Using your plan

Buying coverage is half the job. These guides cover what happens when you actually use it.

• What Health Plans Cover — What ACA plans in Tennessee must cover: the 10 essential benefits, maternity, mental health, preventive care, dental and vision, GLP-1s, IVF, and common exclusions.
• How to Read a Health Plan's Deductible and Cost… — What "copay after deductible," "family deductible," and "no charge after deductible" really mean, how to estimate a plan's total yearly cost, and how HSAs fit in.
• PPO vs. HMO vs. EPO — PPO vs HMO vs EPO, explained for Tennessee: referrals, out-of-network coverage, cost, why marketplace PPOs are scarce here, and how to check your doctor's network.
• Deductible, Copay, Coinsurance, Out-of-Pocket Max — Deductible, copay, coinsurance, and out-of-pocket maximum explained in plain English — with a worked example of how a year of care adds up under a 2027 plan.
• Prior Authorization and Referrals — Prior authorization and referrals explained: why insurers require them, what to ask, what to document — and what to do if approval is denied or slow.
• Formularies and Drug Tiers — How formularies and drug tiers set what you pay for prescriptions, why to check your medications before enrolling, and TennCare members' pharmacy benefits.
• Denied Claims — Denied claim in Tennessee? The ladder that works: read the denial letter, file an internal appeal, then request independent external review through TDCI.