Tennessee Medicaid Health Plans: TennCare MCOs Compared 2026

Tennessee runs the most concentrated Medicaid managed care market in the country. Almost every one of TennCare's 1.4 million members is enrolled in one of just three Managed Care Organizations (MCOs): BlueCare Tennessee (BlueCross BlueShield of Tennessee), UnitedHealthcare Community Plan of Tennessee, and Wellpoint Tennessee (which TennCare lists as "formerly known as Amerigroup"). A fourth plan, TennCare Select, serves defined special populations and is administered by Volunteer State Health Plan (BlueCare's parent company) under a separate, non-risk agreement with the Division of TennCare.1,2

Most other Medicaid managed care states have ten or more plans, regional carve-outs, separate networks for different programs, and complicated carve-out rules for behavioral health, dental, or long-term care. Tennessee has three statewide MCOs sharing one program-wide pharmacy formulary and one statewide dental network, so the two categories families shop hardest on drop out of the comparison entirely. Non-emergency transportation is the exception to watch: the benefit rules are the same for everyone, but the broker that actually arranges your rides is assigned by plan, not by the state.3

This guide explains who must enroll, how the three plans actually differ, how to switch, and how to pick the right one for your family.

Why Tennessee Has Only Three MCOs

TennCare operates under Section 1115(a) demonstration authority. The current demonstration, TennCare III (Project Number 11-W-00369/4), was approved by CMS effective January 8, 2021 through December 31, 2030, an unusually long ten-year approval that authorizes Tennessee's entire Medicaid program. The demonstration is what lets Tennessee run nearly all of Medicaid, long-term care included, through a small number of at-risk contracted MCOs: TennCare CHOICES home and community based services are paid as demonstration expenditures rather than under a Section 1915(c) waiver of Tennessee's own, which is how most other states authorize their Medicaid LTSS. (Tennessee does still operate a separate Section 1915(c) waiver for individuals with intellectual disabilities, which is why some members are assigned to TennCare Select instead of a standard MCO. More on that below.)7

Why the small-number structure: Tennessee's TennCare design philosophy has been to leverage scale, simplify the member experience, and concentrate accountability in a few large plans. The trade-off is less plan choice; the upside is uniform pharmacy and dental coverage and a single set of switching rules for the whole state.

Who Must Enroll in a TennCare MCO

Most TennCare members must enroll in a plan. The major exception is Medicare-only QMB (Qualified Medicare Beneficiary) enrollees, people whose Medicaid coverage pays only their Medicare Part A and Part B premiums (the standard Part B premium is $202.90/month in 2026) plus their Part A and Part B deductibles, coinsurance, and copayments, without providing full Medicaid benefits. Under 42 USC § 1396a(n)(3)(B) a QMB is protected from being billed for that Part A and Part B cost-sharing. Note the boundary: it is not a promise that every Medicare charge disappears. A dual-eligible who is not institutionalized (or would not be but for home and community based services) can still owe nominal Part D per-prescription copays.4 Full-benefit dual eligibles (those with both Medicare and full TennCare, sometimes called "QMB Plus" or "SLMB Plus") ARE enrolled in MCOs for their Medicaid services. For the full breakdown of QMB / SLMB / QI eligibility and how the Medicare Savings Programs interact with TennCare CHOICES, see our Tennessee Medicare Savings Programs deep guide.6,8

Certain populations are assigned to TennCare Select rather than a standard MCO. TennCare Select is a state self-insured prepaid inpatient health plan (PIHP) that operates in all areas of the state and covers the same services as the MCOs, and it is not open to voluntary selection. Under Tenn. Comp. R. & Regs. 1200-13-13-.03, its four populations are:6

• Children under 21 who are eligible for SSI
• Children in state custody, plus children leaving state custody for six months post-custody as long as the child remains eligible
• Children under 21 in an institutional eligibility category who are receiving care in a nursing facility or an intermediate care facility, and children and adults in the Section 1915(c) home and community based services waiver for individuals with intellectual disabilities (BlueCare serves this group through its SelectCommunity product line)
• Enrollees living in areas where there is insufficient MCO capacity to serve them

Children under 21 eligible for SSI and children in an institutional eligibility category may choose to leave TennCare Select for another MCO if one is available. Children in state custody and members in insufficient-capacity areas must stay.

