MAJOR health care changes in TX in 2016 (Pre-Medicare RVers)

[WheelingIt]

[QUOTE=saydiver;2684328]

Originally Posted by Taterpeeler

BCBS is coming out with an open access plan that may work for full timers, if CMS approves it./QUOTE]

CMS is Medicare and they do not approve pre-Medicare plans, which is what we're discussing.

Sue

Ah yes. That makes ALL the difference. The entire discussion here is for pre-Medicare specifically.

Taterpeeler - Have you heard anything about pre-Medicare?

[Taterpeeler]

[QUOTE=saydiver;2684328]

Originally Posted by Taterpeeler

BCBS is coming out with an open access plan that may work for full timers, if CMS approves it./QUOTE]

CMS is Medicare and they do not approve pre-Medicare plans, which is what we're discussing.

Sue

CMS is the governing body of ACA plans along with HHS. im discussing ACA (ObamaCare) plans.


Open access is a plan that does not require referrals and is generally an HMO or EPO type structure. Also, the plan I am discussing will offer out of network bennies... Again, not approved yet.


Humana offers a PPO in Texas as well as UHC however the UHC plan dose not offer out of network benefits... Cigna at the moment has a PPO

[rhusak]

Originally Posted by Ramets

WHAT??? I thought if you liked your plan you could keep your plan....period!!

Yeah, and your doctor too!

[WheelingIt]

[QUOTE=Taterpeeler;2684407]

Originally Posted by saydiver

CMS is the governing body of ACA plans along with HHS. im discussing ACA (ObamaCare) plans.


Open access is a plan that does not require referrals and is generally an HMO or EPO type structure. Also, the plan I am discussing will offer out of network bennies... Again, not approved yet.


Humana offers a PPO in Texas as well as UHC however the UHC plan dose not offer out of network benefits... Cigna at the moment has a PPO

I see. HMO, EPO is generally a problem for us fulltime travelers since we spend significant amounts of time out-of-state and the network out-of-state is typically poor (unless you have access to the BCBS "blue card" extended network). I guess we'll see how this plays out.

As for Humana, Cigna & UHC, none of those plans are on the TX ACA exchange as far as I know?

[Taterpeeler]

[QUOTE=WheelingIt;2684879]

Originally Posted by Taterpeeler

I see. HMO, EPO is generally a problem for us fulltime travelers since we spend significant amounts of time out-of-state and the network out-of-state is typically poor (unless you have access to the BCBS "blue card" extended network). I guess we'll see how this plays out.

As for Humana, Cigna & UHC, none of those plans are on the TX ACA exchange as far as I know?

they all are available in the aca market.....

[WheelingIt]

[QUOTE=Taterpeeler;2684950]

Originally Posted by WheelingIt

they all are available in the aca market.....

I just went on both HealthSherpa and the official ACA website using the Livingston TX (Escapees) zip code and didn't get any hits on any of those providers. Are they coming in 2016? Or am I missing something else? Perhaps it's my age? Or the zip code?

I got 17 plans, all offered by BCBS. Nothing else.

[Timon]

Hopefully some day insurance plans will be nation wide and not only state by state.

[Ramets]

Originally Posted by Timon

Hopefully some day insurance plans will be nation wide and not only state by state.

Amen to that. If that would happen then you would really have competition among insurers, which in turn would drive down premiums.

[Taterpeeler]

[QUOTE=WheelingIt;2684982]

Originally Posted by Taterpeeler

I just went on both HealthSherpa and the official ACA website using the Livingston TX (Escapees) zip code and didn't get any hits on any of those providers. Are they coming in 2016? Or am I missing something else? Perhaps it's my age? Or the zip code?

I got 17 plans, all offered by BCBS. Nothing else.

I use Sherpa also as one of my enrollment platforms so they are good. In regards to only BCBS in Livingston... yes, that county and area only has BCBS, not good for RV'ers, I suggest taking up a metro area as your base and you will pick up a larger selection of plans...

Lets look at Dallas metro(where I live), there are 6 companies listed. Stick to the big counties, Dallas, Tarrant, Collin, Harris and so forth. Also, this is for all ON EXCHANGE plans... will address that next.

