No options left for pre-Medicare health insurance in SD for fulltime RVers

[Doggy Daddy]

Glad I have the VA and being retired army I have Tricare for Life.

Sounds like it is time for full timers, Good Sam and FMCA Presidents to contact Republican Congress of the problem and ask they submit a Bill to allow buying Insurance across state borders.

[WheelingIt]

Originally Posted by Doggy Daddy

Glad I have the VA and being retired army I have Tricare for Life.



Sounds like it is time for full timers, Good Sam and FMCA Presidents to contact Republican Congress of the problem and ask they submit a Bill to allow buying Insurance across state borders.

I just want to re-iterate that our only major problem here is in SD. Of the three most popular fulltime RV states, only SD has such poor options for pre-Medicare RVers. TX and FL both offer excellent nationwide coverage plans (on the exchange too) for RVers.

[WheelingIt]

Originally Posted by saydiver

PS to multi-state plans and a PM.

Yes, a multi-state plan can work for full-timers/snow birds too, but not all multi-state plans are nationwide currently, but will be within the next few years according to the following article:

OPM Multi-State Plan Program Fact Sheet

When I looked at a TX multi-state plan last year it wasn't nationwide, but I haven't checked it out this year to see if all states are included.

Sue

Exactly. Multi state plans allow you to port your insurance to another state (say, if you move) and/or to insure family members in multiple states. They are not *necessarily* nationwide, although some may be. So, folks looking at this need to be aware of that detail. Multi-state does not automatically mean you can get care nationwide.

For nationwide coverage you need to look at the participating network size and network strength. For most fulltime RVers this means choosing a PPO plan with a big, strong nationwide network.

[Barbaraok]

Originally Posted by saydiver

Some people have non-emergency medical conditions which require them seeing a specialist, rather than a 'dr in a box', more often than once a year, so they may have drs in multiple places. I know we do.

Sue

And you can't find those specialists in states surrounding and including Texas or Florida? I'm trying to think of a speciality that wouldn't be represented in either of those states and coming up empty.

Or is it a case of wanting to keep physicians one is familiar with even though you are moving? When getting a new domicile when you begin fulltiming should be just like moving when you change jobs. That will often mean finding new physicians, new banks, new dentists, new schools. Just because you can travel back to your old haunts doesn't mean that your insurance, which is based upon a risk pool in your new neighborhood, is going to cover you for routine, non emergency visits with the old physician, whether you are RVing or working for a new company in a new town in a new state.

Barb

[FlyingDiver]

Originally Posted by Barbaraok

And you can't find those specialists in states surrounding and including Texas or Florida? I'm trying to think of a speciality that wouldn't be represented in either of those states and coming up empty.

Or is it a case of wanting to keep physicians one is familiar with even though you are moving? When getting a new domicile when you begin fulltiming should be just like moving when you change jobs. That will often mean finding new physicians, new banks, new dentists, new schools. Just because you can travel back to your old haunts doesn't mean that your insurance, which is based upon a risk pool in your new neighborhood, is going to cover you for routine, non emergency visits with the old physician, whether you are RVing or working for a new company in a new town in a new state.

Barb

I'm not sure what point you're trying to make here. Are you trying to say that nationwide plans aren't needed for some people? Or that people that need nationwide plans shouldn't have to pay for that (additional) coverage?

Non-nationwide plans don't work for many people, especially full-timers or snowbirds. Just because we can find good doctors in TX or FL doesn't mean that we don't need non-emergency coverage other places/times of the year.

[saydiver]

Originally Posted by Barbaraok

And you can't find those specialists in states surrounding and including Texas or Florida? I'm trying to think of a speciality that wouldn't be represented in either of those states and coming up empty.

Or is it a case of wanting to keep physicians one is familiar with even though you are moving? When getting a new domicile when you begin fulltiming should be just like moving when you change jobs. That will often mean finding new physicians, new banks, new dentists, new schools. Just because you can travel back to your old haunts doesn't mean that your insurance, which is based upon a risk pool in your new neighborhood, is going to cover you for routine, non emergency visits with the old physician, whether you are RVing or working for a new company in a new town in a new state.

Barb

Yes, I have a specialist in TX and soon to be FL, but in the summer I'm in the north somewhere and need to see a specialist, rather than a 'dr in a box'.

Yes, a true nationwide PPO plan will pay for those visits, whether you're in TX, FL, MI or some other state and that's why the rates are higher than a HMO, POS, etc.

Sue

[Barbaraok]

Do you need to see the specialist, or do you need lab work done and faxed back to the specialist so that they can see if meds need to be adjusted? We've had Rx written for lab work which was then faxed back and then a new dosage for meds sent to our pharmacy. If you've had a conversation about what you want to do, most physicians can work with you in providing a way to do it.

