Health insurance in Tennessee
Tennessee did not expand Medicaid, so adults below $15,960 can fall through the gap entirely. 11.3% of under-65 residents are uninsured.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Tennessee uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Tennessee has a coverage gap
Tennessee has not adopted the Medicaid expansion. That creates a specific and badly-known problem: the premium tax credit was written on the assumption that everyone below 100% of the poverty guideline would be covered by an expanded Medicaid, so the credit does not start until 100%. In a state that did not expand, an adult below that line qualifies for neither.
In practice that means an adult in Tennessee earning under $15,960 a year — roughly $1,330 a month — may be offered no help at all, while someone earning slightly more gets a substantial subsidy. It is the one part of this system where earning less can leave you worse off.
Tennessee's uninsured rate is 11.3% of under-65 residents, or 658,811 people. Some of them are in this gap.
If your income is near the line, it is worth getting the number right before you assume you do not qualify. Projected annual income is what counts, not last month's pay.
How much choice Tennessee counties get
Counties in Tennessee carry between 3 and 5 insurers, so competition is fairly even across the state without being uniform.
No county in Tennessee is down to a single insurer. Since the previous plan year, 95 counties in Tennessee gained an insurer and none lost one.
How many Tennessee residents buy on the marketplace
569,310 Tennessee residents selected a marketplace plan for 2026. Against the state's under-65 population that is 98 per thousand, above the 26-state median of 79, and 7th highest of the 26 states on this site.
Of those, 92,921 — 16% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (6th of 26).
The spread inside Tennessee
Shelby County is the largest county we publish here, with 732,633 under-65 residents; Bradley County is the smallest, with 91,647. Shelby County has 5 insurers offering 65 plans, and Bradley County has 5 offering 59.
The widest choice in Tennessee is in Shelby County — 5 insurers, 65 plans. The narrowest is Knox County, with 4 insurers and 50 plans. Same state, same rules, 15 more plans to choose from.
Uninsured rates range from 6.5% in Williamson County to 13.3% in Davidson County — 2.0 times as high, within one state.
The 14 largest counties in Tennessee
By under-65 population, covering 63% of the state's under-65 residents. Tennessee has 95 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Shelby County | 732,633 | 12.6% | 5 | 65 | 118 |
| Davidson County | 609,116 | 13.3% | 5 | 65 | 134 |
| Knox County | 413,016 | 9.8% | 4 | 50 | 92 |
| Rutherford County | 328,845 | 11.0% | 5 | 65 | 93 |
| Hamilton County | 306,635 | 11.5% | 5 | 59 | 102 |
| Williamson County | 230,574 | 6.5% | 5 | 65 | 70 |
| Montgomery County | 216,157 | 8.6% | 5 | 65 | 63 |
| Sumner County | 175,579 | 9.6% | 5 | 65 | 77 |
| Wilson County | 142,559 | 8.8% | 5 | 65 | 75 |
| Sullivan County | 124,812 | 10.6% | 4 | 50 | 88 |
| Blount County | 110,795 | 10.0% | 4 | 50 | 82 |
| Washington County | 108,522 | 11.1% | 4 | 50 | 83 |
| Maury County | 92,541 | 9.6% | 4 | 55 | 80 |
| Bradley County | 91,647 | 12.0% | 5 | 59 | 96 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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