Before you start

Tennessee residence
Income information for subsidy eligibility
An SSN or ITIN, plus immigration documents for marketplace eligibility categories
A qualifying life event if enrolling outside the annual open enrolment window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date. Compare the deductible and out-of-pocket maximum rather than the premium alone. In a non-expansion state the employer plan is doing more work than it would elsewhere.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use HealthCare.gov
Tennessee does not run a state exchange, so the federal marketplace is the route. A permanent move to Tennessee is itself a qualifying life event opening a special enrolment period — you do not wait for the annual window.
OnlineWho: You
3
Check TennCare categories rather than just the income figure
TennCare covers pregnant women, children, some parents and caretakers, and people who are aged, blind or disabled. It does not cover adults simply for having a low income, because Tennessee did not expand. Check which category you might fall into rather than assuming income alone decides it.
OnlineWho: You
4
Enrol children in CoverKids if the household qualifies
CoverKids is Tennessee's children's health insurance programme and reaches considerably further up the income range than adult coverage does. It is the main thing that softens non-expansion for arriving families, and it is a separate application from the adults'.
OnlineWho: You
5
Register with a primary care provider before you need one
New-patient waits at the large systems run to weeks. Getting on a practice's books while you are well is the difference between an appointment and an emergency room bill later.
OnlineWho: You
6
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost thousands even when insured. Methodist Le Bonheur and Baptist both run urgent-care sites across the metro at a fraction of the cost.
In personWho: You

Documents you’ll need

Proof of Tennessee residence
Income documentation for subsidy calculation
SSN or ITIN
Immigration documents establishing lawful presence
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Tennessee has a real Medicaid coverage gap, and it is the same shape as Florida's.

TennCare is category-based rather than income-based for adults, so a childless adult on a very low income is generally ineligible while also earning too little for the subsidies that were designed assuming Medicaid covered them. Of the four US cities in this lane, Memphis and Jacksonville share this problem and Cleveland and St. Louis do not.

Source: TennCare

St. Jude never bills a treated family — but it is not general cover.

St. Jude's founding rule is that families of children accepted for treatment pay nothing for treatment, travel, housing or food, regardless of insurance or ability to pay. It is genuinely extraordinary and it is also a specialist referral and research hospital for catastrophic childhood disease, not a paediatrician. Do not treat its presence as a reason to go uninsured.

Source: St. Jude Children's Research Hospital

Lawfully present immigrants can qualify for subsidies below the poverty line — citizens cannot.

Because lawfully present non-citizens are often barred from Medicaid for their first five years, federal rules let them claim marketplace subsidies at incomes below 100% of the federal poverty level. In a non-expansion state like Tennessee, a newcomer on a work visa can end up with better options than a US citizen neighbour on the same income.

Source: HealthCare.gov — immigrants and the marketplace

CoverKids reaches much further up the income scale than adult coverage.

Children can be covered under CoverKids well beyond the point at which their parents have no public option at all. Families arriving on a modest first salary should check the children's eligibility separately rather than treating the household as one unit.

Source: TennCare — CoverKids

Common mistakes to avoid

Assuming TennCare is a fallback for a low first income — for most adults in Tennessee it is not.
Treating St. Jude's existence as a substitute for children's health cover.
Missing the 30-day new-hire enrolment window and waiting a year.
Not realising that arriving in Tennessee opens a special enrolment period straight away.
Choosing a plan on premium alone and meeting a five-figure deductible.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.