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Washington Health Insurance

Facts and Figures

  • Insurance
    Carriers
    9
  • Number of
    General Doctors
    1129
  • Number of
    Hospitals
    1

State Government Insurance Programs Offered

Medicaid


www.tn.gov/tenncare Inpatient and outpatient hospital services, Prenatal care, Vaccines for children, Physician services, Nursing facility services for persons aged 21 or older, Family planning services and supplies, Rural health clinic services, Home health care for persons eligible for skilled-nursing services, Laboratory and x-ray services, Pediatric and family nurse practitioner services, Nurse/midwife services. Eligibility: Must be located or reside in Tennessee and be U.S. citizens or qualified aliens. Medicaid: Income limits: Pregnant women and infants ages 0–1: 185% FPL. Children ages 1–5: 133% FPL. Children Ages 6–19: 100% FPL. Parents living with their children under 19: 129% FPL. Aged, blind and disabled: 75% FPL and asset limit of $2,000 for singles; 83% FPL and asset limit of $3,000 for couples. Individuals living in nursing homes: $2,022 per month.

TennderCare www.tn.gov (Search: TENNderCARE)


TENNderCare: Check-ups that include health history, complete physical exams, lab tests (as needed), immunizations, vision and hearing screening, developmental and behavioral screening (as needed), and counseling on how to keep your child healthy. Eligibility: TennCare Standard: Medicaid-covered children ages 0–18 whose eligibility for and enrollment in Medicaid are ending. Must have no access to group health insurance, and have incomes of up to 200% FPL. If above 200% FPL, then patient must have problems getting health insurance due to a pre-existing medical condition. TENNderCare: Children with TennCare up to age 21.

Indian Health Services (IHS)


Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Medicare


Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age.

CoverRX


www.covertn.gov (Click: CoverRX)

CoverKids www.coverkids.com


Covers Physician office visit, Hospital care, Prescription drug, Maternity, Routine health assessment and immunizations, Emergency room, Chiropractic care, Ambulance service (air and ground), Lab and x-ray, Physical, speech and occupational therapy,Inpatient and outpatient mental health and substance abuse treatment, Dental, and Vision care. Eligibilty: Must be Tennessee residents and U. S. citizens or qualified aliens. Must either be pregnant women or children ages 0–18. Must have no access to state- sponsored health insurance, and are ineligible for TennCare. Children enrollees must have been uninsured and pregnant women must have had no maternity coverage within the last 3 months prior to enrolling in CoverKids. There is no income limit but anyone making more than 250% FPL must pay full premiums.

Heath Care Reform

71,900 small businesses in Tennessee could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 85,000 Medicare beneficiaries in Tennessee hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Tennessee who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 84,700 people from Tennessee retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 3.2 million Tennessee residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 351,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Tennessee peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 2.8 million residents of Tennessee with health insurance from their employer, along with anyone who signs up with a new insurance plan in Tennessee.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 23,100 individuals in Tennessee who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $96.8 million federal dollars are available to Tennessee starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 184 Community Health Centers in Tennessee but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 11% of Tennessee’s population who live in an underserved area.
New Medicaid options for states. For the first time, Tennessee has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

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