Tennessee Health Insurance Cost Report 2026
A statewide look at ACA Marketplace pricing patterns and carrier competition across Tennessee's 18 largest cities, compiled from the same county-level data used throughout this site.
Reviewed by Cameron Erwin, Licensed Tennessee Insurance Agent (TDCI License #3004250804)
Statewide snapshot
These figures track statewide rate-change and subsidy patterns before accounting for your specific household -- most Tennesseans who shop the Marketplace still qualify for some level of subsidy based on income and family size, which can bring the effective monthly cost well below the sticker price. See our statewide cost and subsidy guide for how premium tax credits are calculated.
What actually drives the price difference between cities
Tennessee doesn't price ACA Marketplace plans statewide -- pricing and carrier availability are set by rating area, which generally aligns with county boundaries. Two shoppers with identical ages and incomes can see meaningfully different premiums and plan choices depending on which county they live in, driven mainly by how many carriers are actively competing for business in that specific rating area.
As a general pattern across this data, Tennessee's largest metro areas -- Nashville, Memphis, Knoxville, and Chattanooga -- tend to see deeper carrier competition, which typically clusters more plans toward the lower end of the statewide price range. Smaller and more rural markets often have fewer competing carriers, which can mean less price pressure and, in some cases, higher typical premiums for a comparable plan. Markets with a dominant local economic driver -- a major healthcare system, an auto manufacturing plant, or a large tourism economy -- also see carrier and network decisions shaped by that specific economic base, independent of city size alone.
City-by-city carrier and market notes
The notes below summarize the carrier and market dynamics specific to each city's rating area, drawn from the detailed guide for each city and county elsewhere on this site.
| City | County | Market tier | What shapes pricing here |
|---|---|---|---|
| Nashville | Davidson County | Major metro | As the anchor of the state's largest and fastest-growing metro economy, Nashville has some of the deepest ACA Marketplace carrier competition in Tennessee, giving shoppers a genuinely wide field to compare rather than one or two default options. |
| Memphis | Shelby County | Major metro | Memphis is anchored by a major regional healthcare and logistics economy, which supports a broad carrier field and some of the deepest hospital-affiliated plan options in the state. |
| Knoxville | Knox County | Major metro | Knoxville anchors East Tennessee, with a carrier field shaped by its university and healthcare-system presence and generally strong Marketplace competition for the region. |
| Chattanooga | Hamilton County | Major metro | Chattanooga is home to Blue Cross Blue Shield of Tennessee's headquarters, giving the area a distinct carrier presence alongside its manufacturing and logistics-driven economy. |
| Clarksville | Montgomery County | Mid-size market | Clarksville's Marketplace shoppers often need to weigh coverage alongside TRICARE eligibility, given the city's close ties to Fort Campbell and its large military-connected population. |
| Murfreesboro | Rutherford County | Mid-size market | Murfreesboro's rapid growth as a Nashville suburb has attracted increasing carrier interest, with many residents weighing individual Marketplace coverage against employer options as the area expands. |
| Franklin | Williamson County | Major metro | Franklin's concentration of corporate offices and healthcare-industry employers has made competitive group benefits more of a norm here, which also shapes the broader local Marketplace and Medicare Advantage carrier field. |
| Johnson City | Washington County | Mid-size market | Johnson City anchors the Tri-Cities region, where shoppers typically have a narrower carrier field than Tennessee's largest metros and benefit from comparing options carefully. |
| Jackson | Madison County | Mid-size market | Jackson serves as a regional hub for West Tennessee, with a Marketplace carrier field shaped by its healthcare and logistics-based economy. |
| Smyrna | Rutherford County | Mid-size market | Smyrna shares much of Rutherford County's growing Nashville-suburb carrier landscape, shaped in part by the area's manufacturing base. |
| Hendersonville | Sumner County | Mid-size market | Hendersonville benefits from its position just outside Nashville, with shoppers here often comparing the same carriers active in the greater Nashville market. |
| Kingsport | Sullivan County | Mid-size market | Kingsport is part of the Tri-Cities region, with a carrier field that tends to be narrower than Tennessee's largest metros. |
| Bartlett | Shelby County | Mid-size market | Bartlett is part of the greater Memphis metro, giving shoppers here access to the same broad carrier field as the rest of Shelby County. |
| Collierville | Shelby County | Mid-size market | Collierville shares the same deep carrier competition available throughout the greater Memphis metro. |
| Cleveland | Bradley County | Mid-size market | Cleveland sits just outside Chattanooga and draws on much of the same carrier competition as greater Hamilton County, shaped by the area's manufacturing base. |
| Brentwood | Williamson County | Major metro | Brentwood shares Williamson County's deep carrier competition and corporate-employer base, among the most competitive suburban markets in the state. |
| Spring Hill | Maury County | Mid-size market | Spring Hill's growth as both a Nashville-area suburb and an auto manufacturing hub has attracted growing carrier interest in recent years. |
| Gallatin | Sumner County | Mid-size market | Gallatin's growth mirrors greater Sumner County, benefiting from carrier competition spilling over from the Nashville metro. |
Methodology & sourcing
Statewide rate-change and subsidy figures reflect typical 2026 plan year ACA Marketplace pricing patterns. City and county-level carrier notes are drawn from publicly available carrier service-area filings and this site's own ongoing county-by-county research, and are updated as carrier participation and market conditions change from one plan year to the next. These figures are general patterns, not a quote -- your actual premium depends on your specific age, household size, income, and the exact plan and carrier you choose. This report is not affiliated with HealthCare.gov, CMS, or the Tennessee Department of Commerce and Insurance.
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