Note the age limits, because this one is easy to get wrong. An adult in an institutional eligibility category, an elderly nursing-facility resident for example, is not a TennCare Select population under this rule. Most adults age 65+ on standard TennCare and most adults under 65 with disabilities enroll in one of the three standard MCOs (BlueCare, UHC, or Wellpoint). Separately, members enrolled in ECF CHOICES may select only from the MCOs participating in ECF CHOICES.6

Initial MCO Assignment, How TennCare Picks for You (Or You Pick)

The rule is that individuals or families determined eligible for TennCare select a health plan at the time of application, and the plan must be available in the Grand Division of the state where the enrollee lives. When you apply through TennCare Connect (online at tenncareconnect.tn.gov or by phone at 1-855-259-0701), you can request a specific MCO. You are given your choice of MCO when possible. If your requested MCO cannot accept new enrollees, the Bureau of TennCare assigns you to one that is; if no MCO in your Grand Division is available to enroll new members, you are assigned to TennCare Select until one becomes available.6

Members who reach TennCare through Social Security Administration channels, for example, automatic SSI cascade enrollment, are auto-assigned without an upfront pick. They can switch later within their initial 90-day window or during their Grand Division's annual change month.

Applications and plan selection both run through TennCare Connect. For help choosing a plan, TennCare tells members to contact an agency in their area, the Area Agencies on Aging and Disability, reachable from anywhere in the state at 1-866-836-6678. Free enrollment help is also available from local TennCare advocates, community health navigators, and Legal Aid groups.6

The Annual Change Period, the New-Member Window, and Hardship

Tennessee's switching rules are easy to get wrong because the state has an annual change period staggered by Grand Division, a new-member without-cause window, and a narrow hardship-reassignment path, and the three operate on different timelines.

Annual change period by Grand Division

During your Grand Division's annual change month you can switch plans without giving a reason. Two limits apply: only one MCO change is permitted every twelve months, and members enrolled in ECF CHOICES may select only from the MCOs participating in ECF CHOICES. Outside that window, you need either (1) to be inside your initial 90-day new-member window or (2) an approved hardship reassignment.6

New-member without-cause window

The administrative rule (Tenn. Comp. R. & Regs. 1200-13-13-.03, chapter as revised January 2026) says a newly enrolled member may change MCOs one time within 90 calendar days (inclusive of mail time) of the date of the letter informing them of their MCO assignment, provided another MCO in their Grand Division is currently permitted by the Bureau to accept new enrollees. If you find a source quoting a shorter window, check its date: an older 2008 compilation of this same rule said 45 days and is still floating around online. Ninety days is the current rule, and TennCare Connect (1-855-259-0701) can confirm the date on your own assignment letter.6

Hardship reassignment (the narrow off-cycle path)

Outside those two windows, the Bureau of TennCare can approve a change only as a hardship reassignment, and the rule draws that box tightly. A request must meet all six hardship criteria in Tenn. Comp. R. & Regs. 1200-13-13-.03(2)(b), beginning with a medical condition that requires "complex, extensive, and ongoing care" and a specialist who "has stopped participating in the member's current MCO network and has refused continuation of care."

The rule also names situations that are expressly not hardships, including:

• The member is unhappy with the current MCO or primary care provider, but there is no hardship medical situation.
• The member claims a lack of access to services, but the plan meets the state's access standard.
• The member's PCP is no longer in the MCO's network, the member wants to keep seeing that PCP, and the member has refused the alternative PCP or provider choices the MCO offered.

That last exclusion matters most, because it is the assumption families most often arrive with. In Tennessee, losing a provider from your plan's network is not by itself a ticket to switch mid-year. If your MCO offers you an in-network alternative and you turn it down, the rule treats that as not a hardship.