Barb

[saydiver]

Originally Posted by Barbaraok

Do you need to see the specialist, or do you need lab work done and faxed back to the specialist so that they can see if meds need to be adjusted? We've had Rx written for lab work which was then faxed back and then a new dosage for meds sent to our pharmacy. If you've had a conversation about what you want to do, most physicians can work with you in providing a way to do it.

Barb

We do the same concerning labwork. Yes, I actually need to 'see' a specialist.

Sue

[saydiver]

Originally Posted by WheelingIt

I just want to re-iterate that our only major problem here is in SD. Of the three most popular fulltime RV states, only SD has such poor options for pre-Medicare RVers. TX and FL both offer excellent nationwide coverage plans (on the exchange too) for RVers.

I haven't checked out the rates for the zips in FL most full-timers use, but I do know in the FL zip we're actually moving to sometime next year, the PPO rate is approx $300 more a month for me. I haven't checked on DH's rate yet, but I expect it will be $200-$300 higher per month too.

Sue

[WheelingIt]

Originally Posted by saydiver

I haven't checked out the rates for the zips in FL most full-timers use, but I do know in the FL zip we're actually moving to sometime next year, the PPO rate is approx $300 more a month for me. I haven't checked on DH's rate yet, but I expect it will be $200-$300 higher per month too.

Sue

Base rates are going up. If you qualify for subsidies you'll see some relief, but the base rates are high. On the FL exchange Assurant is offering a solid, nationwide PPO plan.

My point was not so much about the rates, but about the availability of plans. In SD there are NO nationwide plans on the exchange and only ONE off exchange who will accept fulltime RVers. The off exchange guy (Assurant) is overly expensive. As reference PPO plans on FL and TX exchanges price around $580-620/mo for us. The cheapest SD Assurant plan was ~$900/mo.

[oatmeal]

Originally Posted by dougandrobin

In Florida you have to earn I think $11k otherwise you do not qualify for Obamacare.

Under Obamacare, everybody qualifies for insurance--no more exclusions due to pre-existing health care conditions.

If you want to take advantage of a subsidy, you have to have an income of at least around $11,000. If your income is less than $11,000, you don't qualify for a subsidy, but that doesn't mean you can't buy insurance--you can, but you'll have to pay the full premium.

For people who make less than $11,000, ACA covered them through Medicaid expansion. However, the Supreme Court said states couldn't be required to expand Medicaid coverage, which foiled that part of ACA.

That decision left a HUGE hole, and here's the effect:

In states that didn't expand Medicaid, if you make $12,000 a year, you qualify for a heavily subsidized private health insurance plan, with significant cost-sharing reductions (i.e., lower deductibles and out-of-pocket maximums)--about as good as it gets.

But if you make $10,000 a year, your ONLY option is to pay the full premium on an individual health insurance policy, and good luck doing that on a $10,000/year income. Yep, those people get nothing--they don't get subsidized health insurance, and they don't get Medicaid.

This comes as a shock to most people, and not very many understand how that [insane, not to mention cruel] result came about. I know that the first time I heard about it, I literally couldn't believe it because how in the world could that be? But it's true.

Originally Posted by saydiver

A multi-state plan is for a family with members residing in different states.

&

Originally Posted by WheelingIt

Exactly. Multi state plans allow you to port your insurance to another state (say, if you move) and/or to insure family members in multiple states. They are not *necessarily* nationwide, although some may be.

I don't think these characterizations of multi-state plans are accurate.

Having the designation "multi-state plan" means only that it is subject to a contract with the Office of Personnel Management, which has a lot of experience in this field because it also administers health insurance for federal employees. That's presumably the advantage of a multi-state plan. In all other respects, it acts just like other plans. The term "multi-state" is a terrible misnomer.

The definition of "multi-state plan" at healthcare.gov can be found here:

https://www.healthcare.gov/glossary/multi-state-plan/

There's nothing about portability or insuring family members in multiple states.

This website has the best information I've found:

Insurance FAQs

Among the questions and answers:

Why should I choose a Multi-State Plan?
A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.

If I enroll my family in a Multi-State Plan option, can my children be covered if they go to college out of State?
You will want to review the benefits covered by any plan you are considering to see if your children’s out-of-State providers are included in the plan’s network. Services provided by health care providers outside of a plan’s network typically cost more than services delivered by in-network providers.

If I move to a different State, do I get to take my Multi-State Plan coverage with me?
No; however, there may be another Multi-State Plan (MSP) option available to you in the new State.

