2,000 in monthly assets
  • Family of two cannot exceed $1,125 in monthly income and $3,000 in monthly assets

If your income ends up at or below the following after you pay your medical bills (Standard Spend Down):

  • Family of one cannot exceed $241 in monthly income and $2,000 in monthly assets
  • Family of two cannot exceed $258 in monthly income and $3,000 in assets
  • Family of three cannot exceed $317 in monthly income
  • Family of four cannot exceed $325 in monthly income

If you are in a nursing home or have a home nurse:

  • Cannot exceed $2,205 in monthly income and $2,000 in monthly assets

If you have breast or cervical cancer:

  • Cannot have Medicare, and must be below 250% of the Federal Poverty Level.

TennCare Standard

TennCare Standard is for kids under the age of 19 who have TennCare Medicaid but are losing eligibility and do not have access to other health insurance.

TennCare Medicaid Plans Eligibility

There are twelve TennCare Medicaid eligibility categories (not including TennCare Standard):

A: Kids under 21 who don’t have Medicare

B: Adults over 21 who do not have Medicare and are not receiving long-term care

C: Adults aged 21 who do not have Medicare, are not receiving long-term care, and are not enrolled in SSD (Standard Spend Down)

D: Adults over 21 who do not have Medicare, are not receiving long-term care, and are not enrolled in SSD (Standard Spend Down)

E: Adults over 21 who do not have Medicare and get long-term care through CHOICES

F: Adults over 21 who have Medicare and are receiving long-term care

G: Adults over 21 who have Medicare and are getting long-term care but not through CHOICES

H: Kids under 21 with Medicare

J: Adults over 21 who do not have Medicare and have CHOICES 1 or 2

K: Adults over 21 who have Medicare and have CHOICES 1 or 2

L: Adults over 21 who do not have Medicare and have CHOICES 3

M: Adults over 21 who have Medicare and CHOICES 3

TennCare Medicaid and Medicare Together

If you are eligible for Medicaid and are over the age of 65, you may qualify for a Medicare Savings Program:

Qualifying Individuals Program: 

For those who fall between 120% and 135% of the federal poverty level have a yearly income of:

  • Family of 1 – $14,568 – $16,389
  • Family of 2 – $19,752 – $22,221

Qualified Disabled Working Individuals (QDWI) Program:

For those who are disabled, employed, at 200% or less of the Federal Poverty Limit, and fall under the following limits:

  • Family of 1 – Income limit of $24,280 and have asset limit of $4,000
  • Family of 2 – Income limit of $32,920 and asset limit of $6,000

Qualified Medicare Beneficiaries (QMB) Program:

For those who are at 100% or less of the Federal Poverty Level and meet the following limitations:

  • Family of 1 – Income limit of $1,012 and asset limit of $7,560
  • Family of 2 – Income limit of $1,372 and asset limit of $11,340

Specified Low-Income Medicare Beneficiaries (SLMB) Program: 

For those who are between 100% and 120% of the Federal Poverty Level and meet the following limits:

  • Family of 1 – Income limit of $12,140-$12,568 and asset limit of $7,560
  • Family of 2 – Income limit of $16,460-$19,752 and asset limit of $11,340

If you qualify for both Medicaid and Medicare in Tennessee, you can enroll in a dual-eligible Medicare Advantage plan! If you are over the age of 65 or are diagnosed with ALS or ESRD, you can qualify for Tennessee Medicare. Click here to learn more about dual-eligible plans.

Comments 4

  1. Why does Tenncare even still exist, now that there is HealthCare.gov? I know someone who drives a Mercedes and remodeled her Franklin home to top of the line everything and was bragging that she still has her Tenncare because no one has asked her any questions about her income or for updated info. So messed up! Others choose to not even buy health insurance and get fined.

      1. We live in a world that has corrupted governments. Some of the Tenncare administrators probably know about her situation. You’re too sick to work, you owe more money than your annual income which is zero dollars. They can’t help you. On the other hand, you might have a friend of a friend or one of the administrators . You might also have a 100k annual salary but don’t worry, you can’t still get it. It pays to know the right people.

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