Before you start

Tennessee residence
Income information for subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Treat employer coverage as part of the offer, not a perk
Enrol within the new-hire window, typically 30 days from your start date. In a non-expansion state the employer plan carries far more weight than in Oregon or Arizona. Compare deductibles and out-of-pocket maximums between competing offers, not just salary.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, enrol through HealthCare.gov
Tennessee does not run its own exchange, so the federal marketplace is the route. Open enrolment starts on 1 November. Outside it you need a qualifying life event — moving to Tennessee, losing coverage, marriage or a new child all count.
OnlineWho: You
3
Check TennCare eligibility properly rather than assuming
TennCare covers children through CoverKids, pregnancy, some parents at very low incomes and people with disabilities. It does not cover a working-age adult without children, however low their income. Check the categories rather than the income figure, because in Tennessee the category is what decides it.
OnlineWho: You
4
Register with a primary care physician while you are well
Your PCP gates specialist access on most plans. Confirm network status with the practice directly rather than the insurer's directory, which is frequently out of date. New patient waits in Nashville have lengthened with the population.
OnlineWho: You
5
Know where Nashville General and the Metro clinics are
Nashville General Hospital is Metro's public safety-net hospital, with a charity care programme for Davidson County residents, and Metro Public Health runs clinics offering immunisations, sexual health and primary care on a sliding scale. It is not insurance and it will not cover a complex admission, but it is the local backstop and newcomers rarely know it exists.
In personWho: You
6
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat costs thousands even with insurance. Urgent care handles fractures, stitches and infections far more cheaply, and Nashville has a dense network of them. Check the facility is an urgent care and not a free-standing emergency department before you walk in.
In personWho: You

Documents you’ll need

Proof of Tennessee residence
Income documentation for subsidy or charity care eligibility
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Living in the hospital industry's capital confers nothing on you as a patient.

HCA, Community Health Systems, Ardent and dozens of others are headquartered here, and Vanderbilt University Medical Center is a genuinely excellent academic hospital. None of that changes the fact that Tennessee's uninsured rate is well above the national average and TennCare excludes childless working-age adults entirely. The industry's presence is an employment fact, not a coverage one.

Source: HealthCare.gov — Medicaid expansion and the coverage gap

TennCare eligibility turns on category, not just income.

In expansion states, an adult under 138% of the federal poverty level qualifies for Medicaid on income alone. In Tennessee you must also fall into a covered category — child, pregnant, parent at a very low income, aged, blind or disabled. A single 30-year-old earning nothing at all does not qualify. People check the income table, see they are below it, and assume they are covered.

Source: TennCare — eligibility

Losing coverage or moving to Tennessee opens a special enrolment window.

You do not have to wait for annual open enrolment. Moving to the state, losing employer coverage, marrying or having a child each trigger a limited special enrolment period, usually 60 days. Newcomers who arrive in March and assume they must wait until November go uninsured for eight months for no reason.

Source: HealthCare.gov — dates and deadlines

The deductible is what actually shocks people from national health systems.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone arriving from the UK, Canada or India reads 'I have insurance' as 'I am covered', then receives a $2,800 bill for a scan. Read the deductible and the annual out-of-pocket maximum before you look at the premium — that is where the plans actually differ.

Source: community-reported

Common mistakes to avoid

Accepting a Nashville job offer without health insurance and assuming a marketplace plan will be cheap.
Assuming TennCare works like Medicaid in an expansion state.
Missing the 30-day new-hire enrolment window at a new employer.
Waiting until November open enrolment when a move already opened a special enrolment period.
Choosing a plan on premium alone and meeting a five-figure out-of-pocket maximum.

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