There is one path built specifically for long-term care members. If a TennCare CHOICES member is determined, based on an assessment of needs, to require a long-term care service the current MCO does not offer but another MCO does, the Bureau first works with the current MCO to arrange it, which may mean providing the service out of network. It counts as a hardship reason to change plans only if the current MCO, after working with the Bureau, cannot provide the required service.6

How to request a change

Go through TennCare Connect at tenncareconnect.tn.gov, the TennCare Connect mobile app (iOS and Android), or by phone at 1-855-259-0701. Ask for your change's effective date when it is approved, and keep the confirmation, since your old plan stays responsible for your care until the new one starts.6

What's the Same Across All Three Plans

Before getting to differences, it's important to know what is uniform, because the two categories families most often plan-shop on, pharmacy and dental, are not plan-by-plan choices in Tennessee at all. Transportation is the category that looks uniform and isn't quite: same rules, different vendor.

Pharmacy: a single statewide formulary

TennCare uses a single statewide Pharmacy Benefit Manager, OptumRx (TennCare's PBM since January 1, 2020; member call center 1-888-816-1680), and one program-wide Preferred Drug List (PDL) rather than a separate formulary per health plan. If a drug is on the TennCare PDL, it's covered the same way by BlueCare, UnitedHealthcare Community Plan, and Wellpoint. If it's not on the PDL, the same prior-authorization process applies regardless of plan. Where copays apply they are $1.50 per generic and $3.00 per brand-name drug, and they apply only to adults with TennCare Medicaid who are not in a nursing home, an HCBS waiver, or an ICF-MR, and to TennCare Standard children whose family income is at or above 100% of poverty. TennCare charges no pharmacy copay for birth control, hospice medicines, emergency medicines, or medicines you get while pregnant. TennCare stopped enforcing its five-prescriptions-per-month limit effective July 1, 2025; the two-brand-names-per-month limit remains in effect, and drugs on TennCare's Automatic Exemption List don't count toward it. Plan-shopping for prescription coverage doesn't work in Tennessee the way it does in Medicare Part D.4

Dental: a single statewide network

Effective January 1, 2023, TennCare began covering dental services for adults age 21 and older. All dental services for both adults and children are furnished through a statewide dental benefits manager (DBM); since November 1, 2025 that DBM has been Renaissance, reachable at 866-864-2526 from 7am to 5pm CT. Covered adult categories include diagnostic x-rays and exams, preventive cleanings, fluoride treatments, fillings, endodontics (root canals), scaling and root planing, crowns, partial and complete dentures, extractions, and palliative treatment. TennCare states that all adult members have dental benefits at no cost to them for all medically necessary, covered dental benefits. Children receive comprehensive dental services as medically necessary until they reach age 21. The same dentist network and the same authorization rules apply across all three MCOs.5

Non-emergency medical transportation: same rules, different broker

NEMT is a no-cost benefit for members who have no access to transportation, and the benefit rules are the same whichever plan you are in. The delivery is not statewide-uniform: TennCare uses a broker-per-MCO model rather than a single statewide vendor. Verida serves BlueCare and TennCare Select, and Tennessee Carriers serves UnitedHealthcare Community Plan and Wellpoint. So if the transportation vendor matters to you, that one is a reason to compare plans. Rides can be scheduled to any TennCare-covered service and must be booked at least two business days ahead; urgent same-day trips are arranged when the broker verifies urgency with the provider. NEMT does not cover personal errands, non-medical destinations, or trips to non-covered services. A mileage-reimbursement option (paying the member or a designated driver) pays the IRS standard business mileage rate, 72.5 cents per mile effective January 1, 2026.3

Vision: narrow for adults, and the cataract exception matters

For adults 21 and older, TennCare vision coverage is limited to medical evaluation and management of abnormal conditions and disorders of the eye, plus the first pair of cataract glasses or contact lenses following cataract surgery. That cataract pair is the piece older members most often don't realize they have. Because the benefit is limited to those categories, routine eye exams and ordinary eyeglasses for an adult are not covered. The rule is the same across all three MCOs.9

Behavioral health

Behavioral health, meaning both mental health and substance use disorder care, is integrated into each MCO's medical benefit: the plan that covers your physical health covers your behavioral health, and you find providers through your own MCO's directory. There is no separate statewide behavioral-health entity to enroll with.10

