TennCare Covered Services 2026: Complete Benefits Guide

This guide to Tennessee Medicaid covered services answers one question: whether a given procedure, prescription, or doctor visit is covered by TennCare. If you just got approved, or you're trying to figure out what's paid for, start here.

Three things to know before you start. First, TennCare is one of the most managed-care-heavy Medicaid programs in the country. Almost every member is enrolled in a TennCare health plan, BlueCare, UnitedHealthcare Community Plan, Wellpoint (formerly Amerigroup), or TennCare Select, and it's that plan that processes claims, runs prior authorizations, and assigns your care coordinator. Second, TennCare covers a lot more than most members realize, including comprehensive adult dental added in 2023 and a behavioral health benefit delivered by the same MCO that covers your medical care. Third, the answer to "is this covered?" sometimes depends on which TennCare benefit package you're in, adult, child, LTSS, or CHOICES, so we'll walk through each one.1

This guide covers exactly what TennCare pays for in 2026, what it doesn't, what the limits are, and how to appeal if a service is denied.

Key Takeaways

• The federal floor is the same in every state. The Tennessee additions are where it gets interesting. Federal Medicaid law requires every state to cover hospital, physician, lab, family planning, nursing facility, home health, and EPSDT for kids. Tennessee's elected services on top of that include prescription drugs, comprehensive adult dental, behavioral health, durable medical equipment, hospice, and therapy.2
• Adult dental is now comprehensive. Effective January 1, 2023, TennCare added cleanings, fillings, root canals, crowns, dentures, and extractions for all adult members. Renaissance took over as the statewide Dental Benefits Manager from DentaQuest on November 1, 2025, and there are no copays on covered adult dental services.3,4
• Pharmacy is unified across TennCare's health plans. TennCare uses a single program-wide Preferred Drug List administered through OptumRx, so drug coverage does not vary by plan. Copays are $1.50 for generics and $3.00 for brand-name drugs. The old 5-prescription-per-month cap was eliminated effective July 1, 2025, the only remaining limit is two brand-name prescriptions per month for adults (with auto-exempt drugs not counting).5
• Behavioral health runs through your MCO. The same plan that covers your physical health covers your mental health and substance use treatment, and you find behavioral health providers in your own MCO's provider directory.6
• Transportation to your doctor is free, with two business days' notice. TennCare covers non-emergency medical transportation through Verida (BlueCare and TennCare Select) and Tennessee Carriers (UnitedHealthcare and Wellpoint). Self-driver mileage reimbursement in 2026 is the IRS rate of 72.5 cents per mile.7
• Adult vision is narrow, and hearing aids are not on the adult benefit chart. The adult vision benefit is limited to medical evaluation and management of abnormal conditions and disorders of the eye, plus the first pair of glasses or contact lenses after cataract surgery. TennCare's benefit-package chart carries no hearing or audiology line for adults at all, so don't assume a hearing aid will be paid for.2
• If a service is denied, file a TennCare medical appeal. You have only 60 days to appeal after you find out there is a problem, so don't sit on it. Call TennCare Member Medical Appeals at 1-800-878-3192, mail or fax the appeal form, or file online through TennCare Connect.6

How TennCare Defines What You Get: Benefit Packages

Tennessee's Medicaid benefit isn't a single list. It's organized into "benefit packages" that depend on your enrollment category. The document that lays out coverage service by service is the TennCare Benefit Packages chart (last updated April 20, 2026).2

The four packages most relevant to senior members and their families:

If you're age 65 or older and dual-eligible (Medicare + TennCare), Medicare is generally your primary payer for medical services and Part D for drugs, TennCare wraps around with what Medicare doesn't cover, including most long-term services and supports.

Federally-Mandatory Services Every Tennessee Medicaid Plan Covers

These are the services every state Medicaid program must cover under 42 CFR §440.210. TennCare covers all of them, though not all of them sit inside the standard adult package:2

• Inpatient hospital services (excluding institutions for mental disease)
• Outpatient hospital services
• Physician services
• Nurse practitioner and nurse-midwife services
• Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services
• Laboratory and X-ray services
• Family planning services and supplies
• Nursing facility services for members 21 and older (delivered through a long-term care benefit package, not the standard adult Package B)
• Home health services (with adult hour limits, see below)
• Non-emergency medical transportation (NEMT)
• EPSDT for members under 21
• Tobacco cessation for pregnant women