If I sign up for a Multi-State Plan option and then need to get care in a different State, can I get in-network benefits in that State?
Some Multi-State Plan options offer in-network care outside of your service area, but not all. If you live in one State and work, go to college, or spend a lot of time in another State, carefully check the provider directories of the plans you’re considering buying. See if their networks have doctors, hospitals, and other healthcare providers in the places you’ll be. Also, check out the plan’s payment policies for out-of-network care.


The main thing for a fulltimer to look for is the out-of-state network. Being designated a multi-state plan means nothing when it comes to the network, and really, shouldn't even enter into the equation. When I was first shopping, I looked for multi-state plans until I realized it didn't have any bearing on what a fulltimer is looking for in insurance.

[WheelingIt]

Originally Posted by oatmeal

Having the designation "multi-state plan" means only that it is subject to a contract with the Office of Personnel Management, which has a lot of experience in this field because it also administers health insurance for federal employees. That's presumably the advantage of a multi-state plan. In all other respects, it acts just like other plans. The term "multi-state" is a terrible misnomer.

The definition of "multi-state plan" at healthcare.gov can be found here:

https://www.healthcare.gov/glossary/multi-state-plan/

There's nothing about portability or insuring family members in multiple states.

This website has the best information I've found:

Insurance FAQs

Among the questions and answers:

Why should I choose a Multi-State Plan?
A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.

If I enroll my family in a Multi-State Plan option, can my children be covered if they go to college out of State?
You will want to review the benefits covered by any plan you are considering to see if your children’s out-of-State providers are included in the plan’s network. Services provided by health care providers outside of a plan’s network typically cost more than services delivered by in-network providers.

If I move to a different State, do I get to take my Multi-State Plan coverage with me?
No; however, there may be another Multi-State Plan (MSP) option available to you in the new State.

If I sign up for a Multi-State Plan option and then need to get care in a different State, can I get in-network benefits in that State?
Some Multi-State Plan options offer in-network care outside of your service area, but not all. If you live in one State and work, go to college, or spend a lot of time in another State, carefully check the provider directories of the plans you’re considering buying. See if their networks have doctors, hospitals, and other healthcare providers in the places you’ll be. Also, check out the plan’s payment policies for out-of-network care.


The main thing for a fulltimer to look for is the out-of-state network. Being designated a multi-state plan means nothing when it comes to the network, and really, shouldn't even enter into the equation. When I was first shopping, I looked for multi-state plans until I realized it didn't have any bearing on what a fulltimer is looking for in insurance.

Reading more into this you are correct about the portability, although I still see references to allowing family members in different states to enroll in the same plan. From the OPM website:

http://www.opm.gov/healthcare-insura...am-fact-sheet/
"These plans may also provide families with members who live in different states the option of being enrolled in the same plan."

Either way "multi-state" has no real bearing for RVers. Honestly not sure why they even call them "multi state". The key for RVers who travel extensively is to enroll in a PPO plan with strong, nationwide network.

[oatmeal]

Originally Posted by WheelingIt

Either way "multi-state" has no real bearing for RVers. Honestly not sure why they even call them "multi state". The key for RVers who travel extensively is to enroll in a PPO plan with strong, nationwide network.

I got the impression, when I first started looking into this, that there might have been an actual plan (or hope?) for some sort of "real" multi-state plans, but it didn't work out. Maybe that fell away, but the name stuck. It's exceedingly unfortunate.

In one Q&A I found out that some "multi-state plans" don't even extend to everyone in a given state, although they're "encouraged" to, and there is hope they eventually will. So some multi-state plans aren't even fully intra-state plans, much less inter-state, like the name implies.

For now, the stated justification for multi-state plans is that they provide competition in states where residents would otherwise have only one or two choices of providers. I still have never read anything that made me understand how this result is obtained by having OPM contract with them, and it turns out that Blue Cross is the dominant player in the multi-state plan arena. I think something fell apart between planning and execution, and what we're left with is a red herring.

I think it's generally no big deal because the only people who really truly want what they think a multi-state plan would be is fulltime RVers who are too young for Medicare--a very small group.

[Bumps]

...If you want to take advantage of a subsidy, you have to have an income of at least around $11,000. If your income is less than $11,000, you don't qualify for a subsidy, but that doesn't mean you can't buy insurance--you can, but you'll have to pay the full premium...

A question about "Income" and subsidies:

We still have about a year to go before continuing my company-provided HI will become cost prohibitive. At that point, I wonder what qualifying "income" will be? Both of us without a [paying] job, we will be living off savings. We are scaring age 60, but not quite there, yet.

Please confirm that for the purpose of qualifying for subsidies (or not), the "income" you refer to is the figure on Form 1040 Line 37: "Adjusted Gross Earnings." That being the case, and married filing jointly, then it would force us to take at least $11,000 in distributions from [one of] our 401(k)s each year (but not from both 401(k)s each year). Am I getting this right?

Thanks!

\ken