What Health Insurance Actually Costs in Tennessee

Your total cost for the year is the monthly premium plus what you pay when you get care — your deductible, copays, and coinsurance. There is a ceiling on the care side, the out-of-pocket maximum, but the premium has no ceiling and never counts toward that max. Two federal discounts — premium tax credits and cost-sharing reductions — can cut your premium and your care costs; see Subsidies in Tennessee for 2027 to check whether you qualify.

For plan year 2027, the federal ceiling on the out-of-pocket maximum is $12,000 for an individual and $24,000 for a family, per the CMS 2027 parameters.

We don't publish specific premium prices on this site. Premiums change every plan year and vary by age, county, tobacco use, and plan tier — a printed number would be wrong for most readers within months. Instead, this page teaches you how prices work, and where to check current rates: window shopping on HealthCare.gov (Tennessee uses the federal marketplace) or directly on insurer websites. Five insurers sell individual/family marketplace plans in Tennessee for 2027: BlueCross BlueShield of Tennessee, Celtic/Ambetter, Oscar, UnitedHealthcare, and Alliant Health Plans. Cigna exited the Tennessee marketplace at the end of 2026, so Cigna enrollees need to pick a new plan for 2027.

The five pieces of the cost puzzle

1. Premium

The premium is the monthly bill you pay to keep your coverage active — whether you see a doctor that month or not. Your first premium must be paid for your coverage to take effect. What moves your premium:

• Age. Older buyers pay more; younger buyers pay less.
• County. Tennessee has eight rating areas, and where you live determines which area (and which carriers and prices) you're shopping in.
• Tobacco use. Insurers can charge tobacco users more.
• Plan tier. Bronze, Silver, Gold, and Platinum plans trade lower premiums for higher cost-sharing, or the reverse. See The Marketplace for how the tiers work in practice.

Tennessee's approved statewide weighted-average individual-market rate increase for 2027 is about 15.6–15.9% (finalized September 2026) — the second consecutive year of double-digit increases nationally. That's the average; your county, age, and plan tier determine your actual number. Check current rates with HealthCare.gov window shopping rather than relying on any published price.

2. Deductible

The deductible is the amount you pay out of pocket each year for covered care before your plan starts sharing costs. If your deductible is $2,500 and you have a $3,000 hospital bill, you pay the first $2,500 and the plan's cost-sharing kicks in for the remaining $500. A lower premium usually comes with a higher deductible, and vice versa.

3. Copay

A copay is a fixed amount you pay for a specific service — for example, a set fee for a doctor visit or a prescription refill. Copays are due at the time of care regardless of whether you've met your deductible. (Plans differ on whether copays count toward the deductible; the example below assumes they don't.)

4. Coinsurance

Coinsurance is the percentage of a bill you pay after you've met your deductible. If your coinsurance is 25% and you have a $4,000 procedure after your deductible is met, you pay $1,000 and the plan pays $3,000. Many plans show this as a split, like "25/75."

5. Out-of-pocket maximum

This is the most you will pay in a year for covered care: your deductible + copays + coinsurance, combined. Once you hit it, the plan pays 100% of covered services for the rest of the year. For 2027, federal rules cap this at $12,000 per person / $24,000 per family — a plan's actual max can be lower, but never higher. Your premium does not count toward it.

How the pieces fit together: an illustration

ILLUSTRATION — the numbers below are round, made-up figures to show the mechanics, not a real plan. Meet Maya, 34, who buys a marketplace plan:

• Monthly premium: $500
• Deductible: $2,500
• Copays: $35 per doctor visit (don't count toward her deductible in this illustration)
• Coinsurance: 25% after the deductible
• Out-of-pocket maximum: $8,000 (illustrative; the federal ceiling for 2027 is $12,000)

Her year of care:

1. Two sick visits. She pays two $35 copays: $70. Nothing else changes.
2. An MRI billed at $3,000. She pays the first $2,500 — that satisfies her deductible — then 25% of the remaining $500 ($125). MRI cost to Maya: $2,625. Her deductible is now met.
3. Knee surgery billed at $20,000. With the deductible met, she pays 25% coinsurance: $5,000. Running care-cost total: $70 + $2,625 + $5,000 = $7,695.
4. Follow-up physical therapy billed at $1,500. Twenty-five percent would be $375, but she's only $305 below her $8,000 out-of-pocket max — so she pays $305 and the plan covers the rest, including any further covered care that year.

