The ACA (aka ObamaCare) & Its Impact on FullTime RV Health Insurance
This is one of those posts I’ve been meaning to write for a long time. I’ve been both looking forward to it and dreading it. One the one hand it’s a really important post, on the other hand it’s a really complicated subject mostly because there is no easy answer to health insurance for fulltime RVers on the road. Alot depends on your situation, your age, your personal health and your finances. So, if you’re ready to take this ride take a deep breath, fortify yourself and get reading on my longest post ever….
Things Are A-Changing….
For the past 4 years we’ve carried a high-deductible ($10,000 deductible) insurance backed by a HSA (Health Savings Account) from Coventry in South Dakota that we bought online from ehealthinsurance.com and which I detailed in this post. It’s suited us perfectly because it has a strong nationwide network and it’s inexpensive, plus we are in good health and we pay most of our regular expenses out-of-pocket. What we’ve needed was a health insurance that would cover us in catastrophic terms (i.e. if something really bad happened) and for less than ~$200/mo this insurance fit the bill.
All that changed with the ACA (Affordable Care Act aka ObamaCare) which went into effect this year.
Now, I’m going to say up-front that I do not want this post to be about politics, and I will moderate comments the same way. This is a purely a practical interpretation of what ACA provides (or doesn’t provide) fulltime RVers and how it may (or may not) change the decision you make on where you domicile and what insurance you buy. Also, I’m not going to discuss Medicare or Medicaid (a whole other topic!) just to keep things simple. This post is really targeted towards younger (pre-Medicare) RVers who need to buy their own insurance. Finally keep in mind I am not a qualified insurance agent, so this stuff is only my personal opinions and understanding. With that said, let’s get started:
What Is The Affordable Care Act (ACA)?
The way I look at it, the ACA is basically an insurance bill. It regulates who insurances can sell to and what minimum coverage they must include, plus it requires everyone to have insurance or pay a penalty fee (there are certain exemptions). Also it created a centralized spot (the Health Care Exchange) where you can buy and compare insurance plans. In a way it levels the playing field, in that all insurance companies must now conform to specific minimum requirements and if you buy a particular level of insurance (say, Bronze level) from one guy, you can be pretty sure it’ll cover the same basics as the same level of insurance from another guy. In other ways it’s not so simple.
Certain things are now a requirement -> for example insurance companies can no longer differentiate between sick and healthy people (you ALL pay the same), they are no longer allowed to have lifetime caps (personally I like this) plus there are very basic heath checks (called “preventative care“) which are now included in all plans (Note/ you can read my take on preventative care here).
Other things are not regulated at all -> for example network sizes and out-of-network costs, which can be a potentially really important thing for fulltime RVers, except for emergency care (there’s a gotcha in here which I will explain below). Plus costs can vary substantially from state to state (e.g. the BCBS insurance you buy in one state might be a completely different price in another state). Also, the ACA does nothing to regulate the healthcare side of the equation (what hospital & doctors charge, prescription costs etc.)
The other major thing ACA has done is implement subsidies. What that basically means is that if you earn below certain levels (based on something called MAGI or Modified Adjusted Gross Income -> this year for a couple of two it’s less than $62,040), you can get a tax credit to help pay for insurance costs. The less you earn, the bigger your subsidy, down to a limit. An important thing to understand is that in order to get these subsidies you MUST buy your insurance through the Federal (or your State’s) Health Insurance Exchange or work with an ACA-qualified agent who can help you navigate the exchange.
There’s alot more to this ACA stuff, but in my mind these points are the most important ones for young fulltime RVers. If you want to read more about the intricate details of the ACA law this write-up from RV Dreams is an excellent summary -> The Affordable Health Care Act & RVers. Or check out Kyle’s equally fine summary here -> Affordable Care Act
How Does This Affect My Current Health Insurance?
Now, here’s the rub. What does all this mean for me, specifically?
Well, the very first thing that has affected us is that our current insurance plan (the one we’ve had for 4 years) may no longer be available to us at the end of this year. Our plan was “grandfathered in” (which basically means we bought it before March 2010 and have never changed it), but our insurance company has told us they will no longer support it after the end of this year. This may of course change (you never know), but that’s our current information. Once our insurance expires this Sept we’ll be forced onto an ACA-compliant plan. Our current plan costs around $260/mo for the both of us combined (it went up this last Sept), whereas a new ACA plan will cost around $550/mo (for the same $10,000 deductible), and since Coventry is not on the SD exchange we won’t be able to get any subsidies for it. The big jump in price is a direct result of additional minimum regulations as well as sick people being forced into the same insurance pool at the same level as healthy people (no judgement here…those are just the consequences). Also in the background of all this (and to save costs, I presume) alot of insurance companies are now also changing their coverage networks (many have limited them), plus not all the options out there are “fulltime RV” friendly.
We need to be pay attention to all these things when we go shopping for insurance again later this year.
Key Tips For Shopping For Insurance As A Fulltime RVer
So, how in the world do I chose what to buy? These are the most critical points I think that any new fulltimer (or current fulltimer who is being forced into buying new insurance) should consider:
1/ Should I Buy On The Exchange Or Not?
There’s no doubt the insurance subsidy is a huge benefit and will save significant $$ for those that qualify. If you DO qualify (you can check on this calculator) you *must* buy your insurance off your State’s Health Insurance Exchange, or work with a qualified agent who is certified to help you enroll in the government exchange. For the “big 3” fulltime RV states (TX, SD, FL) that means you buy it HERE. If you don’t qualify for a subsidy you can buy your insurance from any company, even those not on the exchange.
2/ What Are The Important Things To Look For?
Coverage is now limited to 5 categories -> Bronze, Silver, Gold & Platinum levels (Catastrophic is still available if you’re under 30 or qualify for a hardship exemption). When you buy on-line you should be looking at those categories and comparing deductibles and out-of-pocket expenses. I’m not going to go through those particular details, but my advice is that you should pay special attention to the things that are not regulated by ACA such as:
Network Size -> Alot of companies have chosen to reduce network size especially for offerings on the exchange. Limited networks mean you don’t have alot of choice of doctors and services outside of your given state. This is a big deal for fulltime RVers, in my opinion. Many folks have cited the new emergency care regulations as covering you. The ACA law says your insurance can’t charge you more for out-of-network emergency care. So, if I get in an accident out-of-network I’ll just go to the ER and then drive back to my home state for regular care, right? It’s actually not so simple. Although the ACA regulates how much your insurance company can charge in this case, it does not protect you from “balance billing” by the hospital (which basically means if the hospital didn’t feel they got paid enough by your insurance they can charge you directly for the balance!) Unless the State specifically prohibits this, there are NO limits to it and it can mean thousands of additional $$ out of pocket. Also, what if it’s the middle of winter and you can’t get back to your state of residence for follow-up care? Or, the nearest “in network” hospital is days away? For these reasons I think choosing an insurance with a STRONG nationwide network is critical for fulltime RVers. Personally I will only consider PPO plans with big networks (no EPOs, no HMOs). Staying in-network will always reduce your costs and protect you from balance billing.
Out-Of-Network Caps -> Our goal is always to try and stay in-network, but sometimes it can’t be helped. I think it’s good practice to chose insurances that limit out-of-network costs, just in case. This is something ACA doesn’t regulate, so you need to check for it specifically.
Friendliness To Fulltime RVers -> Another thing which is really key to us nomads is that some insurances are not fulltime RV friendly. For example they might require you to be “in state” a certain number of months per year, or they simply won’t accept mail forwarding addresses as proof of residence. This is a particular problem in South Dakota, for example where two out of the three insurance companies on the official exchange (Sanford & DakotaCare) require 6-month residency proof. This is HUGE! I personally know at least 3 RVers who were accepted, and then subsequently rejected for insurance in SD because they couldn’t provide proof of permanent residence, despite all of them having established legal domicile in the state.
Basic Costs -> One of the things us fulltime RVers have as a benefit is that we are not necessarily tied to a given state (for the most part). That means we can truly “shop around”. Trying to do this on the official exchange is a bit of a bear, but you can use HealthSherpa.com to shop around exchange-based insurances with total ease or try something like ehealthinsurance.com or a good, qualified broker for a wider range of choices. In our case, comparing equivalent insurances across TX, FL & SD has revealed costs of several hundreds of dollars of difference. Health insurance should never be your only consideration for domicile, but it’s an important one.
Support For An HSA Account -> We’ve had a Health Savings Account for many years and we really, really like the benefits. The money you put away each year for medical care is tax-free, plus you don’t pay taxes on the interest you earn in that account and you get to spend it tax-free. It’s like a triple-tax benefit. We keep the $10,000 deductible for our health care in this account and try to max out contributions each year. Not all insurance plans offer this, so you have to look specifically for it.
Holey Moley I Need HELP!!
Believe me, you are not the only one. I have personally spent hours (weeks, months) looking at ACA and trying to understand what impact it has for Paul and me. I’ve run 10-page long threads on forums & FaceBook and called slews of insurance companies and I still don’t understand everything. This is why I was overjoyed when I heard about Kyle and his new RV site RVerHealthInsurance.com. Here was finally a site run by a fulltime RVer with actual health insurance experience who completely understands our issues. I don’t usually recommend sites unless I really love them, as you know, and this one definitely qualifies. This guy has good articles on things to consider (whether pre-Medicare or post-Medicare) and can help you walk through your insurance choices, including those on the Government Exchange (Kyle is “ACA-certified”). I’ve actually corresponded with him several times and learned details I would not otherwise have figured out. Given that the ACA law is brand new and that things are likely to change alot in the next few years as insurance companies figure it out (the whole landscape will probably look totally different in 5 years time), knowing someone who is actually keeping ontop of all these changes will be really helpful. I like his site so much I signed up to be an affiliate, so if you click our link or let him know WheelingIt referred you, we get a small referral fee. Even if you never get a quote from him, I highly recommend browsing the site. It’s been invaluable for us.
What This Means For Paul And Me
So, this brings us back finally to Paul and me. What in the world are we going to do?? Since we’re still young and still healthy our plan is to continue to pay basic health care out-of-pocket and keep a (hopefully low-cost) high-deductible insurance plan with support for an HSA account as our back-up in case something goes wrong. But after Sept the plan we have now will likely no longer be available.