Most of these you'd expect from any health insurance. The three that catch families off guard are home health hour limits for adults, NEMT eligibility rules, and the fact that nursing facility care is not part of the standard adult package (it comes with a long-term care package such as E, J, K, or L). All three are covered later in this guide.2

Tennessee's Optional Add-Ons

Beyond the federal floor, Tennessee elects to cover a wide range of services under its Section 1115 TennCare III demonstration, approved by CMS on January 8, 2021 and running through December 31, 2030. These services are described as "optional" in federal Medicaid jargon, but in Tennessee they are locked into the demonstration and treated as core benefits.2,8

Prescription drugs

TennCare's pharmacy benefit is administered by OptumRx, which has been the statewide Pharmacy Benefit Manager since January 1, 2020. OptumRx publishes one program-wide Preferred Drug List for TennCare rather than a separate formulary per health plan, so drug coverage does not vary by which plan you're in, meaning you cannot "shop plans" for drug coverage the way you can in Medicare Part D. Call OptumRx or check the current PDL before you assume a drug is on or off it.5

Copays:5

• Generic: $1.50 per prescription
• Brand-name: $3.00 per prescription

Who pays them: pharmacy copays apply to adults with TennCare Medicaid who are not in a nursing home, on an HCBS waiver (CHOICES, ECF CHOICES, Katie Beckett), or in an ICF-MR, and to TennCare Standard children whose family income is at or above 100% of poverty. If you're in a nursing facility or on a waiver, you pay nothing at the pharmacy counter.5

Who's exempt: TennCare charges no pharmacy copay for birth control, hospice medications, emergency medications, or pregnancy-related medications, regardless of who's filling them. Federal cost-sharing rules at 42 CFR §447.56 add their own exemptions: children under 18 (and, at state option, certain individuals under 19, 20, or 21), pregnant women, people whose institutional or HCBS assistance is reduced by available income beyond a personal-needs allowance, people receiving hospice care, and American Indian / Alaska Native members who currently receive or have ever received an item or service from an Indian Health Service (IHS) or other Indian health care provider.5

The big change in 2025: TennCare eliminated the long-contested 5-prescription-per-month cap for adults effective July 1, 2025. Adults can now fill as many medically necessary prescriptions as their prescribers order. The two-brand-per-month limit remains in effect, though drugs on the Auto-Exempt and Attestation List don't count against that limit.

Questions, and mail order. OptumRx's Member Call Center is 1-888-816-1680; call it to ask whether a drug is on the PDL, or to set up mail service for a 90-day supply. Your prescriber or pharmacist can reach the Pharmacy Support Center at 1-866-434-5520.5

Adult vaccines. Ask OptumRx or your health plan which adult vaccines are covered and whether any cost-sharing applies before you go to the pharmacy for one.

What pharmacy does NOT cover: Erectile dysfunction drugs, fertility treatment, hair-growth agents, cosmetic drugs, weight-loss programs (with a carve-out for GLP-1 agonists prescribed for type 2 diabetes), most cough/cold OTC medications, and DESI / less-than-effective drugs. GLP-1s prescribed for obesity alone (such as Wegovy or Zepbound) are typically excluded, confirm the current PDL because this is a fast-moving exclusion category.

Adult dental

The 2023 expansion was the single biggest TennCare benefit change in years. Effective January 1, 2023, every adult member age 21 and over receives comprehensive dental: exams and diagnostic X-rays, preventive cleanings, topical fluoride and caries-arresting medicament, fillings, endodontics (root canals), scaling and root planing, full-mouth debridement, crowns, full and partial dentures (including immediate dentures and denture relines), extractions and alveoloplasty, removal of exostosis and tori, palliative treatment, and nitrous-oxide inhalation sedation. TennCare states adult dental is provided at no cost to the member for all medically necessary covered dental benefits.3

Renaissance is the statewide Dental Benefits Manager as of November 1, 2025, replacing DentaQuest. Member services: 866-864-2526 (TTY 711), 7 a.m. to 5 p.m. Central, for questions about covered benefits or to find a participating dentist. There is no separate dental ID card, you keep using the TennCare health plan card you already have. Renaissance assigns each member a dentist (a "Dental Home"), and you can change dentists at any time using the Find a Dentist tool on Renaissance's member portal. Whenever possible members keep their current dentist, but TennCare warns you may see changes in which dentists are in network, so confirm your dentist participates before scheduling. The single statewide network applies regardless of which MCO you're in, dental is not an MCO plan differentiator.4

