TennCare Medicaid provides comprehensive health coverage to eligible low-income individuals, families, and children in Tennessee. It covers a wide range of essential health services, including doctor visits, hospital care, prescription drugs, mental health and substance abuse treatment, and dental and vision care. TennCare also provides coverage for long-term care services, such as nursing home care and home health care. The program is designed to help people get the health care they need to stay healthy and productive members of their communities. TennCare is funded by a combination of state and federal funds.
TennCare Medicaid Covered Medical Services
TennCare is Tennessee’s Medicaid program, providing health insurance for low-income individuals and families. TennCare covers a wide range of medical services, including:
- Doctor visits
- Hospital stays
- Prescription drug coverage
- Dental care
- Vision care
- Mental health services
- Substance abuse treatment
- Long-term care
- Home health care
- Personal care services
TennCare also provides coverage for a number of preventive services, such as:
- Well-child visits
- Cancer screenings
- Immunizations
- Lead poisoning screening
The following table provides a more detailed description of the medical services covered by TennCare Medicaid:
| Service | Covered |
|---|---|
| Doctor visits | Yes |
| Hospital stays | Yes |
| Prescription drug coverage | Yes |
| Dental care | Yes |
| Vision care | Yes |
| Mental health services | Yes |
| Substance abuse treatment | Yes |
| Long-term care | Yes |
| Home health care | Yes |
| Personal care services | Yes |
| Preventive services | Yes |
TennCare Medicaid is a valuable program that provides health insurance coverage to low-income individuals and families in Tennessee. The program covers a wide range of medical services, including preventive care, doctor visits, hospital stays, prescription drug coverage, and more. If you are eligible for TennCare Medicaid, we encourage you to apply. For more information about TennCare Medicaid, please visit the TennCare website or call the TennCare customer service line.
Covered Prescription Drugs
TennCare Medicaid provides coverage for a wide range of prescription drugs, including brand-name and generic medications. To find out if a particular drug is covered, you can check the TennCare Preferred Drug List (PDL) or contact your TennCare health plan.
Prescription Drug Coverage
- Brand-name and generic medications
- Prescription drugs for mental health and substance use disorders
- Prescription drugs for chronic conditions, such as diabetes, heart disease, and cancer
- Prescription drugs for acute conditions, such as infections and injuries
- Over-the-counter (OTC) drugs that are prescribed by a doctor
There are some prescription drugs that are not covered by TennCare Medicaid. These drugs include:
- Drugs that are used for cosmetic purposes
- Drugs that are used for weight loss
- Drugs that are used for sexual dysfunction
- Drugs that are used for fertility treatments
- Drugs that are used for cosmetic surgeries
Copayments and Prior Authorization
Copayments are small fees that you may have to pay for each prescription drug you fill. The amount of the copayment will vary depending on the drug and your TennCare health plan. Some drugs may require prior authorization before they can be covered by TennCare Medicaid. This means that your doctor will need to get approval from TennCare before you can fill the prescription.
Table of Commonly Prescribed Drugs Covered by TennCare Medicaid
| Drug Name | Brand Name | Generic Name | Dosage | Strength | Quantity | Days Supply | Cost |
|---|---|---|---|---|---|---|---|
| Acetaminophen | Tylenol | Acetaminophen | Tablet | 500 mg | 30 | 30 | $10.00 |
| Ibuprofen | Advil | Ibuprofen | Tablet | 200 mg | 60 | 60 | $15.00 |
| Metoprolol | Lopressor | Metoprolol | Tablet | 25 mg | 90 | 90 | $20.00 |
| Simvastatin | Zocor | Simvastatin | Tablet | 20 mg | 30 | 30 | $30.00 |
| Lisinopril | Prinivil | Lisinopril | Tablet | 10 mg | 30 | 30 | $40.00 |
Eligibility And Income Requirements
To be eligible for TennCare Medicaid, you must meet certain requirements, including:
- Be a resident of Tennessee
- Be a U.S. citizen or qualified non-citizen
- Meet income and asset limits
- Be pregnant or have a child under 19 years old
- Be eligible for Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF)
- Be blind or disabled
- Be in a nursing home or long-term care facility
Income limits for TennCare Medicaid vary depending on your family size and whether you are pregnant. For example, in 2023, the income limit for a family of four is $53,000 per year.
| Family Size | Income Limit |
|---|---|
| 1 | $21,630 |
| 2 | $29,210 |
| 3 | $36,790 |
| 4 | $44,370 |
| 5 | $51,950 |
| 6 | $59,530 |
If you are pregnant, your income limit is 138% of the Federal Poverty Level (FPL). This means that if you are pregnant and have a family of four, your income limit is $64,430.
If your income is above the limit, you may still be eligible for TennCare Medicaid if you have high medical expenses. You can learn more about this by contacting the TennCare Medicaid office.
Eligibility Requirements
To qualify for TennCare Medicaid, you must meet certain eligibility requirements. These requirements include:
- Age: You must be under 19 years old, 19 years old and pregnant, or 21 years old and enrolled in a high school equivalency program.
- Income: Your family’s income must be at or below 138% of the federal poverty level.
- Citizenship: You must be a U.S. citizen or a qualified immigrant.
How To Apply For TennCare Medicaid
You can apply for TennCare Medicaid online, by mail, or in person at your local Department of Human Services office. The application process is simple and straightforward. You will need to provide information about your household income, expenses, and assets. You will also need to provide proof of your identity and citizenship.
Online
To apply online, visit the TennCare website and click on the “Apply for TennCare” button. You will need to create an account and provide your Social Security number. Once you have created an account, you can fill out the application online.
By Mail
To apply by mail, download the TennCare application form from the TennCare website. You can also request a paper application by calling the TennCare customer service line. Once you have completed the application, mail it to the address provided on the form.
In Person
To apply in person, visit your local Department of Human Services office. You can find the address of your local office on the TennCare website. When you arrive at the office, ask for an application for TennCare Medicaid. Once you have completed the application, submit it to a staff member.
Benefits of TennCare Medicaid
TennCare Medicaid provides a wide range of benefits to eligible individuals. These benefits include:
- Medical care: TennCare Medicaid covers a wide range of medical services, including doctor’s visits, hospital stays, prescription drugs, and mental health care.
- Dental care: TennCare Medicaid covers a variety of dental services, including cleanings, fillings, and extractions.
- Vision care: TennCare Medicaid covers a variety of vision care services, including eye exams and glasses.
- Family planning services: TennCare Medicaid covers a variety of family planning services, including contraception and counseling.
- Transportation: TennCare Medicaid provides transportation to medical appointments for eligible individuals.
How to Find a TennCare Medicaid Provider
Once you are approved for TennCare Medicaid, you will need to find a provider who accepts TennCare Medicaid. You can find a list of TennCare Medicaid providers on the TennCare website. You can also call the TennCare customer service line for help finding a provider.
| Benefit | Covered Services |
|---|---|
| Medical care | Doctor’s visits, hospital stays, prescription drugs, mental health care |
| Dental care | Cleanings, fillings, extractions |
| Vision care | Eye exams, glasses |
| Family planning services | Contraception, counseling |
| Transportation | Transportation to medical appointments |
Thanks for joining me on this journey through the coverage of TennCare Medicaid. I hope you found this article informative and helpful in understanding the various benefits and services available to TennCare Medicaid enrollees. Remember, TennCare Medicaid is here to support you and your family’s healthcare needs. As always, keep an eye out for future updates and changes to the program by visiting our website again soon. In the meantime, if you have any additional questions or concerns, feel free to reach out to the TennCare Medicaid office or your healthcare provider. Stay healthy and take care!