When this whole ACA thing launched the very first thing I figured out was that if we wanted to buy a plan on the exchange in SD we were going to be in trouble. There are currently only three companies on the SD exchange -> Avera, DakotaCare & Sanford. Two of those guys (Sanford & DakotaCare) won’t accept fulltime RVers, while the third (Avera) had an astonishingly crappy network, at least at the time I looked at them (thanks to Kyle I now know this may have recently changed). We could chose to buy off the exchange of course, but the costs are 2-3 times what we pay now even for the $10,000 deductible plans. All this means is that unless something changes between now and Sept we will probably choose to change domicile to another state.
From everything I’ve looked at, and everything I’ve learned from Kyle the most likely candidate is Texas (Escapees address). The change would be easy, there are no domicile issues in TX, I like the BCBS option offered on the exchange there (it has out-of-network caps and very strong nationwide network) plus it’s cheaper than anything I can get in SD. Also Texas is still a tax-free state with good costs for RV insurance, registration, mail forwarding etc. Lastly, since moving state is considered a “qualifying life event“, we will be able to enroll in a new health plan outside of the standard enrollment period.
But honestly at this point I’m still not 100% sure. I’m keeping informed of all the choices and by Sept will let you know of our final decision.
Did You Make It??
Did you survive the post??? I barely did. Hopefully it’s been helpful and will give some of you clarity on what to do with insurance under the new ACA law. Feel free to comment and post questions below (just keep it non-political please).
Good, Related Blog Posts & Links
- Technomadia -> Picking A Domicile State, Getting Mail & Voting As A Nomad (great intro to choosing domicile)
- RV Dreams -> The Affordable Health Care Act & RVers (good overview of the ACA law details)
- The Federal ACA Exchange -> HealthCare.gov (SD, TX & FL are all on this exchange)
- The “Shopping Around” Link -> HealthSherpa.com (get ACA quotes from any state. Great comparison link)
- The “Help Me” Link -> RVerHealthInsurance.com (Kyle’s excellent website for fulltime RVers)
- Self-Medical Care -> My Three-Part Series on self-medical care & cash pay
Thanks Nina. Great info that’s fairly easy to follow and understand. We’ll keep SD as our domicile state, as I have health care under my pension plan. But, things will surely change and we need to keep abreast of developments.
I’m glad it was easy to read through. Such a complicated subject that’s hard to present! Hopefully you get to keep your pension plan. In fact for most folks, if they already have insurance I think it’s worth waiting around to see how all this pans out. Things could change a lot over the next few years.
Nina
Great article, good info. Since I have lived in SD now for the past 18 years, and was in fact born there some 63 years ago, I guess that shouldn’t be a problem for us, should we ever meet our dream of full timing in our old 96 Holiday Rambler Endeavor LE. (still trying to get off the narcotics that are holding us here for my monthly script) Getting off more every month but it is a slow process. The benefit of being on strong narcotics though are slim but good when it happens, for example I just had a tooth cut out by an oral surgeon and the pain was very minimal, in fact only about an hour of soreness at the point of the cut. I will miss that. However I didn’t have dental insurance, that damn tooth cost nearly $900.00 to have it cut out, after a $300.00 root canal about a year before. I am now looking at the dental insurance now offered in conjunction with the VA at 25 bucks a month, as I have long neglected my teeth, many of which were filled back in the 70’s by the Army, most of the fillings have fallen out and been replaced, and now those replacements are falling away.
Currently weighing our ACA options as well. Thank you for the timely post.
Good timing then. Hopefully this helps you in your choices.
Nina
Wow. Confusing to say the least. We currently have no insurance and will probably stay that way. I am fairly sure we could get the subsidized variety though. Just last summer we got our residency in SD so I will be interested to learn what you decide to do. If we do decide to get insurance, I will check out the website you talked about. That looks very helpful. Good luck!
You may want to look at the subsidized insurances. The new law requires that you have insurance or pay a penalty. The penalty is not large the first year, but it gets bigger. If you qualify for subsidies you may find you can get relatively inexpensive insurance. Right now the best (and really only, as far as fulltime RVers are concerned) option on the SD exchange is Avera. I’d recommend looking into it.
Nina
And FYI if anyone wonders how they impose the penalty (as I did: I wondered if the next medical body I had to deal with would simply add the ‘penalty’ to their bill?!) they simply add it to your tax return. So next tax year I presume you have to provide proof of what insurance you have – and when it was taken out (as the penalty is pro-rated to the number of months you don’t have the insurance).
(This brings me to wonder how you nomads out there do your taxes as you wander from state to state – but presumably Nina will do a great article covering that when she re-decides on Domicile! 😉 )
If we move state we’ll do our taxes the same way we would do them if we were physically moving from one house in one state to another house in another state. In SD and TX it’s easy because neither of them have income tax, so no forms needed! If we moved from CA, say we’d submit a part-year resident form to CA for the months we were resident there before we “moved”. Make sense?
Cheers for the info on the penalty.
Nina
Most made sense, but don’t they have to pay tax in any state, even Tx, Federal if not State? (Or is this Health Insurance stuff all State-related only?! The Plot Thickens!)
(Also wonder then how they will hit you with the ‘Penalty’ if you don’t do taxes?! 😉 )
I did have another thought though: given that the Penalty for not having Health Insurance isn’t so great (dependant on income; low for the 1st year; even not so huge 2nd year) maybe those people who don’t want to go for Health Insurance simply CAN gamble and do without, for now. It would be cheaper to pay the penalty than have to pay $$$$ for insurance?! And meanwhile have more time to let the dust settle. Just a thought.
Yes, Federal tax you pay everywhere and that’s where they get you on the penalty. But the health insurance options are state by state. Confusing as mud, eh? Not sure what they’ll do (or how they’ll enforce the penalty) if you don’t file Federal taxes….interesting question.
I have no doubt some folks will chose to pay the penalty, especially in the beginning. I can’t deny we’ve considered it ourselves. The main issue you run into is that if something unexpected and really bad happens, then you’re stuck with the full hospital costs (potentially a bankrupting event) and no insurance until you can enroll (which may not be until the next open enrollment period). It’s very risky…but I’m sure some folks will choose to do it nonetheless.
Nina
Both the wife and I are on Social Security, and I draw some on Workers Comp. Both of which are income tax free since our income is so low. I wonder how that will work, guess I will probably have to file because of that now. From the information I have, I don’t need any of those on the exchange or otherwise as we both have Medicare, and I also have the VA as well as Workers Comp when dealing with my work injury.
Yes, since you have insurance through the VA you will not need to buy separate health insurance on the exchanges. You may just need to check how that insurance “travels” as you go around the country (I’m not familiar with VA details and how you get care out of your home state).
As for whether you need to file taxes, on the federal side you can take this quiz:
http://www.irs.gov/uac/Do-I-Need-to-File-a-Tax-Return%3F
For SD there is no income tax.
Nina
Excellent post! We are anticipating going full-time RVing in the next few months, and health insurance is a major issue. Fortunately for us, we will be eligible for Medicare soon. But until then, we’re buckling in for the ACA ride! Thanks again for your post, and for your references. We’ll definitely be checking them out! God bless!
Glad the post is helpful! I can’t wait until we qualify for Medicare….but that’s many years away. It’s the only reason I wish I were older LOL.
Nina
Great information! After retiring a few months ago and making SD my new residence(to start the full-time lifestyle), I’m hoping I will not have to change it again due to health insurance. While I’m lucky to have insurance (for now) from my previous employer, my girl friend who will soon to be my traveling partner will need insurance so your information is very timely and helpful.
I too believe the high deductible insurance plan are the way to go so will be looking forward to what you and Paul decide to do.
What is the situation if my girlfriend has “no income” after leaving her job? Would she get “free”(I hate that word) insurance?
Thanks,
Mark
Your girlfriends question is not an easy one. If she has no income and very few savings she may qualify for Medicaid. That’s the only “free” option. Alternatively, if she’s below 30 or meets one of the hardship exemptions she may be able to buy a Catastrophic Plan. Otherwise she may, unfortunately, be out of luck for cheap plans. South Dakota chose *not* to participate in the Medicaid expansion plan, and with no income she doesn’t qualify for subsidies. She may need to look at establishing domicile elsewhere.
These are just my initial (and totally non-professional) thoughts. Medicaid is a whole area which I’m not too familiar with so she’ll have to do some research.
Nina
Nina, when I submitted my ACA application on the State of Washington’s Health Care website (they have their own site, and WA is where my “residential” address is, even though I’ve been “portable” for over 6 years), because I’m considered low-income, I qualified for 17 different health insurance plans, about half of which were free to me, meaning the federal subsidy covered the monthly premium 100%. Having a high-deductible health insurance at $0 per month was certainly more attractive than not having health insurance, which is what I’ve had since my job went away almost 7 years ago along with its accompanying heath insurance.
Submitting an application for ACA health coverage in the state you’re a resident of does not mean you have to buy the insurance plans they find for you. You are not obligated to buy anything that I know of. I don’t know if WA chose the expansions or not so I don’t know if having no income disqualifies someone from health care.
Certainly a complicated issue, isn’t it! Thank you for tackling it!
Washington was one of the states who participated in the Medicaid expansion program so I do believe they offer MANY more options for those with lower income. There is definitely a gap in the states who chose not to participate (e.g. SD, TX, FL…amongst others), particularly for those who make below the minimum level for subsidies ($11,490 for a single person this year).
In those states, if you don’t qualify for Medicaid your only real option for low-cost insurance is to buy a Catastrophic plan (which is not subsidized) under a “hardship exemption“. Otherwise you have the option to forgo insurance. If you qualify for the exemption you won’t have to pay the penalty fee either.
Nina
What a service you have provided for your readers, Nina! I am on Medicare and have found my policy allows me care in any state. It’s a relief if I intend to travel from my home state. I agree that it’s vital to consider a more universal plan.
Medicare is just so much simpler than all this personal insurance mess. I can’t wait to qualify!
Nina
Good informative post.
We play the Snow Bird game and depend on a state provided health care, but they changed vendors a few months back and things have changed for us. This is going to be a rough road for all who worked hard and paid their bills. Hope we all survive.
Sure hope you find an easy solution. Wishing the best for you!
Nina
Thanks, Nina, so many of us have been waiting for this important subject post. Right now in California we poor pair had been advised we qualify for Medi-Cal (not quite old enough for Medicare) so applied 7Jan, but still waiting.. (they are in a mess). After chasing them up recently they NOW insisted I have to apply for Unemployment Benefit! – which I really didn’t want anyway – just so they could put the reference number I got from THAT application onto their paperwork… I fear I will be rejected for the unemployment application (since I honestly said I was unavailable for work, because we hope to be moving soon) and then maybe we’ll lose Medi-Cal because of THAT. (Something’s wrong here!). So perhaps we’ll have to hunt for partly-paid-for insurance just as you are talking about – and the Domicile business is also a useful topic to be hearing about too.
