2017 Health Insurance for folks under 65

[Greg Schoenberg]

Originally Posted by saydiver

He must have become "very familiar with all things ACA" overnight, since I had already pointed out he was wrong about FL when he said FL didn't have any nationwide plans. (see page three and four of this thread).

Here's a List of BCBS Plans for anyone who wants to research which ones have nationwide networks.

Sue

And I quickly admitted my mistake and thanked you for your correction. ACA plans in every state are very fluid but how ACA works is not. The formula for the tax credit and other ACA mandates are the same. That is the context of what I meant when I said, "I'm familiar with all things ACA." Note that I didn't say I was an expert with all plans in all 50 states. Who is?

-Greg

[Greg Schoenberg]

Originally Posted by itgeekgal

In Nevada the available BCBS plans are HMO only, nationwide coverage is for emergency and urgent care only (see attachment).

I don't consider Nevada Anthem as having a nationwide network, even though they allow for emergency and urgent care (typical with most HMO's and EPO's). Same is true for Arizona and Texas Blue Cross Exchange plans too.

A true nationwide network is Blue Card with the Blues or 1st Choice with other carriers. Providence, in Oregon, uses the Signature network. Essentially, with a true nationwide network, you have the same preferred benefit as you do when you are close to home.

-Greg

[TechWriter]

(Mod Edit)

Can any person know the ACA marketplace in all 50 states? Yeah, I did for 49 states for the 2016 plans. Just me looking for PPO plans in over 3100 counties. It took months.

I imagine that 2 or 3 people could compile a complete list of nationwide PPO plan in each US county in a lot less time.

[Rotis]

Originally Posted by saydiver

He must have become "very familiar with all things ACA" overnight, since I had already pointed out he was wrong about FL when he said FL didn't have any nationwide plans. (see page three and four of this thread).

Here's a List of BCBS Plans for anyone who wants to research which ones have nationwide networks.

Sue

You still have to be careful with these nationwide plans. We had a Florida BCBS PPO plan last year. Even though we went to an "in network provider" we got a extra $400 charge for each of us because he was an "out of state" provider.

We just went in to get our blood labs done and prescriptions refilled. They can also leave you open for balance billing, check them very carefully and ask a lot of questions before you sign. They may be nationwide but that does not mean they are cost effective out of state.

[saydiver]

Originally Posted by Rotis

You still have to be careful with these nationwide plans. We had a Florida BCBS PPO plan last year. Even though we went to an "in network provider" we got a extra $400 charge for each of us because he was an "out of state" provider.

We just went in to get our blood labs done and prescriptions refilled. They can also leave you open for balance billing, check them very carefully and ask a lot of questions before you sign. They may be nationwide but that does not mean they are cost effective out of state.

Yes, you do have to do some research before choosing an out of state dr. or any dr for that matter.

Without knowing any details about your plan or case, I'm guessing your policy may have required preventive services to be FL physicians only, or possibly the in-network provider used an out-of-network lab, or perhaps the allowed amounts between the host plan and the home plan was a difference of $400. I can't find details at the moment, but I think I read somewhere that you can be charged the difference in allowed amounts between home and host plans in some circumstances, which is why it's always best to have services performed in states with lower allowed amounts than FL.

Sue

[Greg Schoenberg]

Originally Posted by Rotis

You still have to be careful with these nationwide plans. We had a Florida BCBS PPO plan last year. Even though we went to an "in network provider" we got a extra $400 charge for each of us because he was an "out of state" provider.

We just went in to get our blood labs done and prescriptions refilled. They can also leave you open for balance billing, check them very carefully and ask a lot of questions before you sign. They may be nationwide but that does not mean they are cost effective out of state.

That's a regrettable experience. Was this provider part of the "Blue Card" network? Typically a PPO pays a preferred rate if you stay in network and a lower rate if out of network, subject to balance billing.

For example...I was in Arizona and had an urgent medical issue arise. I went on-line with my Premera Blue Cross plan and found a list of urgent care facilities, then had the procedure done at a listed facility. Blue Cross paid it as though I was in Washington, my domiciled stated. Had I gone to one that wasn't preferred, they would have paid at a significantly lower rate, subject to balance billing.

Regardless...your point is right on. You have to be careful with these national networks.

-Greg

[Rotis]

Originally Posted by saydiver

Yes, you do have to do some research before choosing an out of state dr. or any dr for that matter.

Without knowing any details about your plan or case, I'm guessing your policy may have required preventive services to be FL physicians only, or possibly the in-network provider used an out-of-network lab, or perhaps the allowed amounts between the host plan and the home plan was a difference of $400. I can't find details at the moment, but I think I read somewhere that you can be charged the difference in allowed amounts between home and host plans in some circumstances, which is why it's always best to have services performed in states with lower allowed amounts than FL.

Sue

The lab was in network, the extra $400 charge line on the bill stated "out of state provider". We tried to get an explanation from them on it but was never able to get a satisfactory answer.

[Rotis]

Originally Posted by Greg Schoenberg

That's a regrettable experience. Was this provider part of the "Blue Card" network? Typically a PPO pays a preferred rate if you stay in network and a lower rate if out of network, subject to balance billing.

For example...I was in Arizona and had an urgent medical issue arise. I went on-line with my Premera Blue Cross plan and found a list of urgent care facilities, then had the procedure done at a listed facility. Blue Cross paid it as though I was in Washington, my domiciled stated. Had I gone to one that wasn't preferred, they would have paid at a significantly lower rate, subject to balance billing.

Regardless...your point is right on. You have to be careful with these national networks.

-Greg

Yes, they were part of the blue card network, we had Florida Blue and we called them to make sure the provider was approved.