On exchange = purchasing the plan tru the Federal website(or state exchange website) OFF EXCHANGE = purchasing ACA plan directly from the carrier, no federal involvement for enrollment.

OK, these plans will be not eligible for federal subsidies. No one should be enrolling tru the Federal website(FFM) unless they are A) eligible for subsidies with income between 100-400% of federal poverty B) close to or possibly be below that 400% number due to changes to their income during the year(400-500% FPL) Subsidies are only available ON EXCHANGE

These off exchange plans are the same as on exchange for the most part except less intervention on the part of Uncle Sam and yes they are still expensive. Off exchange plans in Livingston offer more than BCBS, I looked up United HealthCare PPO and they are there, Humana probably is too as I think their PPO is state wide for off exchange.

Here is my deal to you... I have enjoyed "lurking" since I bought my Coach but I rarely post because I don't want to seem dumb so you help me and don't beat me up(I am on a health insurance forum and we beat the pee pee out of clowns), make fun of me or call my questions stupid and I will provide answers to your questions....

[WheelingIt]

[QUOTE=Taterpeeler;2685536]

Originally Posted by WheelingIt

I use Sherpa also as one of my enrollment platforms so they are good. In regards to only BCBS in Livingston... yes, that county and area only has BCBS, not good for RV'ers, I suggest taking up a metro area as your base and you will pick up a larger selection of plans...

Lets look at Dallas metro(where I live), there are 6 companies listed. Stick to the big counties, Dallas, Tarrant, Collin, Harris and so forth. Also, this is for all ON EXCHANGE plans... will address that next.

On exchange = purchasing the plan tru the Federal website(or state exchange website) OFF EXCHANGE = purchasing ACA plan directly from the carrier, no federal involvement for enrollment.

OK, these plans will be not eligible for federal subsidies. No one should be enrolling tru the Federal website(FFM) unless they are A) eligible for subsidies with income between 100-400% of federal poverty B) close to or possibly be below that 400% number due to changes to their income during the year(400-500% FPL) Subsidies are only available ON EXCHANGE

These off exchange plans are the same as on exchange for the most part except less intervention on the part of Uncle Sam and yes they are still expensive. Off exchange plans in Livingston offer more than BCBS, I looked up United HealthCare PPO and they are there, Humana probably is too as I think their PPO is state wide for off exchange.

Here is my deal to you... I have enjoyed "lurking" since I bought my Coach but I rarely post because I don't want to seem dumb so you help me and don't beat me up(I am on a health insurance forum and we beat the pee pee out of clowns), make fun of me or call my questions stupid and I will provide answers to your questions....

Cheers for the feedback. I sure hope I didn't come across as beating you up? My questions were meant to be legitimate, not snarky. This is mucho confusing for all us RVers, and I know there are lots of crazy details related to age and zip. I was honestly hoping I had screwed up and missed something simple. More plan choices would be awesome.

With regards to sticking to metro areas, what you'll find is that 95%+ of fulltime TX-based RVers are domiciled in Livingston because of the Escapee RV Mail Service which is located there. Establishing domicile is tricky when you don't have a fixed abode and there are only a few, select places where people do it. Escapees in Livingston is the top (the only?) location I know of for fulltime RVers in TX. They've actually campaigned (gone to court) to make it a legal domicile and they are huge in the RV world. I believe anywhere else in TX would require having a fixed abode (either rental or property) to establish legal domicile. So, for fulltimers based in TX that don't have a fixed abode/residence, they'll be stuck with whatever is on offer in that specific Livingston zip code. That's also why this latest BCBS announcement is so worrisome for fulltimers.

I actually didn't realize the offerings were so much better outside of Livingston, but (sadly) that won't help most folks here on this fulltimers thread. It's good to know there are still some off-Exchange plans, but they may be out of reach (cost-wise) for many.

[Taterpeeler]

[QUOTE=WheelingIt;2685582]

Originally Posted by Taterpeeler

Cheers for the feedback. I sure hope I didn't come across as beating you up? My questions were meant to be legitimate, not snarky. This is mucho confusing for all us RVers, and I know there are lots of crazy details related to age and zip. I was honestly hoping I had screwed up and missed something simple. More plan choices would be awesome.