THANKS again for all your hard work on this Nina!
Geeze…what a mess! Working through health insurance us a massive headache. Sure hope things work out for you.
Nina
I chose BCBS. I’d had them in the past and their network made getting a “second opinion” cheaper. It’s been a while since I had problems, but resolving billing issues was (relatively)easier. Thanks for the links.
The BCBS option in Texas (if that’s the one you meant) looks really good. Strong network, decent terms. Hope it works well for you!
Nina
Good Post, Nina. Still confused, but it is a little bit clearer.
Well I’m happy I could clarify it even a little. To be honest it’s confusing, even for me, and I’ve spent countless hours on this stuff.
Nina
As usual … you are da bomb! Thanks Nina for such a thoughtful write up on such a complex subject.
H
Glad you like the post. It took a lot of deep breaths and cups of coffee to write it!
Nina
We’re in the same boat as you. Most fulltimers we’ve met have some sort of company, union, or government healthcare coverage (and are much older than we are). I wish we could buy into Medicare at an earlier age, but we ended up taking the Avera Silver Plan in South Dakota. It will basically give us the same coverage we had before the ACA, but will cost us about $7,500 more each year. As far as I can tell, the only people who shill in favor of the ACA are people who are covered by employers, the government, etc., and don’t have to buy insurance themselves through the exchanges. I did a post about the ACA on our blog back on August 4th and again on February 4th. It comes to the same conclusions as yours, but I must say we were much less charitable in our analysis than you have been! 🙂
As far as I can tell Avera is the only viable option for fulltime RVers on the SD exchange, at least for now. Maybe other companies will join in the future…we’ll see…
Nina
Forgot to add. We’ve been down in AZ all winter. Avera has a website you can go to and find out of state providers that are within their network. I’ll be getting routine blood tests in Tucson at LabCorp, all covered by the Avera plan. There are also plenty of doctors and hospitals to choose from down here. It looks like with Avera you need to handle planned healthcare expenses in SD, but have plenty of options for care in the event of an emergency while wintering in the southwest. We were able to find primary physicians in Avera’s network in Rapid City, but the majority of their network is in the eastern part of SD. So, for now, Avera seems to work for our fulltiming needs (except for the added premium costs).
Thanks for that very valuable feedback. That’s very good info. In that case looks like Avera *may* be a viable option for us if the network is as strong as you’ve seen. Handling “planned healthcare” expenses in SD may still be an issue for us given our usual travel path, so I’m still not sure. I’ll have to look into it some more. At least it looks like there is one, real, viable option on the exchange in SD for fulltimers. Not ideal…but at least they are there.
Thanks again!
Nina
I’d rather plan an annual trip to Rapid City than an Annual trip to TX any day. I hate the Dallas Cowboys! 🙂
Great summation of a complex topic, Nina! Thank you.
We ‘moved’ to Florida last year in part because health insurance options were so limited up in SD.
And we too are so thankful that Kyle has started offering his help navigating this stuff. Such a wonderful resource.
Yup, your article on domicile choice is a really good one. Required reading for any fulltime wanna-be.
Nina
You are so awesome! Thanks for the post on this very confusing situation.
Glad you liked it. Hope it helps some folks to figure through it all.
Nina
I’ve been looking forward to this post – thanks! I called around in December trying to figure out my options through the subsidized plans (naturally this is just at the time I was trying to choose a domicile state… great timing…), and no-one seemed to understand it. I had insurance agents throwing up their figurative hands!
I needed to get something, so I went for a non-exchange plan with Humana. I looked it up and the same plan was available in both Texas and Florida (slightly different prices, but not by much). That told me (I *think*) that they have a nationwide network (but I could be wrong). So I signed up in my “old” state (i.e. where I physically lived before I went full time), figuring that if an exchange plan never looked good, I could at least get the same plan in my domicile state.
That said… it’s pricey! I had pretty much settled on Texas (with Florida as a close competitor), so hearing that there may be a BCBS plan ON the exchange that would be good for RV-ers is HUGE. That would save me hundreds of dollars each month and I am probably going to take the leap to it before September (will do my own research of course). I really need to establish my new domicile as soon as reasonably possible (i.e. before September).
Anyway, timely info – thanks! Will check out Kyle’s site too.
PS: Meant to say that as a northerner, I had always assumed I would domicile in SD. But your earlier post (and other research) alerted me to the “issues” with ACA/healthcare there, and so I crossed it off my list (just in time). So a big thank you for that, too. (And maybe things there will change so it can again be a good option for folks like me.)
I see now that my post might be confusing. Not that anyone probably cares, but just to clarify, I’m still a resident of the state I lived in before I went full time (have not even set foot back there though!). I’ve just been waiting to choose a domicile because I knew the ACA was coming (this was last year) and I didn’t want to “move twice.” Earlier posts and research ruled out SD for me due to health insurance issues (which may or may not persist) and so I was left to choose between FL and TX. I still have not decided (but should do soon), but if there is going to be an ACA/subsidy/RV-er friendly BCBS plan in Texas that will sway me right over to them. I’ll be glad to get settled!
In the meantime I went for the Humana plan because, although I have no health issues (lucky me), I had a “gap” in insurance coverage from when my COBRA had run out, and wanted to get signed up as soon as possible.
Probably too much boring personal info, but maybe it will somehow resonate with someone else in the same boat.
Gotcha…and yes BCBS is a good RV-friendly option on the TX exchange. If you’re going to domicile in TX I would advise using Escapees as your address. They’ve done good work to make sure their address has been accepted as a proper, legal domicile (they even went to court to win their case) and BCBS TX knows this. We were never able to apply with BCBS in SD because they don’t accept any of the mail forwarding addresses there. In TX, with an Escapees address, you won’t have that problem.
Nina
Glad you caught it early. And like you said everything could change in a year or so….this is all new stuff.
Nina
The nationwide network thing is tricky. Two states offering what looks like the same plan could have totally different networks. Even in the same state they may offer different networks! That’s actually one of the problems I discovered with Coventry. If we stay with Coventry in Sept and move from our current plan onto an ACA plan we’ll actually be put on a totally different (and much more restrictive) network! Turns out Coventry has multiple different networks even in SD. Sneaky right? So, make sure you ask which network the plan applies to and then go research that network. These are the kinds of details Kyle can help you with too.
Yes, BCBS is on the exchange in TX, and if you get an address with Escapees they will accept your application there.
Nina
Looks like it will be Escapees/TX/BCBS for me most likely – thanks for the reply. I am not as good as you are at figuring out things like the network (and so would not be at all surprised if there were a “gotcha” in the Humana plan; also it is quite a bit more expensive). One reason I love and appreciate your posts.
With any luck I won’t need to “test” the Humana network and can simply (heh) change over to the BCBS one when I move domicile to Texas. Will definitely go with Escapees and talk to Kyle. Wish I had known about him in December!
Kyle just “emerged” recently, so he’s a new phenomenon 🙂 Good luck w/ everything!
Nina
Actually, Kyle has been in the insurance industry for quite some time, although his
site for RVers is new.
He is smart, has great character, and knows what he is talking about. If you have any questions, definitely give him a call.
Well yes, my comment was somewhat tongue-in-cheek. Kyle is an experienced agent. It’s just his RVerHealthInsurance site that is new and “emerged” recently 🙂
Nina
Another confusing thing with ACA is there are TWO subsidies.
One for the premium, the other for reduced deductibles and cost sharing, which can be significant. Althought the standard ACA plan may call for a $14000 deductible, in Fla, if your income is above the poverty level, you get a cost subsidy which, at the lower income levels could provide a $2000 deductible and much lower costs increasing as you hit income thresholds.
Be careful though, as I believe you only qualify for cost subsidies if you choose a silver plan. You can get a premium subsidy, choose a gold plan and lose out on the cost subsidy. I did not find that clearly stated anywhere, and it was not mentioned when I called the ACA 800 number. Fortunately I read it some where and when I called back and asked, was told that was true.
We got BCBS policies over the 800 number since the website would not work.
As fulltimers we felt a PPO or EPO were the best options, allowing us to get care where ever we happen to be. An HMO doesn’t appear to be a viable option to me.
In Fla another confusing thing is BCBS has 3 different named plans, Blue Option, Blue Choice and blue something else. your doctor may be on blue option and not Blue choice, so be careful when checking who your doctor is cooperating with!
I hope this all makes sense, because it IS confusing!
Geeze..now you’re getting into new territory even for me. I hadn’t heard about the different subsidies, so I guess I’ll have to look into that and try to understand it some more. More confusing details to work through…ugh!
Regarding plan type I really only consider PPO’s, and then I make sure to check how big the network is. I feel EPO’s are too restrictive and HMO’s are out of the question.
I HAVE seen the network thing you talk about. In fact I figured out that Coventry (our current insurance) offers several different networks all within SD depending on which plan you sign up to. It’s so important to understand this. Now I know that BCBS offers different networks too, all within the same state, depending on the plan. Very important tip that one. Thanks!
Nina
This website may help clarify re. the different BCBS network levels. For a PPO, you’ll want to apply for a Blue Options plan (not Blue Care, which is an HMO; or Blue Select, an EPO). We are domiciled in Florida and just went through the ACA application processing, picking the lowest-price Blue Options plan available to us. It ended up, with the subsidy we qualified for, having the same premium cost as our current catastrophic individual insurance plan through United Healthcare (which is also a PPO plan with a nationwide network). A big difference is that after the deductible is reached, the new ACA plan covers everything 100% vs. only 80% with our current/past plan. So while considering staying with our current plan, it made sense to go ahead and go with the ACA plan even though it meant a lot more research and short-term headaches! We also qualified for the cost-reduction silver plans, which have lower deductibles, but the Blue Options plans offered in that category carried higher monthly premiums, so we went with a bronze plan to keep our monthly premiums reasonable.
Sorry, forget to include the link about BCBS! Here it is:
http://www.mbaileygroup.com/blog/individual-and-family-insurance/difference-between-blue-care-blue-options-blue-select/
Cheers very much. That makes perfect sense now. Good info.
Nina
Recently started following your blog, and read with great interest your comments on the ACA. I had planned to retire and either full-time or part-time at 65, but more recently have been considering retiring earlier at 62 if (and only if), the ACA will allow for fairly affordable health care (maybe the act should have been called FAFA? 🙂 ). I still have a couple years to go, and as you noted, things may be different then. Your post was a great primer and gave me new things to think about beyond those I’ve found in my own research. Thank you!
