TennCare is Tennessee's Medicaid program, not Medicare

TennCare is Medicaid — the joint federal and state health insurance program for people with lower incomes. It is not Medicare, which is the federal program for people 65 and older or with certain disabilities. Tennessee calls its Medicaid program TennCare, just as other states have their own names for the same federal program.

The confusion is common because both programs help pay for medical care and both have "care" in the name. But they are funded differently, cover different groups of people, and have different rules about who can join. If you live in Tennessee and have been told you might be covered by Medicaid, that coverage would come through TennCare.

You may be covered by both programs at the same time — for example, if you are 65 or older and have a lower income, you could have Medicare and TennCare together. But they are separate programs with separate enrollment processes.

Key Takeaways

  • TennCare is Tennessee's name for Medicaid, a program for people with lower incomes; Medicare is a separate federal program for people 65 and older or with certain disabilities.
  • TennCare is funded jointly by Tennessee and the federal government, while Medicare is funded entirely by federal payroll taxes.
  • You can have both TennCare and Medicare at the same time if you meet the requirements for each program.
  • TennCare covers people under 65 with lower incomes, pregnant people, children, and people with disabilities; Medicare covers people 65 and older regardless of income.

How TennCare and Medicare differ

TennCare and Medicare are built on different rules and serve different groups. Medicare is a federal program that anyone 65 or older can join, along with some younger people who have been on Social Security Disability Insurance (SSDI) for at least two years or have end-stage renal disease. Your income does not matter for Medicare — a wealthy person and a person with no income can both have it.

TennCare is for people with lower incomes. In Tennessee, you may be covered by TennCare if you are under 65, pregnant, a child, a parent or caregiver, or a person with a disability. The income limits change each year and depend on your family size and situation. TennCare also covers some people over 65 who have low incomes and cannot afford Medicare premiums.

The two programs also pay for different things. Medicare has three main parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, and Part D covers prescription drugs. TennCare covers hospital care, doctor visits, prescription drugs, and many services Medicare does not, such as dental care, vision care, and nursing home care for people who meet the income and asset limits.

When you might have both TennCare and Medicare

If you are 65 or older with a lower income, you may have both programs. Medicare is your primary insurance, meaning it pays first. TennCare then pays some of the costs Medicare does not cover, such as copayments and deductibles. People in this situation are sometimes called "dual may be able to access."

To have both, you must be enrolled in Medicare Part A and Part B. You do not automatically get TennCare when you turn 65 — you have to meet Tennessee's income limits and explore. The income limit for a single person is set each year by the state; it is higher than the limit for younger adults but lower than the limit for families with children.

If you are under 65 and have been on SSDI for two years, you are automatically enrolled in Medicare Part A. You may also be covered by TennCare if your income is low enough. Contact TennCare directly to find out whether you meet the income limits.

How to tell which program covers you

Your insurance card will tell you which program you have. A Medicare card says "MEDICARE" at the top and has a red, white, and blue design. It includes a Medicare claim number that starts with your Social Security number. A TennCare card says "TennCare" and may have the logo of a TennCare health plan, such as BlueCross BlueShield of Tennessee or Amerigroup.

If you have both programs, you will have two separate cards. Keep both with you when you go to the doctor. Tell the doctor's office that you have both Medicare and TennCare so they bill correctly — Medicare first, then TennCare for any remaining costs.

If you are not sure which program you have, call the number on your insurance card. The customer service representative can confirm your coverage and explain what services are covered.

How to enroll in TennCare

To enroll in TennCare, you can contact TennCare directly by phone at 1-800-342-3145 or visit the TennCare website at tn.gov/tenncare. You can also go to your local Department of Human Services office in person. TennCare staff can tell you whether you meet the income limits for your situation and what documents you will need to bring.

You will need to provide proof of income, such as recent pay stubs or tax returns, and proof of Tennessee residency. If you are explore for coverage based on a disability, you may need medical records or a letter from your doctor. The process usually takes two to four weeks.

If you are already on Medicare and think you might also be covered by TennCare, call TennCare to ask about the income limits for people 65 and older. Do not wait to explore — TennCare coverage can start the month you explore, and you may be able to get back pay for medical bills from the month you applied.

What to ask your doctor or TennCare

If you have both Medicare and TennCare, ask your doctor's office to confirm they accept both programs before your visit. Some providers accept Medicare but not TennCare, or vice versa. Knowing this ahead of time prevents billing problems and surprise bills.

If you are unsure whether a service is covered, call TennCare before you go. Ask whether the specific service, test, or procedure is covered under your plan and whether you need prior approval from TennCare. Some services require TennCare to approve them in advance, and getting approval before you receive care can prevent a denied claim.

If you receive a bill you think should have been covered, contact TennCare's customer service line. They can review the claim and tell you why it was or was not covered.

When to seek help understanding your coverage

If you turn 65 and are not sure whether you should enroll in Medicare, TennCare, or both, contact TennCare before your 65th birthday. They can review your income and tell you what programs you may be covered by. Missing the Medicare enrollment window can result in lifetime penalties, so it is important to act before your birthday month.

If you lose a job or your income drops, you may become covered by TennCare even if you were not before. Contact TennCare within 30 days of the change to see whether you now meet the income limits. A major life change, such as divorce or the death of a spouse, can also change your coverage.

If a doctor or hospital tells you that you are not covered for a service, ask them to put the reason in writing. Then contact TennCare to ask whether the service should have been covered. TennCare has a process to appeal denied claims, and you have the right to ask for a review.

Frequently Asked Questions

Can I have TennCare if I am on Medicare?

Yes, if you are 65 or older and have a low income, you may have both TennCare and Medicare. TennCare becomes your secondary insurance and helps pay costs that Medicare does not cover. You must meet Tennessee's income limits and explore to TennCare separately.

What is the difference between TennCare and Medicare Part D?

Medicare Part D is the prescription drug coverage that is part of Medicare. TennCare also covers prescription drugs, but TennCare's drug list and copayments may be different from Medicare Part D. If you have both programs, TennCare usually pays for drugs after Medicare Part D.

Do I have to pay a premium for TennCare?

Most TennCare members do not pay a monthly premium. Some groups, such as people with higher incomes who are covered under special programs, may have a small premium. Call TennCare to ask whether your coverage requires a premium.

What happens to my TennCare if I move out of Tennessee?

TennCare only covers people who live in Tennessee. If you move to another state, your TennCare coverage will end. You will need to explore for Medicaid in your new state. Contact your new state's Medicaid program to find out how the process works.

How do I know if I make too much money for TennCare?

Income limits for TennCare change each year and depend on your age, family size, and situation. Call TennCare at 1-800-342-3145 and tell them your income and family size. They can tell you whether you meet the current limits without you having to guess.