Tennessee’s High-Risk Pool Experience

AccessTN, Tennessee’s current high-risk pool, was signed into law in 2006 as a part of a plan to respond to the large TennCare disenrollment in 2005-2006. Enrollment for AccessTN opened in 2007. Although the state had initially anticipated covering around 6,000 uninsurable individuals, the pool never enrolled more than 4,100 individuals. Enrollment closed in October of 2010 due to the availability of the federally run high-risk pool.

Tennessee's High-Risk Pool Experience — AccessTN Funding & EnrollmentKey Features of AccessTN

  • Required most enrollees to be uninsured for 6 months prior to enrollment.
  • Required verification of an insurance company coverage denial or exclusion or diagnosis of 1 of 55 specific conditions.
  • Provided 3 coverage options with deductibles ranging from $1,000 to $5,000, coinsurance requirements of 20% of all spending above the deductibles, and premiums ranging from $284 to $1,225 per month.
  • Premiums varied based on age, tobacco use, and weight.
  • Premiums were capped at no more than 200% of the cost of premiums in the individual market for someone with “standard” risk.
  • Included a lifetime benefit cap of $1 million.
  • Restricted coverage for pre-existing conditions for the first 6 months of enrollment to 50%.
  • Provided varying degrees of premium assistance throughout the years depending on funding availability –ranging from up to 60% to up to 75% for low-income individuals with incomes under 250% of the poverty line.
  • Periodically closed enrollment and instituted waiting lists for premium assistance.

Coverage for all enrollees above the poverty line or those not receiving premium assistance ended in April 2014 due to the availability of coverage and subsidies in the health insurance Marketplace. Any individuals remaining on AccessTN are those who enrolled prior to its closure and have incomes below poverty or receive premium assistance. (1)

For more information about how high-risk pools work, see Reinsurance & High-Risk Pools: What Are They and Why Do They Matter for Tennessee?

References

1. State of Tennessee. Access Tennessee Act of 2006 (2016 Public Chapter 867) . [Online] July 6, 2006. http://www.capitol.tn.gov/Bills/104/Chapter/PC0867.pdf.