Health Insurance Time -> 2018 Considerations For Pre-Medicare RVers
Take a deep breath and get ready my dear blog readers because it’s that time of year again. No I don’t mean Halloween, although this is aaaalmost as scary. No it’s the eve of something much more frightening. Tomorrow is Nov 1st which means Open Enrollment and time to nail down your health care choices for next year. Eeeeeek!
Enrollment Time Is RESTRICTED This Year
This year it’s even more important for RVers to be “on the ball” as we have a super short enrollment period starting Nov 1 and ending Dec 15th (in previous years extended enrollment went 13 weeks). Also the enrollment website, healthcare.gov, will be shut down for maintenance for more than 60 hours during open enrollment, including 12-hour maintenance blackouts on five consecutive Sundays. It’s not much time to work with!
NOTE/ After Dec 15th you will only be able to buy insurance on the ACA if you qualify for a Special Enrollment Period. As an RVer, moving your domicile to a new state qualifies for this.
This Is a Layman’s Guide, Not Insurance Advice
The whole reason I’m writing this guide is simply to (hopefully) help fellow pre-Medicare RVers dig through some of the mess of info out there about 2018 health care. But I’m not an agent! I’m writing this as a layman RVer based purely on what I’ve personally read and understood. It’s not meant to be a definitive guide, nor is it meant to be insurance advice. So, please take note of the following:
- I am not a qualified health insurance agent! Don’t just read this post and take my word for it! Feel feel to peruse the info, but then talk to a qualified insurance agent before you make any final decisions on the right health care choices for YOU.
- I will not talk politics & will delete any comments that mention it. My goal with this post is simply to provide some pointers on 2018 health insurance choices (as I see them) for fellow RVers. How we got here or what might or might not happen in the future is irrelevant & will only lead to heated and pointless arguments that will not help any of us actually sign up for health insurance for next year (= the ONLY thing that matters to me for this post). Please keep all discussion focused on current health choices and how to navigate the current marketplace. No politics, period.
- Prices May Change: All the prices I’ve listed in this post are estimates for Paul & I (late 40’s) as of Oct 31st from Healthsherpa.com. They should be accurate, but some may change once Open Enrollment actually starts tomorrow AM.
- Medicare & Medicaid folks can ignore this post. If you’re lucky enough to be past the magical age of 65 and on Medicare, you do need not worry about anything I’m writing in this post today. The same applies if you have coverage through Medicaid, your job, the VA or other means. Be at healthcare peace and enjoy your day 🙂
There Are Experts Out There To Help You (Not Me)
The other important thing I want to mention before I dig into the nitty gritty is that there are experts who can help you much better than I can.
This post won’t be a comprehensive overview of every choice or every option, but there are other resources which are! In particular I recommend RVer Insurance Exchange (no affiliation) who have written an excellent guide to ALL the possible 2018 health choices HERE. They are fellow RVers who not only understand the RV lifestyle but are also qualified insurance agents, so they can help with both insurance choices and enrollment. I used them to enroll last year, and will likely be using them again to enroll this year. So I suggest you start there and read my very non-expert summary afterwards 🙂
With all that said, let’s get into the details of how I view the marketplace this year….
The ACA Still Exists
No matter what you might read in the news or what policies might change in the future, for this coming year the ACA (commonly called “Obamacare”) still exists and it’s what most of us will be working with for our 2018 health care choices.
Through the ACA online website (or thro’ agents licensed to enroll you with the ACA) you can buy different levels of health insurance (bronze, silver, gold, platinum) that all meet fixed requirements, as defined by ACA law. I’m not going to go into all basics of ACA here since I’ve already covered that in previous posts (plus you can read THIS guide from RVer Insurance) but for RVers the most import details to understand are that all the plans must meet certain basic requirements (such as covering “essential health benefits“) and that no plan can reject you or charge you more for pre-existing conditions.
Plus there’s a FEW more things you need to know….
There Are Very Few Nationwide Plans Left On The Exchanges
The first thing to understand about buying insurance on the ACA exchanges is that there’s nothing in the ACA law about requiring nationwide coverage. In fact MOST plans these days do not, and for fulltime RVers that’s an important consideration.
