You can still get a nationwide PPO in Tennessee, even though the marketplace sells only EPOs. Here is how owners of Tennessee LLCs, S-corps and small shops are covering their families.
Hi, I'm Sam Jaber. I'm a broker based in Tampa, licensed in 36 states, and Tennessee business owners can work with me by phone, whether you run a landscaping company in Clarksville, a dental lab in Germantown or a one-person LLC in Knoxville.
This page is about one Tennessee situation: an owner covering a spouse and kids. In a state where every marketplace medical plan is an EPO, a family plan means picking one regional network for everyone, from the pediatrician to the specialist your spouse sees. That choice is where Tennessee owners either save money or quietly lose it, often without realizing which one happened until a claim comes back unpaid.
Tennessee's marketplace has 158 individual medical plans this year, every one an EPO, sold by 3 to 5 insurers depending on the county. No PPO is offered.
You can still get a nationwide PPO in Tennessee, through me. Each family member answers health questions, the price follows from those answers, and the network spans the country. A healthy family gets doctors in every state, which matters for travel, college and the specialist two states over.
With an EPO, care outside the network is generally paid only in an emergency. For a family, that means every doctor everyone sees has to be inside the same plan's network, or you pay for those visits yourself. Before you compare premiums, list the doctors each family member uses and check them against every EPO in your county.
If the company is just you and family, you buy individual coverage; SHOP opens up only after you hire someone who isn't an owner or relative.
Above the credit range, a Tennessee owner pays full price for an EPO for every person on the plan. This is the family that tends to save with an underwritten nationwide PPO, where the insurer reviews each applicant and accepts the application, declines it, or accepts it with a named condition excluded. Benefits differ by policy, so we review them carefully.
Next step: Call me with the family's ages and doctors, and I'll price a nationwide PPO against your county's EPOs for the whole household.
If your spouse or a child has a chronic condition, keep that person on the marketplace, where plans can't turn anyone away or charge more for health history. The job becomes finding the EPO whose network covers their specialists.
Next step: Send me that family member's doctors and prescriptions, and I'll find the EPOs in your county that include them.
In a lean year, a household with children has a Tennessee path worth knowing: KFF lists TennCare's income limit for parents at 105% of the federal poverty level. Above that, the marketplace credit typically takes over.
Next step: Before you enroll in a slow year, call me and we'll see whether TennCare or a marketplace plan fits your family.
Here's the exercise I'd do with any Tennessee owner before choosing a plan. Write down, for each person on the plan:
Then check that list against every EPO sold in your county. In some counties, with only three insurers, one family member's specialist can rule out most of the options on their own. If the list includes doctors in other states, an EPO almost certainly won't cover routine visits there, and that tips the scale toward a nationwide PPO for a healthy household.
The ages of everyone on the plan matter too, since they drive the price on both sides of the comparison. Bring them to the call, along with a rough idea of what the company netted, because that decides whether the marketplace credit is part of the picture at all.
Straight answers, no sales pitch.
No. Every individual medical plan on Tennessee's marketplace is an EPO. A healthy family can still get a nationwide PPO through me.
EPOs generally pay out-of-network only in emergencies, so each family member's doctors need to be in the same network.
Not through SHOP until you hire someone who isn't an owner or family member.
Possibly. KFF lists TennCare's income limit for parents at 105% of the federal poverty level.
Who's on the plan, their ages, your county, and roughly what the business netted. I'll show you the family's options side by side and what each would cost.
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