Medicaid Costs and Coverage in Tennessee

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Medicaid coverage in Tennessee makes affordable health care possible for eligible individuals or families who are struggling with earning enough money for medical insurance. The types of Medicaid insurance and the coverage available to petitioners includes a wide range of medical procedures and services. The financing for Medicaid coverage, known as TennCare, comes from both the federal and state governments. In Tennessee, the officials who handle the program review petitions and confirm Medicaid eligibility for applicants. Medicaid benefits cover various medical services, but exclude coverage as well. The program attempts to keep Medicaid cost estimates low, and in some cases, there are no costs to the recipient. Medicaid costs include some out-of-pocket expenses that the program may not cover. Get details about Medicaid cost estimates and what services are covered by Medicaid in Tennessee by reading through the topics below.

What services are covered by Medicaid in Tennessee?

The federal government outlines the Medicaid coverage guidelines, including the services that the program provides. States may alter certain Medicaid benefits, depending on regional needs and resources. The flexibility of the program is due to the coordination between state and federal officials and the funding which supports the system. States may also adjust Medicaid coverage in TN based on what funds are available.

The coverage benefits of Medicaid provide a range of medical services that are mandatory across the nation and in the state. For instance, Medicaid benefits in Tennessee grants coverage for emergency room services. However, Medicaid coverage does not always mean that there is no cost associated with the program. 

Medicaid coverage benefits are required by all states to implement or are optional, which may or may not be adopted by the state. For instance, the 2010 Affordable Care Act (ACA) introduced an expansion of Medicaid to cover more adult individuals who could not get medical care. Tennessee did not choose to extend Medicaid as outlined in the ACA allowing for that additional coverage to more residents. Regardless of whether or not a service is mandatory or optional, there may be costs required of recipients. Certain types of Medicaid insurance which are mandatory include, but are not limited to:

  • X-Rays.
  • Inpatient and outpatient care.
  • Dental care.
  • Services from a primary care physician.
  • Home health care services.
  • Transportation to and from medical centers.
  • Doctor visits.

To review a more comprehensive list of services covered by Medicaid, download our free guide.

Tennessee Medicaid coverage extends to a range of possible recipients. Individuals and families benefit from the assistance. Additional groups receive other advantages as well. For example, children receive extra aid under Medicaid coverage such as:

  •  Braces.
  •  Home health care professionals.
  •  Vision, hearing and dental checks.
  • Psychological services. 
What services are not covered by Medicaid in Tennessee?

“What does Medicaid not cover in TN?” is also frequently asked by potential applicants, as the program may not help in particular cases. Knowing the services not covered by Medicaid removes any expectation from potential recipients. Resources are not unlimited, so state and federal officials prioritize necessary services and ignore procedures considered elective. Some Medicaid coverage does not extend to services such as:

  • Cosmetic procedures.
  • Occupational, speech or respiratory therapy.
  • Any rentals through on-demand services in hospital rooms.
How much does Medicaid cost in Tennessee?

Medicaid cost estimates are as low as possible to help petitioners struggling with income. However, it is essential to understand that additional costs may be required of beneficiaries. Before learning how to apply for TN Medicaid coverage successfully, applicants can benefit from knowing what expenses may be associated with Medicaid. For example, individuals and families who need certain services, such as preventative care, may face some out-of-pocket expenses. Additionally, some Medicaid recipients may be exempt from extra costs.

Medicaid cost estimates in Tennessee for recipients remain low, because the program receives adequate funding. However, there are circumstances in which costs are required from recipients. Also, in cases where copayments are due, Medicaid coverage limits how much providers may charge for specific procedures. The limits set for Medicaid benefit costs are based on a range of factors. State agents notify eligible petitioners and provide details, such as the limits on costs, via mail. Keep in mind that providers are free to choose to charge the maximum amount, and that Medicaid cost estimates and expenses connected to the program may change periodically.

In some situations, the answer to, “How much is Medicaid?” is sometimes nothing at all.

Some beneficiaries receive exemptions from ever paying copayments or other expenses associated with coverage. The benefits of Medicaid are numerous, and for some petitioners, such as minors, those living in nursing homes, pregnant women or those suffering from disabilities, there are typically not medical costs owed. To read more about the costs and coverage associated with Medicaid, download our guide.