With regards to sticking to metro areas, what you'll find is that 95%+ of fulltime TX-based RVers are domiciled in Livingston because of the Escapee RV Mail Service which is located there. Establishing domicile is tricky when you don't have a fixed abode and there are only a few, select places where people do it. Escapees in Livingston is the top (the only?) location I know of for fulltime RVers in TX. They've actually campaigned (gone to court) to make it a legal domicile and they are huge in the RV world. I believe anywhere else in TX would require having a fixed abode (either rental or property) to establish legal domicile. So, for fulltimers based in TX that don't have a fixed abode/residence, they'll be stuck with whatever is on offer in that specific Livingston zip code. That's also why this latest BCBS announcement is so worrisome for fulltimers.

I actually didn't realize the offerings were so much better outside of Livingston, but (sadly) that won't help most folks here on this fulltimers thread. It's good to know there are still some off-Exchange plans, but they may be out of reach (cost-wise) for many.

No offense taken, never crossed my mind.

Ok, got it on the Livingston local.... makes sense. Then off exchange is the route.... Lets see if Humana sneaks into that county, I will know the play book soon and because of your comment I will look at Livingston and advise...

Lastly, the prices of on and off are about the same except no subsidy... here is a copy of the FPL for 2015 and the income is MAGI, look at line 37 of tax return and add back untaxed SS benefits and a few others(get a tax guy to calculate) but line 37 generally(adjusted gross income)

Sorry, chart wont copy correctly so 400% is about this for next year:
2 on return=$64000
3 on return= $80000

APPX numbers

[WheelingIt]

Taterpeeler - I should also add that if you do hear any updates regarding BCBS in TX I know everyone here would be very grateful for the news. I mean that legitimately. Pulling of the TX PPO plans massively reduces fulltime RVer choices for all our Escapees-based (Livingston) folks. Maybe we can hope BCBS will continue to allow use of their extended network (blue card) outside of TX, even on HMO/EPO plans? I'm grasping at straws here...

The other places fulltime RVers typically establish domicile are SD and FL. Both have historically been "fulltime RV" friendly and fairly easy to establish domicile without fixed abode. There are a select list of mail services in those 2 states that people use in those spots. Sadly, SD has very poor pre-Medicare health care options (nothing nationwide on exchange, and many of the off-exchange plans require proof of 6-month in-state residency). FL still has Wellmark on exchange (and they still allow use of the extended BCBS network out of state, thank goodness), but Assurant (the other great choice there) are pulling out of health care altogether in 2016.

[WheelingIt]

[QUOTE=Taterpeeler;2685652]

Originally Posted by WheelingIt

No offense taken, never crossed my mind.

Ok, got it on the Livingston local.... makes sense. Then off exchange is the route.... Lets see if Humana sneaks into that county, I will know the play book soon and because of your comment I will look at Livingston and advise...

Lastly, the prices of on and off are about the same except no subsidy... here is a copy of the FPL for 2015 and the income is MAGI, look at line 37 of tax return and add back untaxed SS benefits and a few others(get a tax guy to calculate) but line 37 generally(adjusted gross income)

Sorry, chart wont copy correctly so 400% is about this for next year:
2 on return=$64000
3 on return= $80000

APPX numbers

Thanks. I typed my response before seeing yours. Yeah, if you hear of anything new I know everyone here would be dying to hear it. Hopefully Humana will be an option (off-exchange) in TX although it's very costly (ugh) without subsidies, but choices may becoming limited. I have a feeling many insurers are trending towards less PPO and more HMO type plans in the individual marketplace (just a feeling I have..financially it would seem to make sense for them). It's not great for fulltime RVers.

[saydiver]

Originally Posted by WheelingIt

FL still has Wellmark on exchange (and they still allow use of the extended BCBS network out of state, thank goodness), but Assurant (the other great choice there) are pulling out of health care altogether in 2016.

What zip codes in Florida use WellMark? I checked a few areas both north and south and only found Florida BCBS(Florida Blue). Their Blue Options policy is both an EPO and a PPO. EPO in state and PPO out of state, although my card shows PPO only.

Sue