---
title: Using your plan
url: https://www.tnhealthcoverageexplained.org/using-your-plan
description: What Tennessee health plans cover and how to use one: benefits, reading the cost table, networks, deductibles, prior authorization, prescriptions, and appeals.
last_verified: 2026-10-23
publisher: TN Health Coverage Explained (independent; does not sell insurance)
---

# Using your plan

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

- **[What Health Plans Cover](https://www.tnhealthcoverageexplained.org/using-your-plan/what-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…](https://www.tnhealthcoverageexplained.org/using-your-plan/reading-your-plan)** — 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](https://www.tnhealthcoverageexplained.org/using-your-plan/networks)** — 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](https://www.tnhealthcoverageexplained.org/using-your-plan/costs-explained)** — 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](https://www.tnhealthcoverageexplained.org/using-your-plan/prior-authorization)** — 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](https://www.tnhealthcoverageexplained.org/using-your-plan/prescriptions)** — 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](https://www.tnhealthcoverageexplained.org/using-your-plan/appeals)** — Denied claim in Tennessee? The ladder that works: read the denial letter, file an internal appeal, then request independent external review through TDCI.