The two biggest worrying trends on the ACA over the past few years have been providers pulling out of the exchanges (= less choices overall) and the slow, but sure narrowing of provider networks and removal of nationwide plans. I predicted this trend back in 2015 and (unfortunately) I was dead on right. Before 2015 there were multiple choices & decent nationwide plans in all of the the “big 3” RV States (TX, SD, FL). Today however, only a single nationwide choice remains:
- Texas does not have ANY nationwide plans on their Exchange. There is only one provider (BCBS) on offer in the Livingston zip code (Escapees TX domicile) and they only offer HMO plans for 2018.
- South Dakota also does not have ANY nationwide plans on their Exchange. Avera still offers a PPO, but if you look closely into the network you’ll find it has zero providers out of state (seriously none!) so it’s essentially just a SD HMO (I honestly don’t even know why they call it “PPO”). There are no other PPO’s on offer through the SD Exchange for 2018.
- Florida is the ONLY state that still offers a nationwide plan on their Exchange. There are two types of Florida Blue EPO/PPO plans (Blue Select & Blue Options) which act as EPO in-state, but take advantage of the fabulous & very extensive “Blue Card” network out-of-state (essentially making them PPO out of state). These are the only true nationwide plans left on the ACA exchange in the “big 3” RV states for 2018.
NOTE1/ OTHER STATES: I only discuss the “big 3” RV states here since that’s where most fulltime RVers domicile. There ARE other states who still offer nationwide plans on their exchange so if you have the chance to domicile in one (maybe you have property there?) I recommend looking into it.
NOTE2/ EMERGENCY CARE: A note about emergency care. By law all ACA plans are required to cover emergency care, even if it’s out-of-state and out-of-network. For RVers that means you’ll be covered for emergencies everywhere in the USA, no matter what plan you buy. Networks are still important however not just for follow-up care, but also thanks to a little, strange caveat called “balance billing” (I wrote about that HERE. Also read this article HERE) which can still “get you” after the fact.
Bottom Line -> Sign up for the best network you can.
NOTE3/ MULTI-STATE PLANS: When you browse healthcare.gov you might come across plans called “multi-state” which seem like a promising choice? Unfortunately the name does not mean what you think it means. Multi-State Plans are just a contract between OPM (U.S. Office of Personnel Management) and insurance companies for a specific type of plan that is operated in multiple states. It has nothing (NOTHING) to do with provider coverage networks and does NOT automatically mean the plan can be used across multiple states.
Bottom Line -> When shopping For plans IGNORE the multi-state designation (look at coverage networks, not plan names)!
Base Prices Have Gone UP (esp. For Silver Plans)!
The other big change this year is that plan costs have gone up significantly, yet again. Browsing through Healthsherpa I’ve seen base prices (= non-subsidized premiums) increase anywhere from 8% to 40% over 2017, depending on your plan type, age and location (= domicile zip code).
Out of all the metal levels, Silver Plans have by far seen the biggest increase (this was expected based on the Executive Order that Trump signed last month) whereas Bronze and Gold Plans have seen smaller increases. Also FL remains the cheapest of the “Big 3” RV States. I pulled together the 2017 and 2018 base prices for Paul and I (a couple in our late 40’s) in 5 popular domicile locations so you can see what I mean.