Children's braces are a narrow exception. Orthodontic treatment is covered only for a child diagnosed with a handicapping malocclusion, which TennCare rule 1200-13-14 defines as a malocclusion causing one of three documented medical conditions: a nutritional deficiency that hasn't responded to medical treatment, a speech pathology that hasn't responded to speech therapy, or laceration of soft tissue caused by a deep impinging overbite. Each must be backed by the treating professional's progress notes predating the orthodontist's prior-authorization request. Braces sought only to improve a child's smile are treated as cosmetic and are not paid for.3

For the full breakdown including pediatric orthodontia rules, the dentist participation reality, and how to appeal a denied dental service, see our dedicated guide: TennCare Dental Coverage in 2026.

Vision

This is one of the most-misunderstood categories of TennCare coverage.2

For adults 21+ (Pkg B): Vision coverage is "limited to medical evaluation and management of abnormal conditions and disorders of the eye." Translation: TennCare covers eye care for diseases (glaucoma, diabetic retinopathy, cataracts, macular degeneration), but it does not cover routine eye exams, refractions, or eyeglasses. The one adult exception is the first pair of cataract glasses or contact lenses following cataract surgery.

Check your plan anyway. Anything a health plan offers beyond TennCare's covered-service list is a plan-level extra, not a member entitlement, and it can change. Read your MCO's current member handbook or call member services before you pay out of pocket for an exam or a pair of glasses.

For children under 21 (EPSDT): Comprehensive vision, refractions, eyeglasses, contact lenses, treatment for any condition discovered. The federal EPSDT mandate sets the floor.

Hearing

Hearing aids are not listed as an adult benefit. TennCare's benefit-package chart carries no hearing or audiology line at all for members 21 and older, so an adult hearing aid is not something to count on. Before you buy, call your MCO's member services and ask what, if anything, your plan will pay toward it.2

A cochlear implant is a different question from a hearing aid. TennCare's adult package does cover durable medical equipment and medical supplies, and hospital and physician services, all subject to medical necessity and your plan's prior authorization, so ask your MCO in writing how it would handle a cochlear implant request before you commit to anything.2

For children under 21 (EPSDT): Hearing aids and audiology are fully covered as part of the federal EPSDT mandate.

Durable medical equipment and medical supplies

Durable medical equipment and medical supplies are on TennCare's adult benefit chart (Package B), covered as medically necessary and delivered through your MCO. Expect prior authorization on higher-cost items, so ask your care coordinator what documentation your plan wants before the supplier orders anything. If the specific device you need isn't approved, that denial is appealable on the same 60-day clock as any other.2

Behavioral health

TennCare delivers behavioral health care through your own managed care organization, the same plan that covers your physical health. You look up therapists, psychiatrists, and substance use providers in your MCO's provider directory, not in a separate plan's directory, and Behavioral Health Services within the Division of TennCare oversees mental health and substance use services program-wide.6

In practice that means one place to call: your MCO's behavioral health line, listed on the back of your TennCare card.

Adult covered services (available based on medical necessity):6

• Psychiatric inpatient care (prior authorization required)
• Individual and family psychotherapy
• Medication management
• Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP)
• 24/7 statewide mobile crisis response, reached through the 988 Suicide and Crisis Lifeline (call or text 988, then press 0)
• Crisis stabilization
• Peer support services
• Supported housing
• Psychosocial rehabilitation
• Intensive community based treatment
• Residential treatment centers and facilities
• Applied behavior analysis (ABA)
• Substance use treatment, including withdrawal management and inpatient, residential, and outpatient levels of care
• Buprenorphine for opioid use disorder through the TennCare BESMART provider network (prior authorization applies, and those requirements changed effective March 11, 2026)

Tennessee Health Link (THL). For the members with the highest behavioral health needs, TennCare coordinates care through Tennessee Health Link, built with TennCare's three health plans to encourage the integration of physical and behavioral health. THL providers are predominantly Community Mental Health Agencies (Centerstone, Frontier Health, Mental Health Cooperative, Volunteer Behavioral Health, Helen Ross McNabb Center, Cherokee Health Systems, and others).6

Crisis care runs on a statewide continuum. Tennessee operates a 24/7 statewide mobile crisis response for adults, children, and youth, plus crisis walk-in centers and crisis stabilization units. You reach it by calling or texting 988 and pressing 0 to speak with a licensed counselor.6

The Behavioral Health Safety Net (BHSN). If you're an adult with serious mental illness who isn't eligible for TennCare and doesn't have private insurance covering mental health care, the BHSN is a separate program funded by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) that provides outpatient mental health services to low-income, uninsured Tennesseans. Contact your regional community mental health agency to check whether you qualify.