How Tennessee Medicaid Health Plans Genuinely Differ

This is where the comparison gets interesting. The table below is the side-by-side, drawn from TennCare's own MCO listing and annual reporting.2,1

BlueCare Tennessee

BlueCare is the largest TennCare MCO by enrollment and leverages BlueCross BlueShield of Tennessee's broad commercial provider network, which is why it is often described as having one of the widest provider footprints in the state. BlueCare is the TennCare line of business of Volunteer State Health Plan, Inc. (VSHP), a subsidiary of BlueCross BlueShield of Tennessee. VSHP has also administered TennCare Select since July 1, 2001 under a separate agreement with the Division of TennCare, one in which the State, not VSHP, is at risk for the cost of medical services.2

For members needing long-term services and supports, BlueCare runs a layered care-coordinator structure:

• TennCare CHOICES members (adults 65+ and adults 21+ with physical disabilities): dedicated Care Coordinators reachable through member services at 1-800-468-9698.2
• SelectCommunity for members with intellectual or developmental disabilities: nurse Care Managers.
• ECF CHOICES participants: dedicated support coordinators.

The MyHealth Toolkit mobile app provides a digital ID card, find-care search, claims, telehealth, and secure messaging. CareTN is BlueCare's case-management text-message platform, useful for high-needs members and pregnant women.

Best fit for: LTSS members who value a layered care-coordinator structure, and families whose existing providers are in-network with the BlueCross BlueShield commercial network.

UnitedHealthcare Community Plan of Tennessee

UnitedHealthcare Community Plan operates a statewide network with national-scale infrastructure. It is the d/b/a of UnitedHealthcare Plan of the River Valley, Inc., a UnitedHealth Group company. Its flagship differentiator is Healthy First Steps, an outreach and rewards program for pregnant members that pays incentives for attending prenatal visits, postpartum visits, and well-child checks.2

The standard UnitedHealthcare mobile app provides a digital ID card, claims, find-care, and virtual visits. NEMT runs through Tennessee Carriers at 1-866-405-0238.3

If your regular provider leaves the UnitedHealthcare network, that alone does not entitle you to switch mid-year. Ask the plan for an in-network alternative first, and read the hardship section above before assuming you can change plans off-cycle.

Best fit for: pregnant members and families with young children (Healthy First Steps); members who value a strong national app and customer-service infrastructure; families whose existing providers are in-network with UnitedHealthcare.

Wellpoint Tennessee

Wellpoint is the new name for the plan TennCare still lists as "formerly known as Amerigroup." Despite the new name, the contract, network, and Tennessee operations carry forward from Amerigroup, so older sources referring to "Amerigroup Tennessee" mean today's Wellpoint.2

Wellpoint's signature program is Healthy Rewards, cash and gift-card incentives for completing prenatal visits, postpartum visits, well-child checks, and other preventive milestones. Members can check the current Tennessee reward details on the Wellpoint Healthy Rewards page.

The Sydney Health mobile app provides a digital ID card, find-a-doctor, live chat with member services, claims, and prescriptions. Member services: 1-833-731-2153 (TRS 711).2

Wellpoint offers whole-health and community-resource programs (housing, food access, employment supports), with Care Coordinators for TennCare CHOICES, ECF CHOICES, Katie Beckett members, members with complex chronic conditions, and high-risk pregnancies.

Best fit for: members who want a feature-rich mobile experience; families participating in maternity rewards programs; members who benefit from community-resource referrals beyond medical care.

What About D-SNPs and Medicare Marketing?

This is one of the most common sources of confusion among Tennessee Medicaid families.

