TennCare is Medicaid, not Medicare

TennCare is Tennessee's version of Medicaid — a joint federal and state health insurance program for people with low income, certain disabilities, children, pregnant women, and seniors. It is not Medicare. Medicare is a federal program for people 65 and older, regardless of income. TennCare is run by the state of Tennessee and covers a much broader range of people based on income and other factors.

The confusion happens because both programs help pay for medical care and both exist in Tennessee. But they are separate programs with different rules, different income limits, and different enrollment processes. If you are in Tennessee and have been told you might be on "TennCare," you are being told about Medicaid coverage in your state.

Key Takeaways

  • TennCare is Tennessee's Medicaid program — a state-run health insurance for low-income people, not a Medicare alternative.
  • Medicare is a federal program for people 65 and older; TennCare covers younger people, families, children, and seniors who meet income limits.
  • You can be on both TennCare and Medicare at the same time if you are 65 or older and meet income requirements for both.
  • TennCare covers doctor visits, hospital stays, prescription drugs, and mental health services; coverage details vary by the specific TennCare plan you are on.
  • To learn about you are on TennCare or Medicare, check your insurance card or contact the Tennessee Department of Human Services.

How TennCare and Medicare are different

Medicare is a federal insurance program that anyone 65 or older can join, and some younger people with disabilities or end-stage renal disease can also join. You pay into Medicare through payroll taxes during your working years. When you turn 65, you become may be able to access regardless of how much money you have.

TennCare is Medicaid — a program for people with lower incomes. In Tennessee, you can be on TennCare if your income is below a certain level. The income limit depends on your age, family size, and whether you are pregnant, disabled, or caring for children. TennCare is paid for by both the federal government and the state of Tennessee.

The key difference: Medicare is based on age and work history. TennCare is based on income and life circumstances. A 70-year-old with a high income will have Medicare but not TennCare. A 35-year-old with low income and a disability can have TennCare but not Medicare.

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

Yes. If you are 65 or older and your income is low enough, you can be on both Medicare and TennCare. When this happens, Medicare is your primary insurance — it pays first — and TennCare covers some of what Medicare does not pay, like copayments and deductibles.

People on both programs are sometimes called "dual may be able to access." TennCare can help pay for things Medicare does not cover, such as long-term care in a nursing home or personal care services. The exact coverage depends on which TennCare plan you are on.

If you think you might be may be able to access for both, contact the Tennessee Department of Human Services to find out. They can tell you the current income limits and help you understand which program covers what.

What TennCare covers

TennCare covers a broad range of medical services. This includes doctor visits, hospital stays, emergency room care, prescription drugs, mental health and substance abuse treatment, and preventive care like screenings and vaccines. TennCare also covers some services Medicare does not, such as dental care, vision care, and transportation to medical appointments — though the exact coverage varies by plan.

Tennessee has several different TennCare plans. Some are managed care plans run by private insurance companies; others are fee-for-service plans run directly by the state. The plan you are on determines which doctors you can see, which hospitals you can use, and what services are covered. You can find out which plan you are on by looking at your TennCare card or calling the number on it.

How to check which program you are on

The easiest way to know whether you have TennCare or Medicare is to look at your insurance card. A Medicare card says "MEDICARE" at the top and has a red, white, and blue design. A TennCare card says "TennCare" and is issued by the state of Tennessee.

If you do not have a card or are not sure, you can contact the Tennessee Department of Human Services at 1-855-TNHELPS (1-855-864-3577). They can tell you what coverage you have and answer questions about your benefits. You can also create an account on the TennCare website to check your coverage status.

Income limits and who can be on TennCare

TennCare income limits change and depend on your family size and circumstances. In general, if your income is below 100 to 200 percent of the federal poverty level, you may be on TennCare — but the exact number varies. Pregnant women, children, seniors, and people with disabilities may have different income limits than working-age adults without disabilities.

You can also be on TennCare if you are receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), even if your income is slightly higher than the standard limit. The best way to learn about you meet the income requirement is to contact the Tennessee Department of Human Services or check the TennCare website.

What to do if you think you are on the wrong program

If you believe you are on TennCare but should be on Medicare, or vice versa, contact the Tennessee Department of Human Services right away. Mistakes can happen — for example, someone might be enrolled in TennCare when they are actually may be able to access for Medicare, or they might be on neither program when they should be on one.

Bring your insurance card and any paperwork you have about your income, age, or disability status. The Department of Human Services can review your situation and make sure you are on the right program. If you are may be able to access for both, they can help you understand how the two programs work together.

Frequently Asked Questions

Is TennCare the same as Medicare?

No. TennCare is Tennessee's Medicaid program for low-income people. Medicare is a federal program for people 65 and older. They are separate programs with different rules and different enrollment processes.

Can I be on TennCare if I am over 65?

Yes. If you are 65 or older and your income is low enough, you can be on TennCare. You can also be on both TennCare and Medicare at the same time.

What does TennCare cover that Medicare does not?

TennCare covers some services Medicare does not, including dental care, vision care, and long-term care in a nursing home. Coverage details depend on which TennCare plan you are on.

How do I know if I am on TennCare or Medicare?

Check your insurance card. Medicare cards have a red, white, and blue design and say "MEDICARE." TennCare cards say "TennCare" and are issued by the state of Tennessee. You can also call the Tennessee Department of Human Services at 1-855-TNHELPS.

What is the income limit for TennCare in Tennessee?

Income limits vary by family size and circumstances. In general, if your income is below 100 to 200 percent of the federal poverty level, you may be on TennCare. Pregnant women, children, and people with disabilities may have higher limits. Contact the Tennessee Department of Human Services for current limits.