Therapies (PT, OT, speech)

Physical therapy, occupational therapy, and speech therapy are all covered for adults under Package B. Medical necessity governs, and your MCO may apply prior authorization for ongoing courses of treatment, so ask your plan how many visits it has authorized before you start a course.2

Hospice

Hospice care is covered. Hospice members are exempt from pharmacy copays.2

Home health

Home health is a federally-mandatory service that TennCare covers for adults, but the adult benefit carries weekly hour limits on skilled nursing and home health aide services (with somewhat higher limits for members at a higher nursing-facility level of care). Your MCO and plan of care set the exact authorized hours; ask your care coordinator for the current limit that applies to you.2

If you need ongoing hands-on help beyond what home health allows, the conversation moves to private-duty nursing or to CHOICES home and community-based services, which add personal care, attendant care, adult day, and home modifications on top of the standard medical benefit.

Private-duty nursing (PDN)

For adults age 21 and older, private-duty nursing is restricted to services needed to support ventilator equipment or other life-sustaining medical technology. For members under 21, the federal EPSDT mandate removes that ventilator-only restriction.2

Podiatry and chiropractic

Both are covered as medically necessary for adults across all benefit packages, though the practical scope is narrow.2

Transportation: Getting to Your Appointments

TennCare's non-emergency medical transportation (NEMT) benefit covers rides to any covered TennCare service for members who have no other reasonable means of transportation. The benefit is grounded in 42 CFR §431.53, the federal "assurance of transportation" regulation.7

Important: Tennessee uses a broker-per-MCO model, not a single statewide vendor. Two transportation brokers serve four lines of business:

Modivcare and MTM are not current TennCare brokers, that's a frequent point of confusion because Modivcare was the broker in earlier years.

What trips qualify: Doctor visits, specialist visits, dialysis, hospital discharge, PT/OT/speech therapy, lab and imaging, covered dental and vision care, behavioral health appointments, and SUD treatment visits. The rule is simple: if TennCare covers the service, NEMT covers the ride to it.

What doesn't qualify: Personal errands, social visits, family events, non-medical destinations, and trips for services TennCare doesn't cover. Note: Because TennCare does not cover methadone for opioid use disorder pharmacotherapy, transportation to a methadone clinic for OUD treatment is not a covered NEMT trip. (Transportation to other forms of OUD treatment, buprenorphine, residential SUD, outpatient counseling, remains covered.)

Driving yourself, or having someone drive you. Instead of a broker-arranged ride, you can take mileage reimbursement at the IRS standard business mileage rate, 72.5 cents ($0.725) per mile effective January 1, 2026, paid to you or your designated driver. The trip still has to be pre-scheduled with the broker, so call before the appointment rather than after it. Ask your broker what other modes it can arrange, wheelchair-accessible or stretcher transport, for example, and what documentation it needs.7

Scheduling. Rides must be scheduled at least 2 business days before the appointment. Same-day urgent transport is arranged when the broker can verify the urgency with your medical provider. NEMT is for non-urgent scheduled trips only, for a true emergency call 911, since emergency ambulance is a separate Medicaid benefit.

Cost to members: zero. NEMT is provided at no cost.

CHOICES, ECF CHOICES, and Katie Beckett: What Long-Term Care Adds

If you're enrolled in TennCare's long-term services and supports programs, you receive the standard medical benefit plus a wraparound of home and community-based services. The wraparound is not a replacement for regular TennCare, it's additive.

TennCare CHOICES Group 2 and 3 (HCBS for adults 65+ and adults with physical disabilities). The CHOICES home and community-based array includes personal care, attendant care, in-home and inpatient respite, adult day care, home-delivered meals, a Personal Emergency Response System, assistive technology, minor home modifications, and care coordination. The array and its per-service limits are enumerated in Tenn. Comp. R. & Regs. 1200-13-01-.05(8)(l). Two cost ceilings bound the benefit: Group 2 (HCBS in lieu of a nursing facility) is subject to an individual cost-neutrality cap equal to the average daily cost of nursing-facility care, which is $294.87 per day, or $107,627.55 per year, effective January 1, 2026; Group 3 (the "At Risk" population) has a separate annual HCBS expenditure cap of $18,000 (excluding minor home modifications).9

