Do My Medicare and TennCare Plans Have to Be From the Same Company?

TennCare is changing the rules for Dual Special Needs Plans, or D-SNPs, on January 1, 2027. If you have Medicare and full TennCare benefits and you're in a D-SNP, your Medicare plan and your TennCare plan will have to come from the same company.

If you aren't in a D-SNP, this change doesn't affect you. The same goes if TennCare only helps pay your Medicare costs, like QMB-only through a Medicare Savings Program.

01Who does this affect?

A D-SNP is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. In Tennessee, Medicaid is TennCare.

The change applies to full-benefit dual eligibles. That means you get full TennCare coverage, not only help with Medicare costs.

According to TennCare, "By January 2027, full benefit dual eligible individuals who want to be in a Dual Special Needs Plan (D-SNP) must get Medicaid and Medicare benefits from the same health plan."

02What happens if my two plans don't match?

Picture the two cards in your wallet. One is from your Medicare plan. The other is from your TennCare plan.

Both work today. But if each card has a different company's name on it, TennCare says you'll be disenrolled from your D-SNP on January 1, 2027, unless you line them up first.

You'd still have Medicare. You'd still have TennCare. The D-SNP is what ends.

03Why are Medicare and TennCare doing this?

In 2024, CMS finalized a rule that limits new D-SNP enrollment to people in the same company's Medicaid plan starting in 2027, with full alignment required by 2030. Tennessee is requiring it of current members in 2027.

According to CMS, the goal is to "expand access to integrated materials, unified appeal processes across Medicare and Medicaid." CMS also says people with both programs "face a complex assortment of enrollment options" and "aggressive, confusing marketing tactics."

In a 2023 integration project, TennCare set out to "advance quality and experience of care, health equity, and cost efficiency" for people with both programs.

The case for it:

• One company handles both programs, with one set of materials and one appeals process, according to CMS.
• Fewer plans can enroll people outside Open Enrollment, which CMS says cuts down on confusing year-round marketing.
• MACPAC, the commission that advises Congress on Medicaid, says integrated care "has the potential to improve care" and removes the incentive to shift costs from one program to the other.

The concerns:

• Fewer choices. You can only join the D-SNP run by the same company as your TennCare plan.
• Doctors. Two companies can have different provider networks. Justice in Aging, a legal advocacy group, has reported people having to switch providers mid-treatment when plan networks don't line up.
• Fewer chances to fix it. Justice in Aging notes that states limit when you can change Medicaid plans, which limits chances to line the two up.

Not sure how this applies to your own situation? I'll walk through it with you. No cost for the help, and no obligation to enroll.

Logan Cope · Licensed Insurance Agent

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04What are my options?

TennCare lists 2.

1. Change your D-SNP to match your TennCare plan. Call Medicare at 1-800-633-4227 (TTY 1-877-486-2048) or the Tennessee SHIP at 1-877-801-0044. Open Enrollment, October 15 to December 7, is also a time to change Medicare plans.
2. Change your TennCare plan to match your D-SNP. TennCare's window runs June 1 to October 31, 2026. Call TennCare at 1-800-878-3192. The fax number, mailing address and form are on TennCare's D-SNP page.

Which option fits depends on your doctors and which network they're in. Check that before you switch.

05What should I do now?

1. Find your Medicare plan card and your TennCare card.
2. Compare the company name on each.
3. If they match, nothing changes for you.
4. If they don't, pick one of the 2 options. A TennCare plan change has to be requested by October 31.

Two cards. One company name.