Tennessee Travel Nurses: Why Marketplace HMOs Fail When You Travel
Fast take: HMO networks stop at state borders—your Tennessee HMO won't cover you in Georgia, Alabama, or any other state. Marketplace plans are designed for people who stay in one place, not travel nurses. Private PPO plans give you nationwide networks that work in all 50 states, often at lower rates than marketplace plans because of healthier risk pools.
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The Problem: HMOs Are State-Locked
When you buy health insurance on Healthcare.gov in Tennessee, you're getting an HMO network built for Tennessee residents. The insurance carrier contracts with Tennessee hospitals and doctors. Those contracts don't extend to Georgia, Alabama, Kentucky, Virginia, North Carolina, South Carolina, Mississippi, or Missouri.
If you need care outside Tennessee, your HMO will only cover:
- True emergencies — and the insurance company decides what counts as an emergency after the fact
- Nothing else — routine care, urgent care, prescriptions, specialists are all out-of-pocket
You're traveling to Nashville, Knoxville, Memphis, and Chattanooga for assignments. But your assignments also take you to Atlanta, Birmingham, Charlotte, and Huntsville. Your marketplace HMO leaves you uncovered the moment you cross a border.
Real Example: $8,400 Emergency Room Bill
Sarah, a travel nurse from Nashville, took a 13-week contract in Birmingham, Alabama. Week 3, she developed severe abdominal pain and went to the ER. Appendicitis. Emergency surgery.
Her Tennessee marketplace HMO initially denied the claim. After appeals, they covered the surgery but not the ER physician, anesthesiologist, or follow-up care. Her out-of-pocket bill: $8,400.
A Private PPO plan would have covered the entire visit at in-network rates in Alabama.
Why Travel Nurses Need Private PPO Plans
Private PPO (Preferred Provider Organization) plans are off-exchange health insurance options available only through licensed agents. They're medically underwritten, which means you apply based on your health history instead of getting guaranteed acceptance like marketplace plans.
Why medical underwriting actually saves you money: Because Private PPO plans screen for health risks, they attract healthier applicants. This creates a lower-risk pool, which means lower premiums for everyone who qualifies. If you're healthy enough to pass a hospital's employment health screening, you'll likely qualify—and save money compared to marketplace plans.
Key Advantages for Travel Nurses
✓ Nationwide networks — Coverage works in all 50 states
✓ No referrals — See specialists directly
✓ Year-round enrollment — Apply any time
✓ Broader doctor access — Larger provider networks
✓ Lower premiums — Healthier risk pool = better rates
✓ Travel nurse-friendly — Designed for cross-state work
Who Qualifies
✓ Working full-time (healthy enough for hospital screenings)
✓ Generally younger, healthier professionals
✓ Many pre-existing conditions acceptable
✓ May be rated up for significant conditions
✓ Marketplace still available if declined
Private PPO vs Marketplace: The Real Cost Difference
Most travel nurses earning $80,000+ per year don't qualify for marketplace premium tax credits. Without subsidies, Private PPO plans are often more affordable than marketplace plans—and give you nationwide coverage.
Why Private PPO costs less (without subsidies): Medical underwriting creates a healthier risk pool. Marketplace plans must accept everyone regardless of health status, which raises premiums for all enrollees. Private PPO plans screen applicants, resulting in lower claims and lower premiums for those who qualify.
If you're earning above subsidy thresholds and you're healthy, Private PPO typically saves you money while giving you better coverage across state lines.
What About Premium Tax Credits?
If you qualify for marketplace subsidies (generally under $60,000/year for a single person), the subsidized marketplace plan will almost always be cheaper than Private PPO. However, you'll still be stuck with an HMO that doesn't work across state lines. Additionally, likely a higher deducitble and certaintly a higher out of pocket max.
Run the numbers with us:
- Compare your actual after-subsidy marketplace cost
- Compare Private PPO rates for your age and health profile
- Factor in the cost of one out-of-network ER visit, the plans deducitble and max out of pocket. ($5,000-$10,000)
How to Get Private PPO Quotes in Tennessee
Private PPO plans aren't listed on Healthcare.gov. You need to work with a licensed health insurance agent who has access to off-exchange carriers.
Application Process
1. Complete health pre qualifying questionnaire w a licensed advsior (10-15 minutes)
2. Licensed advisor submits to application
3. Complete verification call w carrier (15-20 min)
4. Receive eligibilty determination within 48 hours on avgerage
5. Coverage starts on scheduled effective date
What We Verify
✓ Your current doctors are in-network
✓ Prescriptions are covered
✓ Tennessee hospitals included
✓ Out-of-state coverage confirmed
✓ Total annual cost comparison
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Frequently Asked Questions
Can I keep my Tennessee doctors with a Private PPO?
Yes. Private PPO plans include large nationwide networks. We verify your current doctors are in-network before you enroll. Most major hospital systems in Tennessee (Vanderbilt, HCA, UT Medical Center) are in-network with top PPO carriers.
What if I have a pre-existing condition?
It depends on the condition. Controlled conditions, high blood pressure, hypothroidism or past surgeries are often acceptable. Active cancer, recent heart attack, or uncontrolled chronic conditions may result in declination or higher rates.
Can I cancel my Private PPO if I get a staff position with benefits?
Yes. Private PPO plans are month-to-month. You can cancel any time with 30 days notice. No penalties or fees.
Do Private PPO plans cover prescriptions?
Yes. Most Private PPO plans include prescription coverage with tiered copays. We verify your current medications are covered before enrollment.
What's the difference between Private PPO and travel nurse agencies' health plans?
Agency contracts are typically 13 weeks, meaning any accumilation to deductible is lost after that contract, your coverage is tied to your agency and leaves you shopping coverage every 13 week.
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Licensed in Tennessee and 31 other states. NPN 19540130. For education only; coverage and availability vary by carrier and state.
