By the numbers: health care coverage
Since 1945, we’ve been focused on making health care more affordable for our members. Advocating for affordability is one of the primary ways we live our mission: Peace of Mind through Better Health®. Here’s a snapshot of our members’ experience in 2025 and how we supported them every step of the way.
Claims processed in 2025
Members served
Commercial health plan claims requiring prior authorization
Virtual care visits
Claims costs we paid for our members
Members receiving mammograms as recommended
Putting our dollars to work for members
We used 89 cents from every premium dollar to pay for our members’ medical needs. While working hard to lower our administrative costs, 10 cents of each dollar goes to operating the company and paying local, state and federal taxes.
Reducing costs for outpatient surgeries and improving the member experience
Here’s what we’re doing:
- Negotiating contracts and building networks that keep costs as low as possible
- Providing price transparency tools so members see estimates before surgery
- Helping members find high-quality, in-network providers who offer the same procedure at a lower price
- Assigning a care team to make sure surgery is the right choice and to support members through the journey
We also launched a new partnership with Tennessee Orthopaedic Alliance and Ascension to lower costs and increase clarity for members with “all-in-one” payment for certain joint surgeries.
From needing a walker to motivating others
Before sunrise, Nolan Nevels heads to his Knoxville YMCA, not only as a member but now as a personal trainer — something he never imagined three years ago when he joined overweight, battling high blood pressure, pre-diabetes, and recovering from joint replacements. Medication and yo-yo dieting hadn’t worked for Nolan, but a conversation with a friend inspired him to join the YMCA through his BlueCross BlueAdvantage plan. Starting with water aerobics, Nolan soon needed his walker less and began taking more classes. Encouraged by staff and members who noticed his progress, he trained to become a personal trainer. With support from a BlueCross dietician and the CareTN app to monitor his diet and steps, Nolan transformed his health. Now, he motivates others, sharing, “As you age, you can continue to improve your life journey.”
Continuing our work to improve health opportunities
Our Healthy Tennessee Report gives us a better picture of the health issues and barriers faced by our members and all Tennesseans. And this guides our work to more effectively partner with health care providers to address those issues. Applying our understanding of the data helps us promote better health for all our members, taking into account their unique circumstances.
Since our first edition of this report, we’ve seen positive results among our commercially insured population on: controlling high blood pressure, managing blood glucose levels, prenatal care, colorectal cancer screening rates and childhood immunization status.
Leaping forward with AI technologies
“Generative AI has the potential to improve how people work across industries. At BlueCross, we’re focused on using it in ways the directly benefit our members. By equipping our employees with secure tools, training and clear guidelines, we can work more efficiently, improve service and deploy technology thoughtfully – always with privacy, trust and responsible use at the center.”
– JD Hickey, President and CEO, BlueCross BlueShield of Tennessee
Improving outcomes for high-risk mothers and babies
BlueCare launched the Partnership for Healthy Moms and Babies to better support providers and improve outcomes. Providers who participated in the pilot program outperformed peers in West Tennessee on the timeliness of prenatal and postpartum care. Disparities between members of different backgrounds in the pilot were around 2% – compared to 10% statewide.
Putting our members first
Jessica Lord, a Nurse Case Manager, provided exceptional support to a member during his final months. After helping him begin in-home hospice care, she stayed connected and quickly stepped in when his needs changed. Sensing medical distress during a call, she urged him to seek emergency care and then worked closely with hospital staff to find a hospice provider that honored his wish not to die in a hospital. Despite obstacles – including housing issues and a provider backing out – Jessica secured a hotel and a hospice team to continue his care. She remained involved until his passing, and his gratitude, including his words, “You’re an angel,” affirmed her commitment to preserving dignity and choice at the end of life.
Jessica Lord
Nurse Case Manager
Finding footing in accessible fashion
Aaron Warren, founder and CEO of Zipped Brands, describes himself as “just a regular guy trying to do the best that I can and get out and live life to the fullest with my friends and loved ones.”
As a longtime TennCare member, Aaron joined Employment and Community First (ECF) CHOICES at 18, which provides him with support like paid caregivers he interviews, hires, and trains himself. Through ECF CHOICES, Aaron receives help with daily needs, goal setting, and connections to resources, empowering his independence and enabling him to thrive. He’s used his experience to create accessible shoes through Zipped, making a difference for people with disabilities worldwide.
“If you can make the world even a bit better in your lifetime, you should try to do it. That’s what life is all about to me.”
Promoting colorectal screenings
A campaign to provide Cologuard At-Home test kits to high-risk Tennessee counties expanded statewide to two of our large employer groups. As a result of this program, colorectal screenings among recommended members increased from 50% to 92%.
Medicare Advantage, BlueCare and Commercial plans earn 4.0 star rating
All three plans earned an impressive 4.0 quality rating from the Centers for Medicare & Medicaid Services (CMS) in 2025. The score is based on a 5-star rating system that reviews our operations, customer surveys and enrollees’ health outcomes.
Distinct performance and quality measures that Medicare Advantage plans with prescription drug coverage are evaluated against by the CMS
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©2026 BlueCross BlueShield of Tennessee
BlueCross BlueShield of Tennessee, BlueCross BlueShield of Tennessee Foundation, BlueCross BlueShield of Tennessee Community Trust and BlueCare Tennessee are Independent Licensees of the Blue Cross Blue Shield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace.
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