Eileen in Phoenix
Indeed things may change over the next few years. I’d keep an eye on Kyle’s website. He’s my main source for health news affecting fulltime RVers.
Nina
Great job detailing this information and keeping it politically neutral! We are changing our residency to SD next week and are getting insurance through Barb’s former employer which is a little more expensive for me than some of the other plans we looked at but not enough to make a difference.
A friend of mine who lives in Minnesota and is also going going to domicile out of SD looked into getting a policy in Minnesota prior to changing residency. He found a “portable” policy that he could keep when changing residency but also found that rates are based on the area you live within the state. Once he leaves the Minnesota his rate would be calculated at the highest location rate within the state.
Regardless of what state you live in, it will probably be a year or so before the dust settles.
Agreed. It’s going to take a while for all this business to sort out. I’m hoping it will become clearer within the next few years. Who knows, maybe my insurance company will even change their mind and allow me to continue my current plan for another year (one can always hope)?
Interesting info on your friend from from MN. There are so many little, confusing details state-by-state that are not easy to sort through. Wish there was a simpler way.
Nina
We recently talked to another fulltimer who is changing his residence out of SD due to the insurance issue. SD may end up losing a lot of revenue this year.
So thankful we have insurance through Jim’s previous employer!
Yup, I’ve heard from several people who are battling this exact issue in SD. I sure hope more of the providers decide to change their policies towards fulltimers up there. At this rate they are going to lose alot of younger RVers.
Nina
Whew! Studying the article and the responses was a fantastic experience. And you did a good job keeping the “politics” out of it. The ACA is a law that needed to be done. I worked 22 years at a job to get medical coverage at the end. I truly feel everyone should have medical insurance and it should follow them where ever they go through their lives. It hasn’t always been, and shouldn’t be, a “political” issue.
Glad you liked the article. I just wish the insurance landscape was easier to navigate. Maybe one day, eh?
Nina
Looks like a very useful post, and helpful to a lot of people. Good luck sorting out your future. Have to admit that it simply makes me glad I live in Canada -though that means I can’t go full-timing outside the country.
This stuff sure isn’t easy to sort through. I do wish the system here was simpler, both for taxes and health care!
Nina
Wow. Thanks for taking the time and energy to sort through all of this and write it up so clearly. Looks like I need to do some homework — I was thinking I was okay because I still have my Oregon insurance (we’re maintaining our home in Oregon even though we’re full timing as of last June). I’ve never used my insurance and hope never to need it, but I want to make sure I’m covered wherever I happen to be. (This is when I don’t like being a grown-up.)
I’d definitely recommend checking into the strength of your network. That would be my main concern in your shoes. Since you still have a home in OR you’ll have no problem with your domicile or address, plus you’ll be going back there often enough. Just check into the network.
Nina
Thanks, Nina. I was thinking exactly the same thing — and will be calling my agent on Monday! We share your philosophy of practicing our own preventive health care, so basically health insurance for me has always been just catastrophic coverage — I always tell my agent that I feel like I’m paying “protection money” to the mob. 🙂
I like that…”protection money” LOL. Thanks for the laugh!
Nina
This was a really helpful summary that I actually understand! Just over a year ago I retired from human resources management so you’d think I’d have some basic understanding of this important topic. Nope. So many thanks for the good info! Your advice to “wait-and-see” is likely the key to success for those of us who can wait to see how things shakedown!
Yeah, I really believe that unless you’re forced to into a new plan, right now it’s best to wait it out and see what happens. Glad you understood the post! Success!
Nina
For us the ACA has been anything but affordable. I am now old enough for Medicare but my wife is not. We were notified last Oct. that her high deductible plan would no longer be available. It was a plan very similar to what you have. I had moved her plan from Aetna to Anthem Blue Cross in July 2013 so her plan was not eligible to be grand fathered. So now she has pretty much the same plan with a higher deductible for a much larger premium. The Premium went from 313.00 a month to 526.00. For us that is a huge hit. She is 3yrs from medicare so I guess we will just bite the bullet for now.
The new minimum requirements and inclusion of sick people into the regular insurance pool has definitely increased base premiums…no doubt about that. That was one of the consequences I always expected from the ACA implementation and it’s reflected in the 2x increase in our own insurance costs (= the $550 quote I got from Coventry for a new ACA plan).
If you qualify for subsidies you can bring down the costs, sometimes quite substantially. And of course, if you were previously sick (with a pre-existing condition) the new prices are probably much, much cheaper than whatever plan you were able to get before.
However if you don’t qualify for subsidies and you’re healthy you’re paying the full cost, and (in most cases) substantially more than before. Those are the facts of the change.
Sure hope you guys are able to ride it out until Medicare kicks in. This is not an easy change for anybody.
Nina
WOW Nina, this is amazing. I can only imagine the hours and days and weeks and months you have put into all this research. I’m really hoping that this ACA once it is through the shake down will help all people under the medicare age to able to afford health care that works for them
I hope for that too. This initial ramp-up has been tough, but I’m expecting the landscape to settle down and change over the next few years. Hopefully premiums will settle and decrease too.
Nina
Great thoughtful info but my head hurts!
Me too….it was a headache to write as well LOL
Nina
I am going to need another glass of whine…I mean wine. What a mind tangler!
Make that several glasses…you’ll see it clearer then 🙂
Nina
Thanks for the good information. I realize that it varies from person to person, but I’m very happy with my ACA plan. I was on BCBS before, and now my new plan is also on BCBS. My new premium for the same deductible would be about half what they would be if I continued the old plan (with was having a hefty increase), but I choose a plan with a higher deductible, which makes my new premium less than half.
So, I’m still paying less than what I did last year, and less than half what I would be paying if I stayed on the old plan. I don’t qualify for a subsidy.
What’s more, I’m now on the BCBS national network, which is great for traveling. I verified with BCBS that any provider in their provider directory nationwide is considered “in network”. My old BCBS plan was not on the national network.
Glad your new plan is looking so good! It’s always positive to hear about success stories.
Nina
I’ve got insurance through my ex-employer (pensioner). It’s actually gotten better since it took a deep nose dive a few years back, but that’s more a function of management and the reason it took that dive was Obamacare and adjusting to meet the coming mandated coverages. I don’t envy anyone having to get insurance through the exchanges.
You mentioned it several times and it bears repeating. Obamacare will change. Whether through executive action, delays, glitches, legislative adjustments, the dreaded death spiral or the results of elections, I suspect it won’t look anything like it does today in five years. Like the weather where we live, if you don’t like your insurance, wait five minutes. 😉
Thanks for wading through it all. You’re a brave soul.
LOL…love the weather analogy. And very true. I definitely think the whole thing will look very different in 5 years time.
Nina
Thanks for the good fulltimer perspective. I’m hoping that SD will expand Medicaid soon. In the mean time, its unavailability at least qualifies me for catastrophic coverage from the Marketplace, if I mail in the hardship form. Still 100% unsubsidized—but should be more affordable than the lowest cost $350/mo Bronze plan.
If not, I may be following you to Livingston!
Thanks for that feedback. I’d heard that buying a Catastrophic plan was an option for those who were left in the dark because SD didn’t expand Medicaid, but I wasn’t sure. This is good info. As you said, however, the big negative with Catastrophic Plans is that you cannot get any subsidies. It’s a very difficult situation for those with very limited income.
By the way TX did not expand Medicaid either, so they are in the same boat. Neither did FL. You can see which states choose to expand here:
http://www.advisory.com/daily-briefing/resources/primers/medicaidmap
Nina
Yes, I knew TX didn’t expand either. I am considering the “move” to TX simply because premiums seem to be significantly lower there and the PPO selection is much broader. Unfortunately I cannot even see specific catastrophic premiums until my exemption certificate arrives.
I’d noticed the same thing. In our search across the “big 3” RV states TX seemed to offer the lowest premiums for equivalent insurance. I do think they’re one of the better choices for fulltime RVers.
Sure hope your exemption certificate comes through. Without it there are really no affordable insurance options for anyone earning below the min. Subsidy levels. It’s really a rough situation.
Nina
A quick follow-up: By creating a different ObamaCare account and answering some questions slightly differently, I *was* finally able to view the actual catastrophic Marketplace premium for the Avera PPO plan in SD without filing for the hardship exemption. The result was very disappointing: $292/mo—way too expensive. On top of that, unlike the Avera bronze ($363) and silver ($368) plans, the catastrophic plan has ZERO out-of-network coverage except ER.
The network coverage is definitely the most concerning part of everything, especially for fulltime RVers. What a bummer! I’m honestly not sure if there are any other insurance options which are both low cost & nationwide for those that make below the minimums for subsidies. As you said below, probably the best option will be to look at establishing domicile in a state which has expanded Medicaid. The nationwide coverage will still be terrible, but at least the costs will be affordable & if you confine your travels to stay close to your “home” state you will at least have the option of care when needed. Not ideal at all, but it may be the best available option out there.
Nina
Thanks for the Medicaid expansion map link – now I know where WA stands 🙂
I would not assume that ACA won’t have future effects on those of us on Medicare. Today I was reading about the Independent Payments Advisory Board (IPAB) which consists of 15 appointees whose job is to make recommendations to limit Medicare’s budget by reducing reimbursements to doctors. Their proposals can automatically become law. Depending on how their contributions are received by medical providers, there may be a huge impact on Medicare recipients. I already lost my PCP when he left private practice due to what he deemed too much restriction by the ACA. It’s going to get real interesting…..
I think alot of things will change over the next 4-5 years. It will certainly be interesting.
Nina
Great write up on ACA, very informative. We are one of the many who signed up for Sanford only to be “tossed to the curb” when we couldn’t provide proof of residency. Sanford wrote us asking for proof of being physically in the state for a continuous 9 months. We work (and live) 6 months of the year in South Dakota and could provide proof of that but their “9 month rule” disqualified us. We have chosen to abandon SD as our home state and have taken the steps to become Texans and our BCBS exchange plan starts on 4/1. Hopefully we have this debacle behind us and can start enjoying our fulltime lifestyle once again because the last couple of months have been very stressful trying to navigate the health insurance maze.
My goodness. Sanford is even worse than I thought! Thanks very much for that feedback. Sadly it only confirms the fact that SD is really not fulltime RV friendly for pre-Medicare folks. If you’re still in SD you may want to look at Avera. According to Kyle they’ve recently changed their stance on fulltime RVers so they may be worth a shot?