We moved our domicile to Washington State this last July. We bought some property in Newport to use as a home base, I went on Medicare in August, the wife signed up with Premera and shortly after we received a letter from them saying they were no longer going to offer plans in our county next year, nice.

We have an appointment with our agent this coming week to see what is available.

[Ramets]

The really aggravating thing about all the problems with the ACA, is that they were ALL predicted from the very start. And yet with all that known it was STILL rammed through. I was at a few of the so called town hall meetings held by backers of the plan, and they were just going through the motions. Their minds were already made up, they didn't care what the people thought about it. And to this day a majority of Americans don't want it!!! So my question is, who's representing US in Washington?? I believe it's time for term limits, just as Harry Truman said right after the 22nd Amendment was passed to limit Presidential terms.

[Greg Schoenberg]

Originally Posted by Rotis

Yes, they were part of the blue card network, we had Florida Blue and we called them to make sure the provider was approved.

We moved our domicile to Washington State this last July. We bought some property in Newport to use as a home base, I went on Medicare in August, the wife signed up with Premera and shortly after we received a letter from them saying they were no longer going to offer plans in our county next year, nice.

We have an appointment with our agent this coming week to see what is available.

The only plans in Washington that have a national network is Regence Blue Shield....off exchange. Hopefully it is available in your county.

We are signing up with Providence next year in Oregon. My wife retained her Oregon residency, thus allowing us to enroll. I have a client who used postal connections as a means to establish the domicile in Oregon, where several plans are available with nationwide networks, on or off the exchange. Perhaps that could be an option for you. Oregon has very low RV registration fees, no sales tax, and most important…you don't have to pump your own gas. :-)

-Greg

[Rotis]

Originally Posted by Greg Schoenberg

The only plans in Washington that have a national network is Regence Blue Shield....off exchange. Hopefully it is available in your county.

We are signing up with Providence next year in Oregon. My wife retained her Oregon residency, thus allowing us to enroll. I have a client who used postal connections as a means to establish the domicile in Oregon, where several plans are available with nationwide networks, on or off the exchange. Perhaps that could be an option for you. Oregon has very low RV registration fees, no sales tax, and most important…you don't have to pump your own gas. :-)

-Greg

Unfortunately Regence isn't available in Pend Oreille county. We really love it here and we decided full timing is no longer for us, the wife has 9 more years before she can go on Medicare and we don't want to keep chasing healthcare insurance all over country.

Oregon sounds like a good deal for you though, hopefully they will still have them in 2018 too. I have a deal with my wife, she keeps me in clean underwear and I keep her vehicle full of gas so I don't know if that deal would still hold if we went to Oregon, it's too risky, lol.

[Greg Schoenberg]

Originally Posted by Rotis

Oregon sounds like a good deal for you though, hopefully they will still have them in 2018 too. I have a deal with my wife, she keeps me in clean underwear and I keep her vehicle full of gas so I don't know if that deal would still hold if we went to Oregon, it's too risky, lol.

Thanks for the good chuckle!!!!

-Greg

[saydiver]

Originally Posted by Rotis

Yes, they were part of the blue card network, we had Florida Blue and we called them to make sure the provider was approved.

We moved our domicile to Washington State this last July. We bought some property in Newport to use as a home base, I went on Medicare in August, the wife signed up with Premera and shortly after we received a letter from them saying they were no longer going to offer plans in our county next year, nice.

We have an appointment with our agent this coming week to see what is available.

After doing some research, I’m guessing you probably had a Blue Select plan. If it was a Blue Options plan, then I would certainly talk to my FL agent or file an appeal, if the time limit was not up. You're no longer in FL so it likely doesn’t matter for you, but for anyone else thinking about moving their domicile to FL, please read a plan's documents throughly or even better, talk to a FL agent for help in understanding the differences between BlueSelect and BlueOptions plans.

Yes they're both listed as PPO/EPO plans, but one of the primary differences besides a smaller in-state network is certain services like labs, prescriptions, DME, and other services in Blue Select plans apparently are subject to the Exclusive Provider Provision. For labs the Exclusive Provider is Quest Diagnostics. See:

https://www.flblue.com/sites/flblue/...Fact_Sheet.pdf

This tidbit of info is not mentioned in the Benefit Summaries. I had to do more research on the BlueSelect plan details to find out this info. I found documents several years old with this info, so it’s not anything new. The following document is for a small group plan, but it does a much better job of explaining the exclusions for Blue Select plans:

http://www.rogersbenefit.com/plans/P...68243-0910.pdf

Even with the exclusions, BlueSelect Plans may still be cheaper overall for someone, but for full-timers who will not be in FL most of the time, IMO Blue Options plans are a much better choice.

Sue

[PJStough]

Originally Posted by Ramets

The really aggravating thing about all the problems with the ACA, is that they were ALL predicted from the very start. And yet with all that known it was STILL rammed through. I was at a few of the so called town hall meetings held by backers of the plan, and they were just going through the motions. Their minds were already made up, they didn't care what the people thought about it. And to this day a majority of Americans don't want it!!! So my question is, who's representing US in Washington?? I believe it's time for term limits, just as Harry Truman said right after the 22nd Amendment was passed to limit Presidential terms.

I believe that the ACA is working pretty much as expected. Millions more people have insurance than before it was enacted. I do see two problems with it however. The first being that part of the ACA was for the States to expand Medicare with the Federal Government subsidizing part of the cost of expansion, however, several states chose not to participate, and I believe those are the states where the choices of plans on the Exchange are limited or non existent. The second problem is as problem that has existed in healthcare since the 70s, and that there is little or no economic controls on the cost of healthcare, a couple of examples are Martin Shkreli and the $600 Epi-Pen. Until there are economic controls on the cost of healthcare, ACA, or not, the price of healthcare will continue to climb at an alarming rate.