ECF CHOICES (Employment and Community First for I/DD). ECF CHOICES is employment-first, built around competitive integrated employment and community living. Among its published per-service limits: Personal Assistance, which is available to ECF CHOICES Groups 5 and 6, is capped at 215 hours per month; Community Transportation at $225 per month for members using Consumer Direction; Assistive and Enabling Technology combined at $5,000 per person per calendar year; minor home modifications at $6,000 per project, $10,000 per calendar year, and a $20,000 lifetime maximum; respite at 216 hours (or 30 days) per year; and adult dental at $5,000 per member per calendar year (and $7,500 across three consecutive calendar years) on top of standard adult dental. A Family Caregiver Stipend is available in lieu of Supportive Home Care for ECF CHOICES Group 4.1

Katie Beckett (children with significant disabilities). Part A serves children who meet an institutional level of care but are cared for at home: it provides full TennCare Medicaid plus up to $15,000 per child per calendar year in HCBS wraparound (respite, supportive home care, and home and vehicle modifications), with sub-limits of $5,000 per year for equipment and assistive technology and $500 per year for family-caregiver education. Part A is capped at 300 enrolled children statewide, children are enrolled into an open slot in order of their level-of-care prioritization score, and families with income above 150% of the Federal Poverty Level pay premiums as described in TennCare Rule Chapter 1200-13-20.1

These long-term care services are detailed in our dedicated guides:

• TennCare CHOICES
• ECF CHOICES
• Katie Beckett

Important coverage line: Personal care, adult day services, and home modifications are not part of the standard adult benefit. They are available only through CHOICES, ECF CHOICES, Katie Beckett, or one of the legacy 1915(c) HCBS waivers.

EPSDT: How Coverage Differs for Members Under 21

Federal Medicaid law's Early and Periodic Screening, Diagnostic, and Treatment mandate requires every state to cover any medically necessary service for enrolled children, even if it's not covered for adults. EPSDT raises the floor substantially:2,3

If your child's pediatrician says a service is medically necessary, EPSDT is your legal backstop, services that adults cannot get may still be covered for your child.

What's NOT Covered for Adults

Set realistic expectations up front. The following are either excluded from the standard adult benefit or absent from TennCare's published adult benefit lists, which in practice means you should not count on them:2,3

Anything else you're wondering about, don't guess from this list either way. Ask your MCO in writing what your benefit package covers before you schedule the service, and if the answer is no and you think it should be yes, that denial is appealable.

If you want any of these, expect to pay out of pocket, or, in the case of cosmetic services, through private insurance or self-funded financing.

Copays: Pharmacy and Otherwise

Pharmacy copays ($1.50 generic / $3.00 brand) apply to adults with TennCare Medicaid who are not in a nursing home, on an HCBS waiver, or in an ICF-MR, and to TennCare Standard children at or above 100% of poverty. Exemptions covered earlier.5

Non-pharmacy copays depend on income. For TennCare Medicaid Aged, Blind, and Disabled adults at or below 133% of the Federal Poverty Level, which is the 65+ population most ABD members fall into, non-pharmacy copays are zero for all covered services.2

For higher-income TennCare Standard members:2

• 134–199% FPL: $5 PCP / specialist / inpatient; $8.20 ER non-emergency (waived if admitted)
• ≥200% FPL: $15 PCP, $20 specialist, $100 inpatient, $50 ER non-emergency

Adult dental is provided at no cost to the member for all medically necessary covered dental benefits.3

Prior Authorization: When Your MCO Decides First

Most routine services are covered without your having to think about prior authorization. The categories that typically need PA from your MCO include:2

• Inpatient psychiatric admissions
• Residential SUD treatment
• Intensive Outpatient Programs and Partial Hospitalization
• Specialty drugs and non-preferred drugs (the PDL has a clinical pathway)
• Advanced imaging (MRI, CT, PET)
• High-cost durable medical equipment
• Non-emergency surgical admissions
• Out-of-network non-emergency services
• Crowns, dentures, periodontal surgery, deep sedation, select endodontic procedures (handled by Renaissance for dental)

Decision windows. Federal managed-care rules cap how long a plan may take on a prior-authorization decision and require a faster answer when your health needs one, they do not entitle the plan to the full window. Ask your MCO for its standard and expedited turnaround in writing, and ask for an expedited review by name if waiting would put your health at risk.