Monthly Base Price (non-subsidized) for cheapest Bronze plans in 5 Domicile Locations:
| Domicile | Zip Code | Plan | 2017 Price | 2018 Price | Increase |
|---|---|---|---|---|---|
| TX Escapees | 77351 | HMO Bronze | $ 841 | $ 1,010 | 20% |
| SD DakotaPost | 57104 | Avera Bronze 6550 | $ 906 | $ 1,042 | 15% |
| FL Escapees | 33513 | BlueSelect 1452 | $ 644 | $ 759 | 18% |
| FL My RV Mail | 32536 | BlueSelect 1452 | $ 695 | $ 814 | 17% |
| FL St Brendans Isle | 32043 | BlueSelect 1452 | $ 729 | $ 835 | 15% |
Monthly Base Price (non-subsidized) for cheapest Silver plans in 5 Domicile Locations:
| Domicile | Zip Code | Plan | 2017 Price | 2018 Price | Increase |
|---|---|---|---|---|---|
| TX Escapees | 77351 | HMO Silver | $ 1,072 | $ 1,403 | 31% |
| SD DakotaPost | 57104 | Avera Silver 4000 | $ 1,082 | $ 1,432 | 32% |
| FL Escapees | 33513 | BlueSelect Silver 1443 | $ 767 | $ 1,107 | 44% |
| FL My RV Mail | 32536 | BlueSelect Silver 1443 | $ 828 | $ 1,188 | 43% |
| FL St Brendans Isle | 32043 | BlueSelect Silver 1443 | $ 868 | $ 1,219 | 40% |
Monthly Base Price (non-subsidized) for cheapest Gold plans in 5 Domicile Locations:
| Domicile | Zip Code | Plan | 2017 Price | 2018 Price | Increase |
|---|---|---|---|---|---|
| TX Escapees | 77351 | HMO Gold | $ 1,344 | $ 1,376 | 2% |
| SD DakotaPost | 57104 | Avera Gold 1500 | $ 1,450 | $ 1,583 | 9% |
| FL Escapees | 33513 | BlueSelect Gold 1535 | $ 1,161 | $ 1,292 | 11% |
| FL My RV Mail | 32536 | BlueSelect Gold 1535 | $ 1,253 | $ 1,387 | 11% |
| FL St Brendans Isle | 32043 | BlueSelect Gold 1535 | $ 1,315 | $ 1,423 | 8% |
My Key Takeaways From These Tables:
- Out of the “big 3” RV States, FL is the cheapest state to buy ACA insurance. Also within Florida the Escapees (Sumter County) address has the cheapest base price.
- Silver Plans have increased so much in price this year that Gold plans are now almost equivalent (or in some cases even cheaper) than Silver plans. So, if you had Silver in 2017, make sure you check the Gold options for 2018 before you finalize your choice.
But Subsidies Have ALSO Increased (& Make A HUGE Difference)
Although plan prices have ramped quite significantly from last year so have subsidies* which means that if you qualify for one you may even pay less than you did for insurance last year. Perusing through Healthsherpa for 2017/2018 it seems subsidies have increased marginally in SD (only around 3% year on year), but have ramped significantly in both FL & TX. Here’s a specific example:
Monthly Subsidy for Paul & I At Diff Income Levels In Sumter County (Escapees FL)
| MAGI** Income | 2017 Subsidy | 2018 Subsidy | Increase |
|---|---|---|---|
| $ 70,000 | $ – | $ – | |
| $ 60,000 | $ 326 | $ 726 | 123% |
| $ 50,000 | $ 407 | $ 805 | 98% |
| $ 40,000 | $ 538 | $ 938 | 74% |
| $ 30,000 | $ 665 | $ 1,063 | 60% |
If you plug these 2018 subsidies into the plan premiums I listed above you’ll immediately notice what a big difference they make to the final plan price. As an example the BlueSelect 1452 base price is $759/mo in Sumter County (where Escapees FL is located), but at $60,000 income level we’d only pay $33/mo for it. At $50,000 or below we’d pay nothing at all.
Montly Cost Of BlueSelect 1452 Plan In Sumter County After Subsidy
| MAGI** Income | Plan Cost |
|---|---|
| $ 70,000 | $ 759 |
| $ 60,000 | $ 33 |
| $ 50,000 | $ – |
| $ 40,000 | $ – |
| $ 30,000 | $ – |
The last important thing to understand about subsidies is that they vary by both State AND County. So you’ll get a different subsidy in Clay County FL (for example) than you will in Sumter County FL, and these will both be completely different from any subsidy you might get in SD or TX. So if you’re pricing out insurance make sure you price out for both your expected income level, and where you are or plan to domicile. Here’s what those numbers look like for us in 5 of the more popular Domicile locations for RVers:
Monthly Subsidies For Paul & I Across Different Domiciles & Income Levels
| MAGI** Income | TX (77351) | SD (57104) | FL (33513) | FL (32536) | FL (32043) |
|---|---|---|---|---|---|
| $ 70,000 | $ – | $ – | $ – | $ – | $ – |
| $ 60,000 | $ 1,023 | $ 681 | $ 726 | $ 814 | $ 706 |
| $ 50,000 | $ 1,102 | $ 761 | $ 805 | $ 894 | $ 786 |
| $ 40,000 | $ 1,235 | $ 893 | $ 938 | $ 1,026 | $ 918 |
| $ 30,000 | $ 1,360 | $ 1,018 | $ 1,063 | $ 1,151 | $ 1,043 |
If you plug these back into the base plan prices I published above you’ll see that with subsidies added, SD is now by far the most expensive state for ACA plans, whereas FL is the cheapest. With subsidies the differences are significant!