So sorry you had to go through all that stress!
Nina
A small confession. I didn’t quite “make it” through the whole post. Sort of racing through emails and stuff this morning.
Just wanted to compliment you on your willingness to even broach the subject.
Can’t talk about “healthcare” in the States, as my comment would no doubt be nearly as long as your post.
That would never do.
Carry on!
Well, I definitely don’t expect everyone to make it through the post. Unless you’re actually in the position of having to buy personal insurance in the US, the nutty details will send most folks to sleep LOL. Sometimes I miss living abroad 🙂
Nina
Great post Nina. I liked your explanation of the ACA being an “insurance bill.” Michael is on Medicare and we carry a BCBS supplemental policy which costs us about $160 per month. These two policies cover everything for him except drugs–everything! Two surgeries over the last few years and we received zero bills. I on the other hand have a few more years until Medicare and like you can’t wait. Right now I am still enjoying a premium insurance policy leftover from Michael’s Texas employment. Soon I will have to enter the snake pit and decide what to do.
That’s a great coverage for Michael! Sure hope you can find something affordable for yourself too. Take deep breaths before you jump into it….
Nina
Excellent, I stayed with you to the end, very informative and helpful.
Glad it was helpful!
Nina
Only hurt the first time I read it – I must have been in shock, as the second time it was not too painful!!
Thanks Nina, good summary, good groups of links. I’ve participated in a few of your threads, and have run a few myself. I also have found Kyle to be a great asset.
We are in the Pre 65 group, and had just changed Domicile to SD last year. We elected to eat up some of our retirement contingency funds this year, and remain on my former employers Group Retirement Health Care plan. (BCBS North Carolina. We lost out HSA, 85% increase in rates, less coverage with higher our of pockets. Not political, but for us – it’s certainly an irony to see the word “Affordable” in this plans name:)!).
I’ve been getting help from Kyle, and I believe we too our in the ‘wait and see’ group. Will SD insurance companies make any changes for next years offerings, that include: Mail Forwarding Addresses and no in state time limits; HSA plan; Robust In Network out of State providers; and of course, for an reasonable cost.
The only thing I might add to your blog, is for those in SD to also consider different portions within the state, for next years enrollment cycle. (We are in Box Elder and Americas Mailbox, liked the support we received in our change to SD, and find the staff in Box Elder to all be top notch. However, the Rapid City area in 2014, did not have as many options as the Sioux Falls area. So one option, is to remain within SD, and change to a Domicile address out of Sioux Falls. Sure, not what we’d want to do. And sure, not fair to a Americas Mailbox that has worked and invested hard into the Box Elder area.)
Last comment for those that are again doing the ‘What State to Domicile Dance Analysis’ – is it still is more then just Health Care. Nina, for you and Paul, and for my wife Deb and I, we dirve 40′ Class A’s at such a weight level, that we would require different Drivers Licenses. (I went thru that in California, taking the full Class A Commercial Written Test (nor really was supposed to need to do this, but surprised, the CA DMV was all messed up – so it was just easier for me to take the test), and I also had to take the Driving Test too. My wife, will not do this. So this becomes a factor for us in ‘what state to Domicile’.
Enough, just wanted to point out the ‘in state ZIP’ can make a difference. And that the change a non SD State of Domicile has other ramifications, on top of the costs of changing everything over (wills, trusts, etc.)…
Appreciate your blog, and this post. It is already being referenced and pointed to in other forums I read:)!
Many thanks,
Smitty
Smitty,
Thanks very much for that important point! I had noticed in SD that certain insurance options (e.g. our current insurance with Coventry One) are not available in the Western part of the state, but can be bought in the Eastern part of the state. That is such a key point and I totally forgot to mention it in the blog post.
So yes, totally. For those still in SD and looking to stay in SD it may be worth checking insurance options in the Eastern part of the state, especially if you don’t qualify for subsidies (i.e. you’re not limited to the choices on the Exchange). We are with Alternative Resources in Sioux Falls and there ARE more insurance options there.
Also, you are right that choosing domicile state is NOT just about health care. I tried to point that out in the post, but it’s worth mentioning again. One reason we did not, originally, sign-up in TX was because they require a special license for our size motor-home and that’s something I was not keen on going through. If you own a business (like Technomadia for example) that brings in even more factors to the decision.
Nina
Brava! Excellent post. I’m bookmarking it for future reference in case I need to go on to ACA. I really appreciate your taking the time and effort to write this.
Good. Hope it helps people sort through their options.
Nina
Great summary, Nina!
My husband and I just bought a 40ft 5th wheel and will be traveling a great deal, although not full time. (At least that’s what we say now!) He is retired military and Medicare, I am covered through his military service. This may very well be the safest insurance situation to be in given the ACA limitations, although if military cuts keep happening, we might have to give up our traveling dream…
We’ll keep this article handy! Good luck to you! Maybe we’ll cross paws on the road!!(We travel with 4 dachshunds.)
Susan
My advice would certainly be to stick with your current insurance while you can. That will give this whole thing time to settle.
Nina
I’m still 2 years out from hitting the road but am following the changes to see how it evolves. I notice subsidies are not offered if you are under the $11,490 income level…I’m wondering why? I realize those in the “poverty level” may qualify for Medicaid but If I choose to leave my school job & work on the road (making perhaps $8,000) and I’m planning on purchasing & paying for insurance, shouldn’t I also get a subsidy, rather than the “free” Medicaid. Yep, clear as mud. I don’t do well with illogic so luckily it will change many times over in even 2 years. lol
Yes, the intent of the law is is that below the $11,490 level you have Medicaid. Unfortunately some states (e.g. SD, FL and TX) chose not to participate in the Medicaid expansion program so there is now a gap between the local Medicaid levels in those states and the levels at which you can buy insurance with subsidies. Doug commented on exactly this issue above.
At the moment, if you don’t qualify for Medicaid and do not make enough to meet the subsidy levels, your best choice is to try and buy a Catastrophic Plan under a hardship exemption. It will not be subsidized, but it will be cheaper than buying a regular plan off the exchange. At least that’s my understanding.
Nina
Medicaid has very poor out-of-state coverage, so low-income fulltime RVers may be wise to choose a Medicaid Expansion State as their domicile, and then confine most of their annual traveling within that state.
The good news is, this sacrifice is only necessary until one becomes eligible for Medicare, which is both very affordable and very portable. In fact I wouldn’t be too surprised to eventually see a similar “Medicare Expansion”, where Medicare becomes available to those under 65, in return for a monthly premium based on one’s age.
Nina, what you wrote is simply fantastic. Thank you for taking your time and explaining this very important issue. Clearly written but for me still all is so darn complicated and you probably thought you answered all possible questions. I’ll be turning 65 in September which means I can apply for Medicare in June. Meanwhile what do I do? I’m struggling with answers for weeks now. I got several different and conflicting answers. I lost my insurance when my husband died a few months ago. Now I don’t have any coverage. I’m planning to move in April or May to SD or TX and soon after that my plan is to get RV and become a nomad. Nobody is able to answer my questions when asked where do I apply for my health insurance or should I just wait when my Medicare kicks in? I do not worry about being penalized for not having insurance for a few months but although I’m very healthy things do happen.
Honestly my best advise for you is to give Kyle a call. I’m thinking he’ll be able to talk you through more options than I know about. As far as moving state you can apply for health insurance as soon as you have your new address (in TX or SD), so as soon as you get that settled you can be covered. I’m thinking that will solve the gap between when you move and when you go on Medicare. But give Kyle a call…he can probably help you better than I.
Nina
I’m sorry Nina. I knew there are limitations to your figuring out my situation so I will contact Kyle as you suggested and go from there. Thank you again for your extremely valuable post.
To “Grammar Police.” It wasn’t directed to me but I’m always reluctant to make my comments public because of grammar mistake I make. Well, English is not my first language. Not even my second language but does it mean I shouldn’t express myself in writing at all? I consider myself a life-long learner. At least I don’t use “u” and “r” and many other texting style shortcuts.
Have a great day.
Gina,
I’m sorry if I came off as a pedant or scold by being the “grammar policeman”. You should never be afraid to express yourself in any venue for any reason. I just feel that Nina has the best RV blog on the planet and would appreciate making it mo’ better. Ha!
I’m fine with it. I totally agree my grammar is not the best & I don’t mind the corrections. At least I can make the excuse that English wasn’t my first language either 🙂
Nina
Nina, your best post yet. The ACA has been great for my wife and me as we currently live in CA. We plan on going full-time this summer and appreciate the “heads-up” concerning the implications of residency decisions. BTW, we just spent a sunny warm week at Sam’s in Desert Hot Springs. Thanks for the recommendation.
What This Means For Paul And I ?????
The “Grammar Police” must strike!
What this means for Paul and me (object of a preposition)
Ah, grammar…the bane of my existence. There’s a reason I studied Science and not English 🙂 I’ll correct it now.
Nina
Nina, I will just concur with all the others. Thanks for the very good information…and thank you for keeping the politics out of it. It is what it is…and we must just carry on.
Yes, I really don’t want to discuss the political side & I sure appreciate that all the blog commenters have kept this line too. As it is I can’t vote anyway, so my main goal is just to work out the practical side of how to implement what we’ve currently got in the best way possible 🙂
Nina
I commented already above but wanted to add that when I first started searching online for information about the ACA and full-time travelers (RVers, cruisers, nomads, whatever!) I found very limited information. There was no Kyle, you guys hadn’t put your two cents in yet, and there just wasn’t much out there yet. I did find some information on another blog (http://lifeonthebluehighways.com//?s=ACA) and a few other bits and pieces here and there. I pieced together all I could find but decided to wait until the very last month to apply in hopes that more information would be published between October and March, and that our own individual insurance situation would be clarified (we weren’t cancelled but expected a rate increase and finally got the letter just recently). However, I missed your post and link to Kyle’s site by ONE day as I applied for the ACA on March 1 during the day (it was raining hard, great day to tackle it) and didn’t read your blog until that same evening. D’oh! Thank the gods, after reading your blog and then all that Kyle had to say, it turns out I did exactly what he recommended for someone in our situation — go with a bronze PPO plan with a nationwide network (in our case, FloridaBlue Blue Options 1419 plan). I am very relieved to see that I got it right — but I surely wish I’d waited until March 2 to apply instead of sweating it out! LOL… Thanks again for all your excellent research and information.
Very glad you got your insurance worked out despite all the stress & sweat. Looks like you signed a good plan!
