Medicaid Eligibility in Tennessee: Income Limits & How to Apply
Medicaid Eligibility in Tennessee
Tennessee has chosen not to expand its Medicaid program under the Affordable Care Act. Coverage through TennCare remains restricted to traditionally eligible groups — children, pregnant women, individuals with disabilities, and parents meeting very low income thresholds.
Coverage gap in Tennessee: Adults earning below $15,650 per year (100% FPL for an individual) may fall into the coverage gap — too much income for traditional Medicaid but too little to qualify for ACA marketplace subsidies. An estimated hundreds of thousands of Tennessee residents are affected.
Without Medicaid expansion, coverage in Tennessee is generally limited to:
- Children in families with income up to 200-300% FPL (via CHIP)
- Pregnant women with income up to 185-200% FPL
- Parents with very low incomes (often well below 50% FPL)
- Seniors and people with disabilities meeting strict income/asset limits
- Adults in the coverage gap have limited options: community health centers, hospital charity care, and free clinics
About TennCare
If you're a resident of Tennessee trying to understand your healthcare options, here's what you need to know about TennCare (Tennessee's Medicaid program) and marketplace subsidies. Tennessee has not expanded its Medicaid program, meaning that most adults without dependent children will not qualify, regardless of how low their income is. You may qualify for TennCare if you are a child (up to age 21, with income limits varying by age, for example, children ages 6-18 with household income up to 138% of poverty), a pregnant woman (up to 250% of the federal poverty level, or FPL), or a parent/caretaker of minor children (with household income not exceeding 105% of poverty). Seniors and individuals with disabilities may also qualify, though they face income and asset limits, such as a $2,000 asset limit for individuals and a monthly income limit of $2,901 for individual applicants in 2025 for long-term care programs. If you are a childless adult with an income below 100% of the FPL, you will unfortunately fall into Tennessee's "coverage gap" and won't be eligible for either TennCare or marketplace subsidies.
If your income is too high for TennCare but still modest, you might qualify for subsidies on the federal HealthCare.gov marketplace. For example, if you are an adult with dependent children and your income is just above the 105% FPL TennCare cutoff, you could transition to marketplace coverage. The benchmark Silver plan in Tennessee is around $485 per month, which is moderate compared to the national average. With marketplace subsidies, your actual payment could be significantly reduced based on your income. It's important to remember that changes in your household income can shift your eligibility between TennCare and marketplace subsidies, so it's wise to recheck your options if your financial situation changes. During the recent unwinding of pandemic-era continuous coverage, nearly 556,000 people were disenrolled from TennCare, but many can reapply if their circumstances change and they believe they now qualify.
TennCare provides comprehensive benefits to those who qualify, covering a range of healthcare services. The program operates under an "1115 waiver," which allows Tennessee to customize its Medicaid program, and all TennCare beneficiaries are enrolled in plans administered by private health insurance companies. This managed care model aims to provide high-quality, cost-effective care. For those who are elderly or have physical disabilities, the TennCare CHOICES program offers home and community-based services as an alternative to nursing facility care. Additionally, Tennessee has specific programs for individuals with breast or cervical cancer. While some cost-sharing may apply to certain enrollees for covered services, copayments are generally not required for emergency services for Medicaid enrollees.
If you find yourself in the coverage gap, meaning your income is too high for TennCare but too low for marketplace subsidies, there are still practical alternatives in Tennessee. Community health centers, also known as Federally Qualified Health Centers (FQHCs), provide comprehensive primary and preventative care, including dental and mental health services, regardless of your ability to pay. They offer services on a sliding fee scale based on your income. Many hospitals in Tennessee also have financial assistance or "charity care" policies that can reduce or eliminate medical bills for eligible low-income, uninsured patients. Programs like Project Access in Southeast Tennessee coordinate donated specialty medical care for uninsured residents who don't qualify for other programs but earn below 150% of the FPL. Additionally, organizations like the Tennessee Justice Center can help with TennCare enrollment appeals and offer guidance on hospital financial assistance. If your income increases above 100% of the FPL, remember to revisit HealthCare.gov, as you may then become eligible for significant marketplace subsidies.
Tennessee Medicaid Income Limits 2026
The following table shows the key income thresholds for Tennessee in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | N/A | $62,600 |
| 2 | $21,150 | N/A | $84,600 |
| 3 | $26,650 | N/A | $106,600 |
| 4 | $32,150 | N/A | $128,600 |
| 5 | $37,650 | N/A | $150,600 |
| 6 | $43,150 | N/A | $172,600 |
Because Tennessee has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
At $485/month, Tennessee's benchmark Silver plan premium is comparable to the national average of ~$525. Subsidies make marketplace coverage accessible for most income levels between Medicaid and 400% FPL.
Marketplace Insurance in Tennessee
Tennessee residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Tennessee costs approximately $485/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Tennessee might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Tennessee uses the federal marketplace at HealthCare.gov for ACA enrollment. When you apply, the system automatically checks your Medicaid eligibility — if you qualify, your application is forwarded to the state Medicaid agency.
The lack of Medicaid expansion in Tennessee leaves a gap in the safety net. Residents in the coverage gap — too much income for traditional TennCare but too little for marketplace subsidies — rely on community health resources and uncompensated care.
How to Get Coverage in Tennessee
Since Tennessee has not expanded Medicaid, your path to coverage depends on your income level:
- Income above 100% FPL ($15,650+ for an individual): Apply through HealthCare.gov during open enrollment (November 1 - January 15) or after a qualifying life event. You will qualify for premium subsidies.
- Income below 100% FPL: Check if you qualify for traditional Medicaid categories (children, pregnant women, disabled). If not, look into community health centers, hospital financial assistance, and free clinics in your area.
- Children: Tennessee's CHIP program covers children in families with income up to 200-300% FPL regardless of expansion status.
Calculate Your Subsidy in Tennessee
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Tennessee.
Check Your Eligibility →Frequently Asked Questions
What are Tennessee's Medicaid eligibility requirements?
Tennessee has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Is Medicaid expanded in Tennessee?
No, Tennessee has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
How do I get help paying for health insurance in Tennessee?
Yes. Tennessee residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of Tennessee's Medicaid program?
Tennessee's Medicaid program is known as TennCare. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
What should I do if my TennCare coverage is ending?
If your TennCare coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
What are my options if I'm in Tennessee's Medicaid coverage gap?
If you're in the coverage gap (earning below $15,650/year but not qualifying for traditional Medicaid), look into community health centers in Tennessee that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
What's stopping Medicaid expansion in Tennessee?
Medicaid expansion has been a politically contentious issue in Tennessee. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with Tennessee's legislative updates for the latest status.
Medicaid Eligibility in Nearby States
- Alabama Medicaid Eligibility — Non-expansion state
- Arkansas Medicaid Eligibility — Expansion state
- Georgia Medicaid Eligibility — Non-expansion state
- Kentucky Medicaid Eligibility — Expansion state