American Health Advantage of Tennessee

What American Health Advantage of Tennessee does

American Health Advantage of Tennessee operates as a Health Maintenance Organization Institutional Special Needs Plan (HMO I-SNP) under American Health Plan, Inc., headquartered at 201 Jordan Road, Franklin, TN. The plan is contracted with Medicare to serve beneficiaries residing in participating long-term care nursing facilities across 95 Tennessee counties, with eligibility conditioned on residing in a participating facility for 90 or more days. The product combines Medicare Part A and Part B coverage with Part D prescription drug coverage, supplemented by vision, hearing, routine foot care, and preventive services. Care is delivered through an Integrated Care Coordination Model featuring a primary care physician, advanced nurse practitioner, RN case manager, and clinical pharmacist team providing on-site, nursing home-based primary care, including tests and treatments normally performed in hospitals such as x-rays, IV therapy, and dialysis.

The core technology is a care management platform that identifies preventive and HEDIS service needs, applies evidence-based clinical guidelines, and coordinates interdisciplinary care team communications. Operational layers include a domain-specific risk-assessment tool for the nursing home population, individualized care plans derived from Health Risk Assessments, and care transition protocols with post-discharge medication review. The plan uses third-party infrastructure for pharmacy benefit management (Navitus Health Solutions effective January 1, 2026, previously MedImpact), electronic data interchange via Availity, prior authorization via CoverMyMeds, and clinical decision support via InterQual, and conforms to NCQA quality standards.

Revenue is generated primarily through CMS capitation payments for Part A and Part B covered services, supplemented by member monthly premiums ($27.70 for 2026, down from $40.00 in 2025), Part D premiums and deductibles, and member cost-sharing. Distribution is sales-led: licensed sales agents conduct one-on-one phone and in-person appointments during open enrollment (October 1 to March 31, eight hours daily seven days a week) and reduced hours off-season, supplemented by an online Information Request Form and a toll-free member services line. Members can also enroll by mailing a completed enrollment form to the Franklin office. The plan is offered exclusively to residents of participating facilities in Tennessee, with no public disclosure of membership, revenue, headcount, funding history, or parent company affiliation in the available data.

Name

American Health Advantage of Tennessee

Legal name

American Health Plan, Inc.

Website

https://tn.amhealthplans.com

Company type

Private

Operating status

Operating

Short description

American Health Advantage of Tennessee is a Medicare Advantage Institutional Special Needs Plan (HMO I-SNP) operated by American Health Plan, Inc., serving Medicare beneficiaries residing in participating long-term care nursing facilities across 95 Tennessee counties with coordinated on-site primary care and Part D drug coverage.

Ownership category

akta.pro rank

Product category

Medicare Advantage Insurance

NAICS

Ambulatory Health Care Services (621), Other Ambulatory Health Care Services (6219)

SIC

Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), Medicare Member Engagement & Care Management (Utilization, Case/Disease Mgmt) (FSAIAGAL), MA Prescription Drug Plans (MA-PD) (HLAEACAF), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI)

Keywords

• Medicare Advantage plans
• Institutional special needs
• Long-term care insurance
• Part D coverage
• Care coordination services

Headquarters

HQ city

Franklin

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure

Revenue model

1. Medicare Advantage Plan Premiums: American Health Advantage of Tennessee generates revenue through monthly Medicare Advantage plan premiums paid by members ($27.70 per month in 2026), as well as Medicare Part B premiums that members must continue to pay. The plan also receives capitated payments from Medicare for providing Part A and Part B covered services to enrolled members.
2. Part D Prescription Drug Coverage: Revenue is generated through Medicare Part D prescription drug coverage, including Part D deductibles ($615 per year in 2026) and cost-sharing for prescription drugs. The plan provides formulary-based drug coverage through pharmacy benefit managers.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

American Health Advantage of Tennessee is a Medicare Advantage Institutional Special Needs Plan (HMO I-SNP) that provides all Medicare Part A and Part B benefits plus Part D prescription drug coverage to Medicare beneficiaries residing in participating long-term care nursing facilities across 95 Tennessee counties. The plan delivers integrated care coordination through dedicated nurse practitioners who conduct on-site visits, perform treatments such as IV therapy and on-site x-rays, and coordinate care across medical, social, psychological, and pharmaceutical lines via an interdisciplinary team. Additional supplemental benefits include vision, hearing, routine foot care, and preventive services, with pharmacy benefit management transitioning from MedImpact to Navitus Health Solutions effective January 1, 2026.

Product overview

American Health Advantage of Tennessee operates as a single unified Medicare Advantage Institutional Special Needs Plan (HMO I-SNP) that provides comprehensive health coverage for Medicare beneficiaries residing in participating long-term care nursing facilities. The core product combines Medicare Part A and Part B benefits with Part D prescription drug coverage through pharmacy benefit managers (previously MedImpact, transitioning to Navitus Health Solutions in 2026), supplemented by additional coordinated care services including dedicated nurse practitioner support, vision, hearing, routine foot care, and preventive services. The company employs an Integrated Care Coordination Model centered on the Institutional Special Needs Plan Model of Care, providing personalized clinical care through on-site nursing home-based primary care physician and nurse practitioner support, risk assessments, individualized care plans, and interdisciplinary care teams. Supporting programs include the Medicare Prescription Payment Plan and Medication Therapy Management Program.