Nina
This is too much for my brain to take in right now. I skimmed your information, but will go back and drag through it word by word tomorrow. What drudgery! We sold our home in Texas and have remained Texas residents through SKPs, so I’m gathering this may not be the worst case scenario in the world for us. It sure is a lot more fun to read your REALLY FUN blogs — but this is important stuff. Thanks for all your investigation and information.
I think you’ll do fine to keep your SKP TX domicile. The insurance options in that state are actually very good.
Nina
P.S. My next blog will be LIGHT reading!!
Thanks so much for all the excruciating detail of ACA’s effect on RVing full time. We went with AMAC; Assurant Health Insurance, the major Medical Policy similar to your. We are “good” through 2014. However, as you stated Things are a Changing. You have a profound understanding of the Cause and affect Details.
My Sincere gratitude to your efforts.
ggv
The Assurant guys offer a pretty strong network, as far as I understand, so looks like you ended up with a solid choice for the time being. They are one of the better options (off-exchange) in SD & FL. It’ll be interesting to see where all this goes from here.
Nina
Holy moly Nina that was a serious post!!
We’re in the same exact boat as you guys with a $200/month rate increase. Unfortunately, it seems like the plan we’re with is still our best option.
What really “grinds my gears” is that we have to pay for maternity and pediatric now…grr!!
The best bet for self-employed folks our age who are making moderate income is to try and get onto the subsidies (if you qualify). That will definitely bring down costs. Also some states offer many more plans (at cheaper prices) on the exchanges than others, so that’s another option (and another difficulty) for us nomads -> trying to figure out the best balance between income tax, fees, registration & health care for a given domicile state. It’s alot to work through!
Nina
Awesome post, Nina! This issue is a HUGE issue and you tackled it head on with some great information (as usual!) and without all the politics I’ve read elsewhere.
I lived in Washington State for 15 years before going “portable” and I’ve spent the last 6+ years without health insurance of any kind. This coincided with my body heading off on its own adventure after a lifetime of not being sick, making it an adventure all its own to try and find healthcare that I could somehow afford, even being very low income. It’s been a challenge, to say the least.
I keep my residency in WA through a friend’s address, which has worked well for me so far – no state income tax, drivers license & vehicle tag renewals online, emissions check every 2 years, etc. So when I applied for ACA benefits last October right after they became available, I was shocked to see that I qualified for 17 different plans – about half of them at no cost to me (federal/state subsidy paid premiums). I spent many many hours poring over the options in the plans, trying to determine which one would work best for me if I was in state, out of state, or out of country. That eliminated all but about 6 of them and then I spent 2 more days comparing those plans, reading the fine print, trying to make sense of it all. I finally came up with 3 that were interesting (all of them at a cost per month to me) and just chose one, figuring that after 6 years without health insurance of any kind, that at least having some insurance of ANY kind would be better than none at all. And of course, I could change my plan at open enrollment next year (end of this year). I have yet to use it so I don’t know how easy it is or what the process is but I have a card in my pocket that says I have health insurance coverage! Woo hoo! That alone has probably lowered my blood pressure to the point that I could get off the medication 🙂
Thank you so much for this most informative post. I’ve bookmarked it so I can come back to it later. You are a very brave person!
Hello ! I also live here in Washington too! If you registered your vehicles in other cities then you will not have to do emissions . I have my registered in Arlington and have not done emissions for many years. I bet there are other cities in washington that will do the same and just quick way to save some money
Hi Matt! I do know others who’ve licensed their vehicles elsewhere in WA but I stayed with a Vancouver address because that’s where I had friends who would allow me to use their address for a residential residency (my mailing address is a mail service which is a commercial address and would not allow me to keep my drivers license, among other things). The $15 I spend every 2 years is well-worth it to keep from having to find another address to change to, and I can also delay the emissions testing if I’m out of the state during the time it’s required. Thanks for the thought!
Glad you were able to work through all the details and get yourself a good plan. WA offers quite alot of options on their exchange.
Nina
Here’s a idea that some have choosen to do right or wrong who knows ? Some will only get insurance when they need it. Sense they cant refuse you for previous illness this is why it didnt work before. The only catch is the IRS penalty but some wont mind that either. The penalty this year 8 believe was $97 Or 1% of your income. For some it might be their best option
I agree that this is an option some people will choose. I can’t deny we’ve even looked at it ourselves. The one big issue you run into is the official enrollment periods. Unless you qualify for a “life event” (or Medicaid) you can only get insurance during the enrollment periods (typically the end of the year). So, if something bad happens & you end up in hospital you may be stuck with all the bills until you can get insurance (and that could be a potentially bankrupting event). They can’t deny you when you apply, but it’s the in-between periods that are risky.
Nina
Yeah this whole thing can be scary for most. I also went to the hospitals and applied for charity care , which is free , but is soley provided by that hospital. So far I have two hospitals that will give some me free care which has been awesome. Well thanks again for the best rv blogs out there ! I am almost done with me chemo, only 4 more weeks, then off we go full time rving. Your post have been a HUGE help with me during chemo and been a big motivation to say positive. This has been a great gift from you and thank you so much. One day we might se the Beast and come say hi!!
Good tip on the Charity Care, Matt. Maybe that’s something that will ring a bell for other folks here. The best of wishes on your chemo and your future plans. I can only imagine how tough this year has been for you!
Nina
I’m sure like me you remember the Citizens Advice Bureaux in most English towns where one could go to seek advice on such matters! Do they have anywhere here in USA like that? I don’t know where to go for advice. Without going into details, it’s crazy I’m having to apply for Unemployment benefit (that I don’t want!) that seems to be holding up my Medi-Cal application (Social Services can’t/won’t say why exactly) and by the time that comes to an end, one way or another, I’ll miss that enrollment window you mention (in my case, applying thru ‘Covered California’)…
Why, if only this country was letigious, I should sue someone 😉
Also, I DID want to say THANKS again for doing the post on this thorny subject – it actually helps to read many other people’s comments and situations.
Goodness…sorry, I really don’t know who you’d be able to contact in this case. That’s a right mess of a situation.
It’s possible that applying for unemployment would qualify as a “life event” (not sure here, just speculating) in which case it might be possible for you to apply for insurance outside the standard enrollment period?
Also, it could be that Medi-Cal has different enrollment periods from the regular exchange? My understanding is that Medicaid is something you can apply for anytime (it isn’t restricted to the same enrollment limitations as the exchange-based plans), so perhaps that will apply to your case too?
In any case I really hope it all sorts out for you!
Nina
I think I got the answer for you! If you qualify for Medi-Cal you do not need to worry about enrollment periods.
See #5 on this list:
http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014c.aspx
“If you are eligible for Medi-Cal, the open enrollment period does not matter.”
The enrollment period only applies to buying regular insurance through the California exchange. Medi-Cal (= California’s version of Medicaid) is separate. This is true (as for as I know) for Medicaid across the country. If you qualify for Medicaid you are not restricted to the enrollment periods.
This page confirms it:
https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/
“You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time—there is no limited enrollment period for these programs.”
Nina
You’re WAY too young to be our Agony Aunt Nina! 😉 Thanks, for your research! But actually I was referring to the (probable) situation where I WON’T qualify for Medicaid (get rejected because I won’t (be able to) make serious job-seeking attempts, because we hope to travel!) and so would need to go back to Covered California to apply for some other assisted insurance – but their enrollment window closes 31 March…
Fortunately they have said Kim qualifies – but they aren’t giving it to her – although she needs it – because we applied together.. I can only hope if they reject me, they will issue hers – or else we have to divorce and she applies alone all over again! hee hee isn’t this all fun!
Ahhh…in that case, I mean in case where you actually go fulltime RVing, my advice would be to establish domicile in another state if you can. Moving state qualifies as a “life event” and so you can get insurance outside the official enrollment period. Don’t know if that’s an option for you, but wanted to throw it out there just in case. Really hope things work out for the both of you!
Nina
Nina,
Thanks again for the work you do for our community of fulltimers. I have contacted Kyle Henson at rverhealthinsurance.com and he got us started. Turns out that they went to the same class of RV-Dreams that we did in 2010. What a very large small world we live in!
Outstanding! Very glad I was able to help you on your way with all this…and yes, it’s an interesting & small world out there. I always find that to be true 🙂
Nina
I’ve been reading your blog for quite some time. But this entry about the ACA is one of the best, most helpful, pieces you’ve written. Health care these days is hard enough to understand for people who live in one location. I can only imagine the added complexity for full-timers. Thankfully, all of this doesn’t apply to me (on Medicare with an excellent Medicare supplement plan), but you performed a tremendous service by focusing on the impact to full-time RVers. Well done!
So glad the post was helpful! I’m impressed you read it through 🙂
Nina
Nina, I cannot imagine what this took to write as I am exhausted just reading it and have been as I delve into what to do going forward. As you know I have been approved for BCBS in SD but am waiting for the other shoe to drop. We have also looked into TX and read Kyle’s thoughts on the three states (excellent) so change may be in the offing for us as well. Kyle is who Terry went through for his gap plan so we feel very comfortable with him. Thanks so much for braving these waters and writing such an informative piece.
Well cheers Lu. I’m glad you guys have your plans sorted, at least for now. I’ve no doubt things will change over the next year, so who knows what we’ll end up doing. Glad Kyle helped you out too…he’s a knowledgeable fellow!
Nina
Nina, thanks for the great summary and discussion, it is an extremely complicated and personal issue. It makes complete sense for people to minimize expenses and consider no-income tax states as their domicile state. Those states were the first I looked at. However, since insurance rates vary so much between states, some states, even though they have an income tax, may actually cost less overall. For us personally, a BCBS Multi-State plan from MI will actually cost us less than the same plan in TX because of the much smaller premium in MI based on our income. It took me a morning of research but was really eye opening and financially a good idea.
Good job figuring out your situation. Taking all the financial aspects into consideration is a very important point, and it’s true that insurance costs vary quite a bit by state.
Nina
Thank you. You confirm what I have found as well. I have a $10,000 deductible thru Humana so far. Since I receive a paycheck from WI and work on the road 6 months or so I am not sure Texas is going to work for me. At least WI taxes will allow me to deduct what I pay for health insurance.
Well I’m glad you found a solution that works for you. It’s not easy to wade through all this stuff.
Nina
Maybe it would work to change domicile every time I snowbird in a new state each winter …….
It’s an idea, but I really feel it would be alot of work (changing domicile each year). As long as you’re able to get a good nationwide plan I don’t think this is necessary.