Maya's year: $6,000 in premiums (12 × $500) + $8,000 in care costs = $14,000 total. The premium was due every month even when she saw no doctor, and once the out-of-pocket max was hit, her covered care cost her nothing more.

The two big cost reducers

Most Tennesseans shopping on the marketplace qualify for at least one federal discount:

• Premium tax credits lower your monthly premium. For 2027, they're available to households earning roughly 100%–400% of the federal poverty level, with a hard cutoff at 400%.
• Cost-sharing reductions lower your deductible, copays, and out-of-pocket max — but only on Silver plans, and only for households earning 100%–250% of the poverty level.

Both are explained in full — who qualifies, the income bands in dollars, and how to avoid a surprise at tax time — on Subsidies in Tennessee for 2027.

A third tool, if you pick a bronze plan: a health savings account lets you pay for care with pre-tax money and can lower the income used for your tax credit. HSA guide

Your next step

1. Window shop on HealthCare.gov to see 2027 plans and actual prices for your age, county, and household — this is the only place to get real numbers.
2. Read Subsidies in Tennessee for 2027 to see whether tax credits or cost-sharing reductions apply to you.
3. Learn how the metal tiers trade premium against cost-sharing on The Marketplace, and look up any term you don't know in the Health Insurance Glossary.

Frequently asked questions

Why doesn't this site just tell me what a plan costs?

Because any number we printed would be wrong for most readers. Your premium depends on your age, your county's rating area, tobacco use, and plan tier — and it changes every plan year. We'd rather teach you how prices work and send you to HealthCare.gov window shopping, where the numbers are real and current.

What's the difference between a copay and coinsurance?

A copay is a flat fee for a specific service (like a doctor visit) that you pay regardless of your deductible. Coinsurance is a percentage of the bill that you pay only after you've met your deductible. Both count toward your out-of-pocket maximum.

Does my premium count toward my deductible or out-of-pocket max?

No. The premium is the price of keeping your coverage active; the deductible and out-of-pocket max only track what you pay for care itself. Think of them as two separate buckets.

If I hit my out-of-pocket maximum, is everything free after that?

Your plan pays 100% of covered services for the rest of the year — but you still owe your monthly premium, and anything the plan doesn't cover (out-of-network care your plan excludes, non-covered services) is still on you.

Can a subsidy lower my deductible too, or just my premium?

Both kinds exist. Premium tax credits lower your premium. Cost-sharing reductions lower your deductible, copays, coinsurance, and out-of-pocket max — but only if you pick a Silver plan and your household income is 100%–250% of the poverty level. Details: Subsidies in Tennessee for 2027.

How do I compare two plans with different premiums and deductibles?

Add the annual premium to what you'd expect to pay for care. A cheap-premium plan can cost more overall if you use a lot of care; an expensive-premium plan can win if you do. Check that your doctors are in-network and your prescriptions are covered before you decide — price alone doesn't tell the whole story.

Sources

• CMS 2027 benefit and payment parameters (federal out-of-pocket maximums: $12,000 individual / $24,000 family), via plan-year 2027 reporting
• HealthCare.gov — Tennessee marketplace enrollment, window shopping, and 1-800-318-2596
• healthinsurance.org, Tennessee ACA marketplace page — 2027 carrier list, Cigna exit
• Tennessee SERFF rate filings (finalized ~Sept 28, 2026), via acasignups.net — statewide weighted-average increase ~15.6–15.9%
• KFF (Aug 4, 2026) — national median proposed 2027 premium increase ~15%

Our verification method — primary sources only, dated stamps, and a published corrections policy — is described on How we verify everything on this site.