How Much Is Health Insurance in Tennessee?

Health insurance costs in Tennessee vary significantly based on individual circumstances and plan choices. This article clarifies the factors influencing these costs, explores avenues for obtaining coverage, details available financial assistance, and provides average cost figures for health insurance plans in Tennessee.

Factors Influencing Health Insurance Costs

Several elements significantly impact the monthly premium an individual pays for health insurance in Tennessee. Age is a primary determinant; premiums generally increase as individuals get older, reflecting a higher likelihood of needing medical care. For instance, a 60-year-old typically pays more than double the premium of a 21-year-old for the same plan. Location within the state also plays a role, with costs potentially varying based on specific regions due to differences in competition, local regulations, and the cost of living.

Tobacco use can lead to higher premiums, with insurers permitted to charge tobacco users up to 50% more than non-users. The type of health plan and its “metal tier” also directly affect costs. Plans are categorized into Bronze, Silver, Gold, and Platinum tiers, indicating how costs are shared between the insurer and the policyholder. Bronze plans typically have the lowest monthly premiums but the highest out-of-pocket costs when medical care is needed. Platinum plans feature the highest premiums but the lowest out-of-pocket expenses.

Beyond metal tiers, the plan’s structure, such as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), influences both cost and network access. HMOs often come with lower monthly premiums and out-of-pocket costs but require members to choose a primary care physician (PCP) and obtain referrals for specialists. Coverage is limited to in-network providers except in emergencies. Conversely, PPOs generally have higher premiums but offer greater flexibility, allowing members to see out-of-network providers, often at a higher cost, without requiring a referral from a PCP.

The size of the family covered under a plan also increases the overall premium, with costs rising as more dependents are added. The specific cost-sharing features within a plan—including deductibles, copayments, coinsurance, and out-of-pocket maximums—have a direct relationship with the monthly premium. A higher deductible, the amount paid before the insurance plan starts to cover costs, typically results in a lower monthly premium. Plans with lower deductibles and cost-sharing amounts usually have higher premiums.

Options for Obtaining Health Insurance in Tennessee

Individuals and families in Tennessee have several pathways to secure health insurance coverage. A primary source for individual and family plans is the Affordable Care Act (ACA) Marketplace, accessible through Healthcare.gov. This federal platform facilitates enrollment during an annual Open Enrollment Period, typically from November 1 to January 15. It also offers Special Enrollment Periods for those experiencing qualifying life events like marriage, childbirth, or loss of other coverage.

Employer-sponsored health plans represent another significant avenue for coverage, with many Tennesseans obtaining insurance through their workplace. These plans are often cost-effective as employers typically contribute a portion of the premium, reducing the financial burden on the employee. The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides a temporary option for individuals to continue their employer-sponsored coverage after leaving a job or experiencing other qualifying events. This continuation usually lasts for 18 to 36 months, though the individual is responsible for the full premium plus a 2% administrative fee.

For those with limited incomes, TennCare, Tennessee’s Medicaid program, offers health insurance coverage. TennCare provides comprehensive medical services to eligible low-income pregnant women, children, parents of minor children, and individuals who are elderly or have disabilities, with no monthly premiums for qualified enrollees. Medicare serves individuals aged 65 and older, as well as certain younger people with disabilities or specific health conditions. Medicare includes Part A (hospital insurance), Part B (medical insurance), and Part C (Medicare Advantage plans), which are offered by private insurers and often include additional benefits.

Short-term health insurance plans are available as a temporary solution to bridge gaps in coverage. These plans typically have lower premiums but offer limited benefits and do not cover pre-existing conditions or essential health benefits mandated by the ACA. As of September 1, 2024, federal regulations limit their duration in Tennessee to an initial term of three months with a possible one-month renewal, for a maximum of four months.

Financial Assistance for Health Insurance

Financial assistance programs are available primarily through the ACA Marketplace to help reduce the cost of health insurance for eligible individuals and families. One form of assistance is premium tax credits, also known as subsidies, which directly reduce the amount paid for monthly premiums. Eligibility for these tax credits is determined based on household income and family size relative to the Federal Poverty Level (FPL). These credits are paid directly to the insurer, effectively lowering the monthly bill for the policyholder.

Another form of financial help is Cost-Sharing Reductions (CSRs). These reductions decrease the out-of-pocket costs associated with a health plan, such as deductibles, copayments, and coinsurance. CSRs are available to individuals and families who enroll in a Silver-tier plan through the Marketplace and have household incomes up to 250% of the FPL. The lower an individual’s income within this range, the greater the reduction in their cost-sharing responsibilities.

Both premium tax credits and Cost-Sharing Reductions are determined when an individual applies for coverage through the ACA Marketplace. The application process assesses household income and size to determine the level of assistance for which one qualifies. Even if an individual does not qualify for CSRs, they may still be eligible for premium tax credits, which can substantially lower monthly premium payments.

Average Health Insurance Costs in Tennessee

The actual cost of health insurance in Tennessee varies considerably depending on the individual’s specific circumstances and chosen plan. For a 40-year-old in Tennessee, the average monthly premium for a Silver plan was approximately $558 in 2025. Bronze plans, which typically feature higher out-of-pocket costs, averaged around $449 per month. Gold plans, offering lower out-of-pocket expenses, had an average monthly premium of about $578. Platinum plans, which provide the most comprehensive coverage with the lowest out-of-pocket costs, averaged around $797 per month, though these plans may have limited availability. Catastrophic plans, with very high deductibles and limited eligibility, averaged about $380 monthly.

These average premiums represent the full, unsubsidized cost. Many Tennesseans qualify for significant financial assistance through premium tax credits. For those who receive subsidies, the average net cost can be as low as $45 per month. Individuals with incomes between 100% and 150% of the federal poverty level may even qualify for a zero-dollar premium Silver or Bronze plan after tax credits are applied.

The cost also differs significantly between individual and family plans. While the average annual premium for single coverage through an employer-provided plan was about $1,686, a family of four typically paid around $1,785 per month for health insurance. Employer-sponsored plans often result in lower out-of-pocket premium costs for employees due to contributions from the employer. For individuals eligible for TennCare, Tennessee’s Medicaid program, there are generally no monthly premiums.