Nina
If a spouse and potentially children as well are no longer covered by an employer policy but family income is too high for a subsidy, is there anyway the non covered spouse (farmer, income roughly 45,000 and 3 kids) can obtain ACA coverage.
From another conversation I will answer my own question……If the family was divorced they could get an ACA subsidy but not married since the income is combined.
Thanks for reporting back Teri. I didn’t actually know the answer to your question.
Nina
Hi Nina,
We are currently SD residents with our health insurance with Coventry One. Well we got the letter from Coventry One that says our current plan does not meet the ACA requirements and we have until June 15th to enroll in a plan. Their qualified plan is $760/month vs $305/mo!! We are so curious if you have had the same letter. When I spoke with a representative back in March he said we would be able to renew in July 2014 for one more year. We are thinking Texas…..any suggestions or thoughts?
Bettina
Our plan is valid until Sept so we haven’t had that letter yet, but we’ve heard from other RV buddies who’ve received the very same info. I have no doubt we’ll get exactly the same letter in Sept.
Kyle (from RVerheatlthinsurance) offers Avera as a possible solution in SD. Apparently they have opened up to RVers (I.e. They no longer require 6-month in state) and are offering a nationwide network. This all happened recently so they are now a possible solution there, plus they are on the exchange (so if you qualify for subsidies you can get some relief in price). Otherwise changing state domicile to either TX or FL is the only other option.
We’re honestly still not sure what we’re going to do, but I’d really recommend giving Kyle a call and asking him for his input. He has his finger on the pulse of what is possible in the health insurance landscape for fulltime RVers, including all the latest changes in SD, TX and FL. Plus he’s an RVer himself and really nice guy 🙂 Let him know wheelingit sent you.
Nina
I’ve always wondered how people who move a lot get insurance to work for them…not very well, I see now. But, the nomad style is so free, but the constraints put on us for wanting to be footloose sure makes things more difficult in many respects, doesn’t it?
Everything in life is a compromise of sorts, and that includes fulltime RVing. The only question is whether those compromises are worth it, and you’re the only one that can answer that..for you 🙂
Nina
Wow. This site has helped me a lot. Harry and I are not full-time RVers; however, we have chosen a similar lifestyle of renting and living in different vacation homes in different states so that we can experience different areas of the country, seek out a certain climate, etc. We are currently living in our second vacation home since we began doing this, which was in October, 2013. We started in Oregon, where we established residency as renters, have Oregon driver licenses, and I purchased my medical insurance via an independent agent. I am now running into many of the same issues as have been described here by RVers, and I’m trying to seek solutions to the problems. I am under 65, so I don’t have Medicare. My medical insurance coverage is confined to a very small network within the area of the city where we were living. Now that we are in a new location in the state of Washington, I realize that it’s going to be very expensive if I need any medical care at all while I’m here. It is a sorry state of affairs for us who have chosen the nomadic life.
Thanks for the information and insights ~
Frieda
Certainly sounds like we have a lot in common. Last time I looked at WA (around 6 months ago) they had BCBS as one of the options on their exchange which has very good nationwide coverage. If you don’t manage to find a solution in OR it may be worth looking into this and potentially re-establishing domicile in WA. Do double check my facts, of course, but it was one of the states we briefly looked at while I was researching this post.
Nina
Hello – I’ve been following a lot of your threads and this is one of our top concerns at this point. We plan to go fulltime next year and plan to purchase our own health insurance, we’re in our 50’s. Our plan is to domicile in either Texas or SD. I noticed that you may have to pick another domicile state AND another health insurance policy. Have you all ready decided on either? We are very interested in your decision since we appear to be in the same boat. We’re in conversation with Kyle about our next move and I’ll tell you, it’s not an easy one. Would like to hear your experience on this decision….
Paul
We’ve not made any final decisions yet. We just got a letter from our insurance recently and it *looks* like we can keep what we have (our grandfathered plan) until the end of the year. Then, we need to switch. So the decision has been delayed a few more months at least for us. By the end of the year we’ll see what the landscape looks like and make a plan. If SD has a viable option then we’ll stick with SD, otherwise we’ll have to move. TX is still a very good choice, as is FL. No idea which way we’ll go yet.
Nina
I’m retired dual insured with both Blue Cross Premium and United Healthcare Premium (soon to be Wellpoint), on top all that I have the Veterans Admin healthcare too.
Well colon cancer set-in and I discovered something important.
Neither plan wanted to cover the treatment we selected.
Both health plans would only cover the old conventional radiation and surgery method. Not the new USC/Sloan Kettering/UCLA/City of Hope modern treatments.
This isn’t gargling with apricot pits in Mexico, the newer treatments really work better than past treatments.
But,, a study grant picked up over $500.000 of the treatment, and a new law came into effect that if the treatment has the word “study” in it,, the insurance companies now have to pay under Obamacare.
I’m cured,, the new treatments are amazing.
Melanoma go to UCLa, Colon cancer go to USC.
Avoid community hospitals for cancer treatment.
Their is a way to get it paid for. Even some county pblic health depts will pick up the cost.
It’s excellent that you got coverage for your treatment (cancer is a terrible, and expensive illness). Thanks for sharing the options you looked at. Wish you the best of health & healing going forward.
Nina
We switched everything to SD in June this year and everything went smoothly. That was then and this is now. Now I am told that there is no insurance carrier that will cover full-time RVers. I have directly spoken with reps from Dakotacare and you must physically live in the State for 6months each year. Avera is no longer covering anyone with a PO box and when we made the switch, they were the only option for Obamacare. There is a lot of misinformation on the internet and thus I use an insurance agent who is very knowledgable. At this point, I am considering other options…Texas previously was our other choice and it may just win out, as Medicare is years away.
Yup, this is our information too. As far as I know there are currently NO viable options on the SD exchange for pre-medicare fulltime RVers. So, we are thinking we will need to switch domicile at the end of this year. I haven’t been to check the exchange today (they just recently opened up for browsing of options/pricing), but I am not expecting to see anything new.
Nina
End of year is just around the corner Nina. You must have some idea about what your going to do? I also hope that everyone else out there have given a lot of thought to this. Since we’re about 1.5 years away, possible 2 we hope that things will change in our favor before we leave the work force. Obama is going to have a tough 2 years after this past election.
Paul
Since the exchange is just opening now, I’m going to be looking in detail at it this week, but our current leaning is to re-establish domicile in TX.
Nina
Well the doctors tell me that I can’t go full timer so I guess I am OK in SD. Being on SS we have medicare, but our supplement coverage is through Blue Cross Blue Shield of South Dakota, I wonder if you have checked to see if that may be an option for you? My doctors tell me I could do like 3 weeks on the road but need to come home the week of my monthly doctors appointment so I can receive my much needed narcotic prescriptions. Sucks but I guess we will have to settle with living up here full time and traveling in the warm months. I am very disappointed in this but I guess that is the way it has to be,
BCBS in SD requires 6-month in-state residence as well. I’ve heard other RVers who’ve “snuck in” to BCBS by not mentioning they were fulltimers, but I’m not at all comfortable w/ this. Their corporate policy is not to insure fulltimers.
Nina
Great information and I’ll certainly do some deeper exploring as I’m a year away from Medicare and we’ve become TX residents this year. One thing to consider is to invest in an emergency medical transportation service that will get you back to your home network in the event of a serious illness or injury. It’s a solution to traveling outside of your medical network but be sure to read the “fine print”.
Yup, it’s a good tip and something we’ve thought about. I’m not clear I would want to end up in SD for treatment say, in the middle of winter, but it’s a decent interim solution for those who are stuck with a limited network and do not have many other options.
Nina
Jumping back to an old post that I linked to from your most recent post!
Can you clarify why you say above, “personally I will only consider PPO plans with big networks (no EPOs, no HMOs).”
Especially the EPO part. The plan we are singing up for is a BC/BS EPO and is very good for out of area (there essentially is no area!) and even out of country coverage, Stay within the huge BC/BS network and you’re good – any doctor, any hospital – couldn’t find a one in any of the areas we travel to that wasn’t in the system! Go outside BC/BS and lose some co-insurance percentages. To me, that’s pretty much like Medicare except you even get some international coverage!
What am I missing?
Steve
EPO’s are essentially very similar HMO plans. They generally only offer a limited in-state (sometimes even in-county!) network and do not give you the same nationwide coverage as a full PPO plan. Do not confuse “E” with an extended network base. Typically its the opposite and EPO’s only offer a subset of the full network. Check the network details very carefully before you sign up.
Kyle has a good definition of EPO, HMO and PPO here:
http://rverhealthinsurance.com/our-recommendation-for-rvers/
Nina
Thanks Nina –
I read Kyle’s original posting and it backs up what you related.
I also called BC/BS VT back and they backed up everything that I had been told previously. That is: their EPO does only cover their network but that network covers the entire country as well as international providers. In VT, that is exactly 100% of the hospitals and over 97% of the physicians. Nationwide it is well over 90% of the physicians and a vast majority of hospitals! I looked up Florida & Texas BC/BS and their EPO plans are very similar – the network is nation and worldwide. I see this being about on par with Medicare and it makes me feel pretty comfortable.
Kyle’s disclaimer “There may be exceptions to this with some carriers” is a point well-taken but, indeed, BC/BS is the largest carrier in the country (world?) and many of their EPO plans are better than what is outlined in his and your posts.
While it may be that some EPO plans still are very limited, I think it perhaps prudent to not broadcast that in general they are inappropriate for vagabonds.
The EPO plans offered might be worth considering if you end up in Texas or Florida!
In the spirit of clarity and fairness, Steve
Well that’s good info and good to know. Generally EPO plans are very restrictive, but it seems the BCBS plans are not.
Nina
So, just to follow-up on this. After 4 days and countless hours on hold I was finally able to get through to a BCBS agent to discuss the various BCBS plans (in Florida specifically). My question to her was “what is the difference between BCBS EPO and PPO plans on the exchange?” Her answer was network size.
According to the agent there are 2 main types of BCBS plans on the FL Exchange:
BlueSelect -> This is “officially” their EPO plan which means it has a much more restrictive network. The agent specifically told me this would NOT be a good option for folks who travel extensively outside of FL since coverage outside of state is limited.
BlueOptions -> This is their wider PPO-type plan which has coverage cross-nation with the extensive BCBS network. So, this is the one she recommended for travellers.
I’m not sure if the plan offerings are different in VT, but this is what I was told for FloridaBlue. So, bottom line. Looks like the BlueOptions plans on the FL ACA Exchange are a valid RV-friendly choice, but the BlueSelect plans are not.