A Dual Eligible Special Needs Plan (D-SNP) is a separate Medicare enrollment from your TennCare health plan. D-SNPs are Medicare Advantage plans designed for dual-eligibles (people with both Medicare and full Medicaid), and the extra benefits a D-SNP advertises are Medicare benefits attached to that Medicare plan, not TennCare Medicaid benefits. So don't pick a TennCare MCO based on Medicare D-SNP marketing copy; they're different product lines, and the extras don't follow you to the Medicaid side. Each TennCare MCO has an aligned D-SNP product:

• BlueCare Tennessee → the BlueCare Plus D-SNP plans (BlueCross BlueShield of Tennessee)
• UnitedHealthcare Community Plan → the UnitedHealthcare Dual Complete D-SNP plans
• Wellpoint Tennessee → Wellpoint's own D-SNP plans (Wellpoint was formerly Amerigroup, so check the current product name with the plan)11

If you are a dual-eligible in a D-SNP, alignment is no longer optional. By January 1, 2027, a full-benefit dual eligible who wants to be in a D-SNP must get Medicaid and Medicare benefits from the same health plan. TennCare opened a special enrollment period running June 1, 2026 through October 31, 2026 so members can change their TennCare health plan to match their D-SNP. If your D-SNP with BlueCare, UnitedHealthcare, or Wellpoint and your TennCare health plan still don't match on December 31, 2026, you will be disenrolled from the D-SNP and moved to Original Medicare. Ask your D-SNP or 1-800-MEDICARE what happens to your drug coverage in that case, since it moves with the Medicare plan, not with TennCare.2

If you're a dual-eligible and the two don't match today, this is the single most time-sensitive item on this page. Check which company runs your D-SNP, check which MCO runs your TennCare, and if they differ, call TennCare Connect at 1-855-259-0701 during the special enrollment period.6 Aligned products also tend to share a single Care Coordinator and cut down on paperwork.

Quality, Accreditation, and Where to Look for Performance Data

TennCare states that all three of its Managed Care Organizations have passed the NCQA (National Committee for Quality Assurance) accreditation process. Each plan's individual ratings are published on its NCQA Report Card page.2

Read that statement for what it is: a pass/fail floor cleared by every plan, not a ranking that separates them. For plan-level detail, start with each plan's own NCQA Report Card page, and ask TennCare Connect at 1-855-259-0701 which HEDIS and External Quality Review reports are posted for the year you're deciding in.6

For dual-eligibles also picking a Medicare D-SNP, CMS Star Ratings (a separate methodology from NCQA) apply to the Medicare side and are published annually at medicare.gov.

How to Choose Among Tennessee Medicaid Health Plans

Most Tennessee families will spend less time on this decision than they should. Here's a five-minute framework that catches most of the meaningful differences.

How TennCare Compares to Other States

If you've moved to Tennessee from another state, the shape of the program here is probably simpler than what you left. Tennessee runs nearly everything through the same three MCOs, plus TennCare Select for defined special populations, with one program-wide pharmacy formulary, one statewide dental network, and one set of switching rules for the whole state.6,4

Many other states do the opposite: more plans, plan choice that varies by region, and separate managed-care programs or carve-outs for behavioral health or long-term care. Don't carry another state's assumptions into Tennessee, and check that state's own Medicaid agency for how its plans are structured, because this page describes Tennessee only.

The Tennessee approach trades plan choice for simplicity. For most families, simplicity wins.

Key TennCare and MCO Contacts

Start with TennCare Connect to apply, pick a plan, or switch. To confirm whether your doctors are in-network, call each MCO's member-services line directly.6,2

What to Read Next

• Tennessee Medicaid Programs, the master Medicaid hub explaining how CHOICES, ECF CHOICES, Katie Beckett, standard ABD, and MSPs fit together.
• Tennessee Medicare Savings Programs (QMB / SLMB / QI): The Complete 2026 Guide, the deep dive on Medicare premium and cost-sharing assistance for low-income Tennessee Medicare beneficiaries.
• How to Apply for TennCare, the four application channels, document checklist, and ex parte renewal mechanics.
• TennCare CHOICES, the LTSS umbrella for adults 65+ and adults with physical disabilities.
• ECF CHOICES, the I/DD program for children and adults with intellectual or developmental disabilities.
• Katie Beckett, the program for severely disabled minors whose family income would otherwise disqualify them from TennCare.
• Tennessee Medicaid Nursing Home Coverage, how nursing facility care under CHOICES Group 1 actually works.
• Managed Care Organization (MCO), Glossary, the technical primer on Medicaid managed care.

Learn More

Find personalized help comparing TennCare MCO plans 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.