Open enrollment begins November 1. If you are self-employed in Nashville, the first thing most people sort by is the monthly premium. In this city, that is the wrong place to start.
Nashville has more doctors, practices and hospital campuses within a short drive than anywhere else in Middle Tennessee. That should make choosing a plan easier. In practice it makes one part of the decision harder to see, because the thing that separates a cheaper plan from a more expensive one here is very often the network, and the network is the part nobody reads until they need it.
This post is about checking the network before the price, and why that matters more when nobody in HR is checking it for you.
Why the premium is the wrong first filter here
A plan can lower its premium a few ways. One of the most common is contracting with fewer providers. In a smaller town that tradeoff is easy to spot, because there are only so many doctors to leave out. In Nashville there are so many that a plan can leave out a lot of them and still look full on paper. I made the short version of this point in the post on how networks differ across Middle Tennessee cities. This is the longer version, for the people it hits hardest.
That is the self-employed. When you work for a company, a benefits team picks the plan, negotiates it, and fields the complaints when a network is too thin. When you are a 1099 contractor, a consultant, a musician or a small business owner, you are the benefits team. You pick it, and you find out what it does not cover at the worst possible time, usually in a waiting room.
So the lowest premium on the screen is not a bargain or a trap by itself. It is a question: what did this plan give up to get there? Sometimes the answer is nothing you would ever use. Sometimes it is the specialist you have seen for six years.
Doing nothing is still a decision
A lot of people plan to let their current plan roll over. Healthcare.gov is clear about what happens if you have marketplace coverage and do not pick a plan: you are automatically re-enrolled in a plan for next year, and it may be a different plan with the same insurance company. It also says plan costs can change.
What it does not do is check your doctors. In what I have seen, a plan's network can change from one year to the next the same way its premium can. The renewal letter is where that shows up, and most people read the premium line and stop.
Auto-renewal is fine if you looked first. It is a problem if it is the reason you did not look.
Three questions to ask about any network
Are my doctors in it, by name? Not "is my hospital system in it." Your primary care doctor, the specialist you see, the practice your kids go to, and the hospital you would want to be taken to. Search each one in the plan's directory by name and by the location you actually visit. Directories are not always current, so a short call to the office asking about that exact plan is worth the five minutes.
What happens when I leave Middle Tennessee? This is the one that catches self-employed Nashvillians. Musicians tour. Consultants travel. Owner-operators are gone for days. Some people have a kid in college three states away. Many plans on the marketplace here are built as EPOs or HMOs, and on those, care outside the network is generally not covered outside of a true emergency. I break down the difference in PPO vs. EPO for Tennessee's self-employed, and the mechanics of balance billing in in-network vs. out-of-network.
What happens if I need a doctor I do not have yet? The list you write today covers the care you already get. It does not cover the referral you have not received. If next year brings a diagnosis and a referral to a sub-specialist across town, the question is whether that person is in your plan. A wider network is not a guarantee, but it is the part of a plan that matters most in the year you did not expect.
| Lane | Network, generally | Often worth a look for | When you can enroll |
|---|---|---|---|
| ACA marketplace | Often regional, many built as EPOs or HMOs | Households with a meaningful subsidy, or a health history that makes guaranteed-issue coverage the safer path | Open enrollment, beginning November 1, or a special enrollment period |
| Private PPO | Nationwide PPO access, no referrals | Healthy self-employed people above the subsidy range, especially anyone who travels | Any time of year, with medical underwriting |
| A spouse's employer plan | Whatever the employer chose, often built around where the employer is | Households where the employer pays a real share and the network fits | The employer's own enrollment calendar |
Where the private PPO lane fits, and where it does not
If you are healthy, earning above the subsidy range, and your work takes you out of Middle Tennessee, a private PPO is worth pricing alongside the marketplace. The network question is the main reason. A nationwide PPO follows you to Atlanta, to a festival in Colorado, or to a job site two states over.
These plans are medically underwritten. The application asks health questions and it can come back as a no. That is also why timing helps you: a private application can go in any time of year, so applying in October means you know the answer before the marketplace window opens. If it is a no, the marketplace is still there on November 1. I walk through the application step by step in what happens when you apply for a private health plan.
If your income qualifies for a meaningful subsidy, or your health history makes guaranteed-issue coverage the safer path, the marketplace is often the right lane. Then the job is the same one: pick the marketplace plan whose network actually covers your doctors, not the one at the top of the price sort.
What to do before November 1
Write the list this week. Every doctor, practice and hospital for everyone on the plan. Include where you get prescriptions filled. This takes fifteen minutes and it is the step almost nobody does.
Read the renewal letter for more than the premium. When it arrives, look for anything about the plan name, the network, or the plan you are being moved to. If the plan is changing, treat it like a new plan and check the list against it.
Price the private lane now if it applies to you. Healthy, above the subsidy range, and out of town often? Start that application in October so the answer is in hand before November 1.
Check every name against every plan you are considering. Directory first, then a call to confirm. The plan that covers your list is the plan worth comparing on price.
Then choose on purpose. A plan chosen during open enrollment generally starts January 1. Keep your current coverage in place until the new plan is approved with a start date.
If you want the local detail, our Nashville page covers the three lanes for Davidson County. If you are still deciding who to work with this fall, I wrote separately about choosing a health insurance broker in Nashville. And if a spouse in your household has benefits through work, the Nolensville post in this series covers which enrollment to settle first.
Common questions
If I do nothing during open enrollment, does my marketplace plan just renew?
Generally, yes. Healthcare.gov says that if you have marketplace coverage and do not pick a plan, you will be automatically re-enrolled in a plan for next year, and that it may be a different plan with the same insurance company. Plan costs can change too. Re-enrollment does not check whether your doctors are still in the network, so it is worth reviewing the plan before you let it roll over.
Is a cheaper plan in Nashville always a narrower network?
Not always. But contracting with fewer providers is one of the common ways a plan keeps its premium down, and in a city with as many providers as Nashville, a smaller network can still look complete on paper. Check your own doctors by name before treating a lower premium as a better deal.
Will a marketplace plan cover me when I travel outside Tennessee?
It depends on how the plan is built. Many marketplace plans here are EPOs or HMOs, and on those, care outside the network is generally not covered outside of a true emergency. A PPO typically covers some out-of-network care at a higher cost, and a nationwide PPO network can follow you out of state. Read the plan's own documents for the details.
Can I apply for a private PPO before November 1?
Yes. Medically underwritten private plans can be applied for any time of year, so applying in October means you know the answer before the marketplace window opens. The application asks health questions and can be declined, and if it is, the marketplace is still available during open enrollment. Coverage availability and eligibility vary by individual circumstances.
How do I check whether my doctor is in a plan's network?
Search the plan's provider directory by the doctor's name and the specific location you visit, not just the hospital system. Directories are not always current, so call the office and ask whether they take that exact plan by name. Do it for every person on the plan and every plan you are considering.
Where to start
In a city with this many doctors, the network is where plans quietly differ, and the self-employed are the ones who have to catch it themselves. Price still matters. It just belongs second.
Write the list, check it against every plan, and then compare the plans that pass. That is the conversation I have with self-employed Nashvillians every fall, and it goes a lot better in October than in a waiting room in March.
DC Insurance is an independent health insurance agency serving Middle Tennessee. This is general information about how coverage works, not advice about your particular situation. Coverage availability and eligibility vary by individual circumstances.
Denton helps self-employed individuals, 1099 contractors, and small business owners in Middle Tennessee find coverage that actually fits, comparing every lane available, not just what's easiest to sell. Learn more about Denton →