Differentiator

Problem solved

Functional benefit

Products and services

• Medicare Advantage Institutional Special Needs Plan (HMO I-SNP) A Medicare Advantage health plan designed for Medicare beneficiaries living in participating long-term care nursing homes with complex care needs, providing all Medicare Part A and Part B benefits plus coordinated care services and Part D prescription drug coverage across 95 Tennessee counties.
• Part D Prescription Drug Coverage Medicare Part D prescription drug coverage administered through pharmacy benefit managers, with Navitus Health Solutions taking over from MedImpact Healthcare Systems effective January 1, 2026, including formulary management, prior authorization, step therapy, and medication therapy management.
• Care Coordination Services Integrated care coordination model providing personalized clinical care including dedicated nurse practitioner support, regular nursing home visits, on-site tests and treatments, and coordinated care across medical, social, psychological, pharmaceutical, and economic lines.
• Medicare Prescription Payment Plan Payment option that spreads Medicare Part D drug costs across the calendar year (January-December), helping members manage out-of-pocket prescription costs on a voluntary participation basis.
• Medication Therapy Management Program Program to help members manage their prescription drugs effectively, including eligibility requirements and personal medication lists.
• Institutional Special Needs Plan Model of Care Specialized care model focusing on residents in nursing facilities or individuals requiring institutional level of care, addressing medical, functional, and behavioral health needs in a coordinated, member-centric manner.

Quantifiable outcome

• Avoid unnecessary hospitalizations through regular nurse practitioner visits and on-site treatment capabilities (x-rays, IV therapy, dialysis)
• +2 more outcomes

Named customers1 record

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature4 records

Partnerships

Four partnerships are on record, tiered core.

• Navitus Health Solutions, LLCcoreTechnology or Integration · 1 January 2025Navitus Health Solutions, LLC serves as the pharmacy benefit manager (PBM) for American Health Advantage of Tennessee starting January 1, 2026, replacing MedImpact Healthcare Systems, Inc. Navitus handles prescription drug coverage, provides pharmacy helpdesk support at 866-270-3877, and manages coverage determinations and redeterminations for Part D drugs through their member portal.
• AvailitycoreTechnology or IntegrationAvaility provides electronic data interchange (EDI) services for the plan, enabling electronic claim submissions and administrative transactions with providers. An Availity EDI Guide is provided to contracted providers for proper submission of claims and information.
• CoverMyMedscoreTechnology or IntegrationCoverMyMeds is an electronic prior authorization platform used by prescribers to submit coverage determinations and redeterminations for Part D drugs. The platform provides an online channel for healthcare providers to request medication coverage approvals from the plan.
• National Committee for Quality Assurance (NCQA)coreOthersAmerican Health Advantage of Tennessee follows standards developed by the National Committee for Quality Assurance (NCQA) for quality and safety in healthcare delivery. The plan's Quality Improvement Program demonstrates commitment to providing effective, system-wide, measurable quality improvement for monitoring, evaluating, and improving care quality.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Humana: One of the largest Medicare Advantage carriers in the U.S. and a major I-SNP operator nationally. Competes with American Health Advantage of Tennessee for institutional Medicare beneficiaries in Tennessee nursing homes while offering a far broader portfolio across the country.
• Elevance Health (Anthem Blue Cross Blue Shield): Operates Blue Cross Blue Shield plans in Tennessee and a broad set of Medicare Advantage products including Special Needs Plans, competing with the I-SNP for institutional MA members in overlapping counties.
• Centene Corporation: Major managed care insurer with a strong presence in government programs including Medicare Advantage SNPs, overlapping with the institutional/dual-eligible population American Health Advantage of Tennessee serves.
• Molina Healthcare: Government-program-focused managed care company offering Medicare Advantage plans including dual-eligible SNPs; competes in many of the same low-to-moderate income and institutional populations served by I-SNPs.
• UnitedHealthcare (Optum): The largest Medicare Advantage insurer in the U.S., offering institutional and dual-eligible SNPs that compete directly with the company's I-SNP product across Tennessee's 95-county footprint.
• Aetna (CVS Health): National Medicare Advantage carrier with SNP offerings and integrated pharmacy/PBM capabilities (CVS Caremark) that overlap with American Health Advantage of Tennessee's I-SNP/Part D value proposition.
• Cigna Group: Sells Medicare Advantage plans including Special Needs Plans with national reach and a sizable PBM (Express Scripts), competing with regional I-SNPs on Part D economics and integrated SNP delivery.

Emerging players

• Devoted Health: Medicare Advantage-focused insurer with D-SNP products serving complex seniors; comparable as a smaller, senior-focused MA upstart with care-coordination-driven differentiation.
• Clover Health: Technology-driven Medicare Advantage insurer serving complex, often dual-eligible seniors; operates at a similar regional/single-product scale as a smaller MA challenger and competes for overlapping senior populations.
• Alignment Healthcare: Tech-enabled Medicare Advantage insurer focused on senior care with SNP offerings; smaller and geographically narrower than national incumbents, more comparable in scale and go-to-market model to a regional I-SNP.

Market position

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/american-health-plans

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about American Health Advantage of Tennessee