Although Tennessee's marketplace offers EPOs exclusively, I can still help you get a nationwide PPO. Let's look at how people running LLCs, S-corps and smaller businesses across Tennessee are choosing coverage for their households.
Hi, I'm Sam Jaber. I'm licensed as a broker in 36 states, and I work with Tennessee business owners over the phone. You might own a landscaping business in Clarksville, operate a dental laboratory in Germantown or run an LLC by yourself in Knoxville. We can review your coverage either way.
Let's focus on a common situation for Tennessee business owners: providing insurance for a spouse and children. Because the state's marketplace consists entirely of EPOs, the whole family has to work within a particular regional provider network. That includes your children's pediatrician and any specialist your spouse visits. Getting that network decision right can save an owner money. Getting it wrong can create unexpected expenses that don't become obvious until the insurance company refuses to pay a claim.
This year, Tennessee's individual marketplace lists 158 medical plans, all classified as EPOs. Depending on where you live, between 3 and 5 insurance companies offer them. There are no marketplace PPO options.
I can still arrange private nationwide PPO coverage in Tennessee. The insurer asks each family member medical questions and uses those answers to establish the premium. The provider network reaches across the United States. For a healthy household, that means access to doctors in every state, including during vacations, college trips or visits to a specialist two states away.
An EPO typically covers treatment outside its provider network only when there's an emergency. That means the physicians used by everyone in your family need to participate in the same network, unless you're prepared to pay for those appointments yourself. Before looking at monthly premiums, make a complete list of each person's doctors and compare it with the networks of every EPO available in your county.
When the company consists only of you and your relatives, coverage is purchased individually. SHOP becomes available only once you employ someone who isn't an owner or family member.
If your household earns more than the marketplace credit allows, you'll pay the full EPO premium for every covered person in Tennessee. That's where a medically underwritten nationwide PPO often saves families money. The insurer evaluates each applicant separately and may approve coverage, deny it, or approve it while excluding a specified condition. Since benefits vary by policy, I'll walk you through those differences carefully. And if someone in your family is receiving treatment for a health condition, tell me about it. That doesn't automatically eliminate the PPO route. The details matter, and I'll compare both approaches for your household.
Next step: Give me a call with everyone's ages and the doctors your family visits. I'll compare nationwide PPO pricing against the EPO options in your Tennessee county for the entire household.
When business slows down, Tennessee families with children should know about another possibility. KFF reports that TennCare allows parents to qualify with income up to 105% of the federal poverty level. Marketplace credits generally become available above that threshold. Keep track of what the company pays you month by month, so periods of lower income are reflected in your estimate before you enroll.
Next step: If you're enrolling during a difficult business year, call me first. We'll compare TennCare eligibility with marketplace coverage and see which path works for your family.
Before helping a Tennessee business owner select coverage, I'd have them make a simple checklist. For every family member who'll be insured, write down the following:
Once that list is ready, compare it with the provider network of each EPO offered in your county. Some counties have just three insurers, and a single specialist needed by one family member may eliminate most of the available choices. When your list includes out-of-state physicians, routine appointments with them almost certainly won't be covered by an EPO. For families in good health, that can make a nationwide PPO the more practical choice.
I'll also need the age of each person being insured, because age affects premiums on both sides. Have those details ready when we talk, along with an approximate figure for the company's net income. That income determines whether marketplace financial assistance belongs in our comparison.
Straight answers, no sales pitch.
No. Tennessee's marketplace offers only EPO individual medical plans. But if your household is healthy, I can help you obtain a nationwide PPO privately.
Outside emergencies, EPOs usually don't cover out-of-network treatment. That's why the doctors used by every family member should participate in the same plan network.
SHOP isn't available until the business employs someone who is neither an owner nor a relative of the owners.
It's possible. According to KFF, Tennessee's TennCare income threshold for parents is 105% of the federal poverty level.
Tell me who needs coverage, everyone's age, the county you live in and approximately what the business earned after expenses. I'll compare the available family plans and explain the pricing for each.
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