Subsidized Cost of Silver Plans At $60,000 MAGI Level In Diff Domiciles
| Domicile | Zip Code | Plan | Subsidized Cost |
|---|---|---|---|
| TX Escapees | 77351 | HMO Silver | $ 380 |
| SD DakotaPost | 57104 | Avera Silver 4000 | $ 751 |
| FL Escapees | 33513 | BlueSelect Silver 1443 | $ 381 |
| FL My RV Mail | 32536 | BlueSelect Silver 1443 | $ 374 |
| FL St Brendans Isle | 32043 | BlueSelect Silver 1443 | $ 513 |
My Key Takeaways From These Tables:
- If you qualify for subsidies definitely get them!
- As of this year, SD is by far the most expensive state to get subsidized insurance of the “Big 3” RV states, whereas FL & TX are much better. Within FL, MyRVMail (Okaloosa County) actually has the cheapest overall subsidized prices, but Escapees (Sumter County) is not far behind.
*NOTE5/ Subsidies: f you’re not familiar with subsidies they are advanced tax credits which are applied directly to the cost of your insurance. How much you get is based off your MAGI** income. In SD, TX and FL you’ll qualify if you make between 100-400% of Federal Poverty Level (FPL). This means your MAGI is between $12,060-$48,240 as a single or $16,240-$64,960 as a couple in 2018. Subsidies decrease with income (the more you make, the less you get), but increase with age (the older you are, the more you get).
**NOTE6/ Modified Adjusted Gross Income: MAGI income is related to Adjusted Gross Income (AGI) which you’re used to seeing on your tax returns, but it’s not the same. It’s basically your AGI plus a few excluded items things such as tax-exempt interest, tuition expenses, IRA contributions, taxable social security payments, rental losses and more. You can read more HERE.
If You Don’t Qualify For Subsidies Look Off-Exchange
As you can see from the above tables if your MAGI income is too high to qualify for subsidies (even $1 over disqualifies you completely), then you are looking at significant $$$ increases for your health insurance this year. It’s expensive and it’s not pretty at all!
In this case I wouldn’t limit yourself to the choices on the ACA exchange. By looking outside the exchanges you will not only get more plan choices, but the base prices may actually be cheaper than the “full price” of any plan you can get through the ACA.
As an example RVer Insurance is offering an interesting-looking nationwide ACA-compliant Group Plan (available in all 50 states) that costs $936/mo (for the two of us on the Advantage 5000 PPO plan). Depending on your age and location this may well be a cheaper & more comprehensive option than whatever you can buy without subsidy on-exchange. This particular plan does have some extra requirements (e.g. primary applicant must work 30+ hrs/week to qualify) and it’s just one example. There are likely many more options out there so definitely talk to an agent & shop around.
Short-Term Plans *May* Become An Option Again in 2018
Back in 2015 we ended up buying a short-term (STM) health insurance plan for the entire year. Costs were much better than anything we could get on the ACA, even with the Tax Penalty*** added on top. Plus it provided nationwide care with minimal deductibles. It was available to us as long as we didn’t have any pre-existing conditions (which we still don’t) and served us well that year.
The last few years however STM’s were limited to 3-mo max so they were no longer an option for us, but this may be changing again for 2018. Trumps recent Executive Order allows extension of STMs beyond 3 months which makes them (yet again) a potential option. This is all still an evolving story so I’m not sure we can count on it before Open Enrollment closes. Also we’d have to look at the plans & see what extra $$ the Tax Penalty would add to them before we could make a final decision.
Either way we’ll be keeping an eye on RVer Insurance Exchange news to see what they announce
***NOTE7/ Tax Penalty In 2018 – YES the tax penalty for not having insurance (or for having non-ACA compliant insurance such as an STM) still exists! Many folks believe it was repealed by Trump’s recent Executive Order, but that is simply not the case. The IRS have confirmed they are still imposing the penalty, and until Congress enacts the change it is not law. So, unless you are exempt, you will still owe it. Bottom Line -> you won’t be absolved of paying the penalty until law actually changes.