The pharmacy backstop. Federal law (42 USC §1396r-8(d)(5)), which Tenn. Code §71-5-197(b) expressly ties TennCare to, requires a response to a drug prior-authorization request within 24 hours and requires that a pharmacist be able to dispense at least a 72-hour emergency supply of a covered outpatient drug, so you should never go without a critical medication while PA is being processed.5

EPSDT and emergencies. EPSDT gives members under 21 a broader entitlement than the adult package does, and an emergency is an emergency, call 911 rather than waiting on an authorization. If a plan denies a child's medically necessary service or an emergency service for want of prior authorization, treat that as appealable and file inside the 60-day window.

How to Appeal a Denied Service

This is the section TennCare members get wrong most often, and the deadline is the part that bites. You have only 60 days to appeal after you find out there is a problem, and the appeal goes to TennCare Member Medical Appeals.6

You can still file an MCO grievance, and you should if your concern is about quality of care, customer service, or a billing dispute that doesn't involve a covered-service denial. But for a denied, reduced, or delayed service, the pathway that protects your rights is the TennCare medical appeal, and its 60-day clock keeps running while you wait on anything else.

Get help filing. Free help with TennCare appeals is available from these organizations:

Dental follows the same path. Even though dental is administered by Renaissance as the statewide DBM, a dental service that is denied, reduced, or delayed goes to TennCare Member Medical Appeals like any other denial, on the same 60-day clock. Call Renaissance at 866-864-2526 with questions about what your dental benefit covers, but don't let that call eat your appeal window.4,3

How TennCare Coordinates with Medicare for Dual Eligibles

If you have both Medicare and TennCare (a "dual-eligible"), Medicare is your primary payer for medical services and Medicare Part D for prescription drugs. TennCare wraps around:5

• Part D-covered drugs: federal law bars Medicaid from paying for a Part D-covered drug, or any cost sharing on it, for a full-benefit dual (42 USC §1396u-5(d)(1)). A state may elect to cover drugs that Part D excludes, such as benzodiazepines, barbiturates, and certain prescription vitamins. If you take one of those, check the current TennCare PDL rather than assuming either way.5
• Part B coinsurance / deductibles: what TennCare picks up on the Medicare side depends on which dual-eligible category you're in. Ask TennCare Connect at 855-259-0701 to confirm your category before you pay a Medicare cost-sharing bill.
• Part D copays: full-benefit duals qualify for the full Part D Low-Income Subsidy (Extra Help), which pays 100% of the Part D premium up to the benchmark and zeroes out the annual deductible (42 USC §1395w-114). Coinsurance is eliminated entirely only for duals who are institutionalized, or who would be but for home and community based services. Every other full-benefit dual still owes a nominal copay per prescription, and TennCare cannot pay it for you.5
• Long-term services and supports: Medicare doesn't cover most LTSS. TennCare's CHOICES, ECF CHOICES, and standard nursing facility benefits are the LTSS pathway for duals.

Bottom Line

If you just got approved for TennCare, the short version of what to expect is this:

• The federal floor is solid, hospital, physician, lab, family planning, home health, and EPSDT for kids. Nursing facility care is covered too, but through a long-term care package rather than the standard adult one.
• Tennessee adds a comprehensive adult dental benefit (since 2023), a unified statewide pharmacy formulary through OptumRx, behavioral health delivered by your own MCO, and free non-emergency transportation through your MCO's broker.
• The biggest gaps in adult coverage are routine vision and eyeglasses, adult orthodontia, fixed bridges, dental implants, and services like personal care or adult day care, those last two reserved for CHOICES and ECF CHOICES. Hearing aids belong on that list in practice too: TennCare's adult benefit chart carries no hearing or audiology line at all, so ask your plan before you assume.2,3
• For dual-eligibles 65+, Medicare runs primary; TennCare wraps around with what Medicare doesn't cover, including most long-term services and supports.
• If a service you believe should be covered is denied, call 1-800-878-3192 within 60 days of finding out there's a problem and file a TennCare medical appeal.

The hardest part of using TennCare in 2026 isn't the benefit. It's navigating a managed-care system where the answer to "what's covered?" depends on which package you're in, which MCO you're enrolled in, and whether the question is medical, dental, pharmacy, or behavioral health. When in doubt, call the member services line on your TennCare ID card, and don't take a verbal "not covered" from a provider's front desk as the final answer.

Learn More

Find personalized help understanding what TennCare covers at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.