Nina
Thanks Nina! This is basically what I found out when I researched Florida Blue last year. I signed us up for a BlueOptions plan and will do the same this year. They are more expensive (though we do qualify for a subsidy) than BlueSelect but definitely worth it for us travelers. Interestingly, the BlueOptions plans were listed as “PPO” through the exchange last year and are listed as “EPO” this year, but I can’t find any change in the actual plan itself, including the network.
Yes, this is exactly what confused me when I looked at the exchange. All the plans were listed as EPO this year which I why I just dismissed them. Not sure why that is? Someone made a silly clerical error? Either way the agent on the phone clearly told me that the BlueSelect plans are EPO (= *not* recommended for travellers) while the BlueOptions plans are PPO (= recommended for travelers).
Glad I got to the bottom of it. Now, for the next question 🙂
Nina
My Humana plan with a great network was cancelled since at over the age of 30 I am not eligible for a castrophic plan. So I have a plan that will only partially cover emergency care out of state with prior authorization. I live in WI. The broker in our area felt the HMO in our county has better coverage for emergency services than the so called national network of Anthem/Blue Cross PPO and will also cover emergency services in Canada.
I searched for MDs in each state I am going to and no coverage eventhough Anthem advertises a national network they are only available in the more expensive silver and gold plans and still not good payment history according to my broker.
Unfortunateley with any emergency care, say for example a broken leg, you can get the cast but have to travel to your home state to get the followup care like having the cast removed. So I am hoping not have to test this coverage and that some type of change will happen in the future for people like traveling nurses…..and RVers
You’re in a tough situation. Very similar (unfortunately) to the limitations we’re facing in SD at the moment (= no nationwide plans on the exchange).
Although it’s not ideal one option you may look into is getting an added insurance that transports you back to your “home” state in case of medical issues. Some of these will even take care of your RV and family too. Examples are Medjet, Sky Med and Medical Air Services Association (MASA). This way at least you’ll have some coverage to bring you home.
Nina
I do have the MedAssist coverage through FMCA but that will not cover the cast removal if someone on this order happens. May just have to remove that myself.
Also for emergency care on the road, the PPO vs EPO vs HMO may not be as much of a consideration. All plans seem to cover some level of “emergency” care. It is how they define emergency and whether they charge you the difference between what they think is reasonable and customary or if they negotiate on your behalf and cover the cost of the provider as in network toward your deductible once they approve the service as emergent.
Indeed. The amount of coverage you can get thro’ Medjet is limited. Like I said, not ideal.
The other *big* question is whether your plan has any out-of-network caps. With these network-limited plans, having out-of-network caps will (at least) partially protect you. Those without any caps are more vulnerable.
Nina
Is there a good phone number to start with when trying to get some quotes? I started with the (855) 283-5272 number off the rverhealthinsurance.com website and ultimately got a gentlemen who was a bit pushy.
I’m 31 living in Iowa and HOPING to go full time sometime next year. I currently have a Coventry plan with a subsidy as well as a $5600 deductible for $69/month. This plan expires at the end of the year and they will gladly enroll me in a similar plan for and extra $20/month. But since I’m hoping to change lifestyles I thought I’d check into more of an RV type health insurance. Plus my current plan’s network is like 45 mins away (who knows why).
This gentleman started with saying if I qualify for a subsidy I must have an on-exchange plan and none of those allow for travel or have a 100 mile radius or something along those lines. My only option according to him is a $300/month plan thru Assurant Health with 100% preventative care covered and a $6000 deductible. It was a very short conversation as he just wanted to sign me up today and be on his way.
Was this number the right place to start? Any suggestions for someone in Iowa? Thank you in advance!
Are you keeping Iowa domicile when you go full timing? If not, I suggest you figure out domicile first since health care plans vary ALOT by state. If you move domicile you’ll be able to switch plans even outside of open enrollment, since moving is considered a “qualifying life event”. Most fulltime RVers domicile in either FL, TX or SD.
As for current options, I’ve only dealt with RVerhealthinsurance for my plans, but I’m also domiciled in SD which is one of their specialty states (FL and TX are the other two). For Iowa I’d suggest contacting a local broker and explaining your travel plans to him/her.
Nina
Yes I probably will stay with Iowa for now. This full time thing is a “shot in the dark” for me I guess. still need to sell my business and figure out how to make money. Lots of big changes all at once. Thanks tho.
Great article! We’re kinda in the same boat. Bought an Avera plan from SD (for now), but thinking of moving to TX for better coverage and an out-of-network expenditure cap. Did you move out of SD in the end? If so, to where? Thanks 🙂
We haven’t moved yet. We bought a short-term insurance plan in South Dakota to cover us through the end of the year. Then we’ll likely move to TX (still not completely sure).
Nina
Everyone refers to Tx, SD or Fl as the states to register in for RV’ers. Has anyone done any research on if this should change since they haven’t expanded coverage so everyone loses out on the subsidies? Would the health care savings make some place like WA with no income tax also viable for RV’ers?
I’ve looked around a lot. The problem is that establishing domicile as a fulltime RVer in other states is often tricky. In WA, for example, you cannot establish domicile without a physical residence which means either renting for a year or buying property there. In OR there is a similar issue (you need to be physically present for over a year before you can apply for continuous traveller status). And so on…
I spent months looking at this when ACA was launched and have not found an easy alternative that does not involve having to rent or purchase property in another state.
Nina
Because I am traveling further from my permanent address I am checking into another state to change my domicile. I am in WI and will be spending most of my time in the coming years on the west coast. The insurance companies in both states said that if I buy a subsidized plan I can’t spend so much time out of the service area and continue to keep their policy. Now the state I am in did not know how much I traveled (will only be in the state 3 months) until I asked a question about a future trip and using a PO Box for my mail since my house may sell while I am gone. The comment also was I will have trouble finding providers in the future that accept plans on the west coast. I am hoping to work in Yellowstone at least on a seasonal basis.
Teri,
I recommend you look at establishing Domicile in either FL or TX on your way out west. Both states are very RV Friendly and (more importantly) offer TRUE nationwide health insurance plans on their Exchanges. Many states, as you’ve found out, do not but FL and TX do. There are some very good organizations in both states (e.g. Escapees) who can help you establish domicile and a very good RV friendly insurance broker (RVerhealthinsurance.com) who can help you on the insurance side.
I have more info on all this in a post I did this winter. Read here:
https://www.wheelingit.us/2014/11/25/health-insurance-sd-domicile-are-there-any-options-left-for-younger-fulltime-rvers/
Nina
I am in contact with the people you mention an have another call this afternoon. I do not see being able to get to FL for sure nor TX in the next couple of years especially if I have to drive my older RV there. Maybe I need to fly to purchase a newer Roadtrek in TX once my house sells. I thought buying a policy closer to where I spend 6-9 months out of the year or more should work but I guess not.
Marketplace folks told me the address I use for them for health insurance does not have to be my permanent address. I think that person I spoke with is not correct but am double checking.
I have heard the suggestion and checked into short term insurance before but was not encouraged by the local broker to get this.
I thought that with my evacuation coverage I might be covered to get at least flown back to my home state for insurance coverage. But then again what is defined as an emergency.
My husband (60) and I (56) are anticipating “retiring” in the next few months, and being….uh…..”nomads” for a while. We are also hoping to hike the Appalachian Trail next year (2016). Many of your suggestions appear that they would apply to us as well, even if we are hiking, not RVing. Thanks!! 🙂
Very true. The ACA and health care topic applies to anyone pre-Medicare that has to buy their own insurance. By the way your “retirement” plan sounds awesome!! I’ve always wanted to hike one of the big trails (PCT, AT). What an adventure!
Nina
Just now becoming familiar with long-term RV as a lifestyle. Spouse is 64, I am 61. Would like to have things in place to start the adventure within next six months. Appreciate all your research! Look forward to continued dialog!
We are currently in CA (San Diego) and want to be very flexible on our travels. Any additional recommendations to research would be greatly appreciated!
Raz
I really recommend joining up with one of the many RV forums (e.g. RV.net, iRV2.com etc.). We learned a ton from the forums and I continue to use them whenever we have questions. They’re very active and excellent places to learn. Here’s a post I wrote about them:
https://www.wheelingit.us/2011/01/21/online-rv-forums-beacons-of-help-on-the-road/
And of course, other people’s blogs are great sources of info too. You can check my blog and resource listing on the right for some of the links I like the best.
Good luck with everything! You’ll find RVers are a very welcoming community.
Nina
I found a solution (for some). I am self employed and among the first to be affected by the ACA regulation. Also, due to my income level, I am not eligible for any subsidies under ObamaCare. So, with our families health insurance slated to go up by 35% for the leanest of plans, I spent much time looking at ACA alternatives (and went bare the first year). In March 2015, I’ve found 2 faith based medical sharing organizations: Medishare and Liberty Share. Because they are faith based, they are protected from state control and ACA government regulation by the 1st amendment, but they are an accepted alternative to ObamaCare satisfying the coverage requirement (no IRS penalty). Technically not classified as insurance companies, I do not believe there is a need to maintain a State of Residency. I pay only $380/mo for myself and my husband for “coverage” under a $2500 deductible plan. How good is their coverage? I don’t know as I have not had a need to request help with medical bills. But they well for me in negotiating down a $50 lab fee to only $10. FYI: one of these faith based groups only accepts “Christians” but for the other – like the Boy Scouts – you only need to be a person of faith. Thus, Jewish, Muslim or Mormon are OK but atheists and agnostics are SOL. If you are in need check them out.
My concern with this option is that you are treated as self pay and when you are sick is not the time you have the energy to negotiate. Which company negotiated the lab for you?
It sounds like even with the PPO options if there are any you are still having to negotiate balance billing and non covered providers so maybe I will look at these again. Trying to establish a domicile and be anywhere near a network of providers with one plan is getting to be impossible if you work kamp or volunteer seasonal positions.
Without a preferred provided list, I can take my medical needs anywhere I want. I have a “insurance card” that was not questioned at the small lab; I now assume it would be accepted without question at a large facility or hospital. So, there is no negotiating in a crisis but the group negotiates on my behalf after the fact. But, I have been negotiating a cash pay rate with numerous doctors prior to joining this group; I just pay them for all my non-emergency needs and send in the recipe for credit towards the deductible. This may not be for everyone but for me its keeping costs down. I don’t know all the rules but it seems flexible enough to work for the full time RVer’s who can’t claim a home state.