Pathway to Independence (PTI)

Pathway to Independence (PTI) is a new TennCare pilot program that helps parents and caretakers move from TennCare to other health insurance. This happens when a family makes too much income to qualify for TennCare anymore. If you are making the change from TennCare to private health insurance, PTI can lower the cost of your new coverage. PTI provides financial assistance to help pay monthly health insurance premiums for up to one year.

Who can participate?

You may qualify if you:

  • Are a parent or caretaker relative of a child under 19.
  • Are losing TennCare because your income increased after getting a new job, working more hours, or receiving a raise or promotion.
  • Have or acquire employer-sponsored health insurance or insurance through a Health Insurance Marketplace plan after losing TennCare.
  • Make between 100% to 250% of the federal poverty level.
Household/family size income limits: two people, $21,641–$54,100; three people, $27,321–$68,300; four people, $33,001–$82,500.

Note: PTI is a pilot program with limited enrollment.

What help is available?

If you are enrolled in PTI:

  • You pay your monthly health insurance premium to your health plan each month and submit proof of payment. PTI reimburses you for the amount over your required contribution of $15 that month, up to a total benefit of $2,000 during the 12-month program.

For example, if your monthly premium is $30, you can be reimbursed $15 from the PTI program.

Note: If your monthly premium is less than $15, your contribution will equal your monthly premium amount.

For example, if your premium is $10 a month, your contribution will be $10.

  • If you haven’t used the full $2,000 by the end of the year, you may be able to use the remaining amount for reimbursement of eligible out-of-pocket medical expenses, such as:
    • Copays
    • Coinsurance
    • Deductibles

Note: You will need to keep receipts for reimbursement for eligible out-of-pocket expenses.

How do I get started?

Next Steps

1. Complete the online interest form

Fill out the interest form to let us know you’d like to participate in the program. You can do this while you are still on TennCare.

TennCare’s PTI partner, Consumer Direct Tennessee (CDTN), will check the information you submit and tell you if you can move forward to the next step.

Note: This is not an application and does not guarantee enrollment.

2. Enroll in Health Insurance and complete enrollment form

If approved in step 1 and there is a slot available for you, CDTN will contact you within 60 days of your TennCare benefits ending and provide you with the PTI enrollment form.

To fill out the enrollment form, you will need to provide proof of enrollment in private health insurance through:

  • Your employer’s health insurance plan, or
  • A qualified Health Insurance Marketplace plan.

Note: Only Silver Marketplace plans qualify for PTI.

3. Receive Premium Assistance

  • If you complete the enrollment requirements and CDTN confirms you are enrolled in PTI, you can be reimbursed for eligible premium payments.
  • Keep your medical receipts if you think you might be eligible for out-of-pocket medical expense reimbursement at the end of your 12 months of PTI.