Health Share Ministries Are Popular (But They’re Not For Us)
I have to add a note on Health Share Ministries because I know they’ll come up in the comments as a viable alternative. Many of you won’t like my opinion on this, so I apologize in advance for that.
With ACA plan prices ever increasing many of our RV friends, especially those that don’t qualify for subsidies, have chosen to go non-conventional and get coverage through Health Share Ministries. For those of you not familiar with Health Shares, these are faith-based organizations that share health care costs amongst their members. Basically your money goes into a central pool that is paid out to other members (as needed, and as approved by the ministry) for their health care.
Their biggest advantages are that they avoid the Tax Penalty (through religious exemption) and their costs are SUPER attractive. As an example this is what Paul & I would pay if we signed-up for the most basic share level at each of the big Health Shares:
| Health Share Ministry | Plan Share Cost |
|---|---|
| Liberty Health Share | $ 299 |
| Medi-Share | $ 223 |
| Samaritan | $ 280 |
| Aliera | $ 119 |
Pretty compelling right? So why are we not members??
Most of the Ministries have limitations on pre-existing conditions and require some kind of faith statement, but that’s not really the issue for us. What scares me and the main reason we are not members is this:
Health Shares are not insurance. In fact they are not even regulated!
They are religious organizations that are not subject to review, standards or any other requirements. This means they can chose to drop you, they can choose to deny payment for any reason (even moral!) and if they do not pay, you have literally zero legal grounds to go after them. In addition this also means they are not required to publish financials, so you can’t even check if they’re financially healthy or what their pay-in or pay-out rates are. Lastly words like “trust” and “faith” are used liberally in their marketing pages, and legal notices such as this one (from Liberty Health Share) are standard:
“This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such this program should never be considered as a substitute for an insurance policy” (emphasis mine)
Payment is voluntary?!! Although I realize folks may argue passionately about this, that is a huge risk and I personally can’t live with those insecurities. This is especially true if I’m in the midst of a serious health issue that might potentially bankrupt me (= the main reason we carry health insurance!). I understand why people go this route, but it is not and will never be for us. Do what’s right for you, but just be fully aware of what you’re getting into if you sign-up to one of these.
So What Are The Key Takeaways For 2018?
Basically I have three takeaways from all this:
FL Is The Best: For RVers needing to buy individual insurance there’s no doubt that FL is now the single most attractive of the “big 3” RV states. It still offers a nationwide plan AND the plan costs are lower than other states. If we were newbie RVers today, there is no doubt that’s where we’d go and establish domicile.
Subsidies Are Awesome: If you qualify for subsidies make SURE you buy your insurance through the ACA website (or through an agent qualified to enroll you in the ACA). Subsidies have increased big-time in FL & TX this year and will make a big difference to your plan costs. Take advantage of them if you can!
Off-Exchange For Non-Subsidy: If your income to too high to qualify for subsidies, look off-exchange for other options. You may well find something cheaper (and more comprehensive) that way.
What Are WheelingIt Going To Do?
We’re still domiciled in SD which has zero nationwide plans on the exchange for 2018. This past year we had the Avera Silver 4000 Plan which gave us a “bit” of coverage out-of-state by offering 40% coinsurance (after deductible) for out-of-network care. However in 2018 the price for that plan will ramp significantly and the subsidies in SD have not increased to match (ugh!)
We’re Considering Gold: If we stick with ACA we will likely dump the Silver Plan and switch to the Avera Gold 1500 (still no network out of state, but that same 40% co-insurance deal). It’s not HSA-compatible (a negative), but it would get us much lower deductibles for only a small increase in cost.
We’re Considering STM Or Off-Exchange: If it becomes a real possibility we might consider buying an STM again (I’ll have to crunch the numbers to see if it makes sense). We’re ALSO seriously looking at the off-exchange plan that I mentioned above. It’s some extra $$, but it would provide us a much better plan than what we have now.
We’ll likely go with one of these three options.
PHEW!!! That’s it folks. I know this was long, but I hope it was somewhat helpful. Feel free to comment and ask questions below (I’ll do my best to answer). We’ll get back to our regularly scheduled travel blogs next…
All I have to say is “Yuck !!”. I’m happy to see all the leg work you put into all the above plan costs. Being also a Pre 65 retiree couple maybe I should be glad my insurance only went up 15%. But it represents over 50% of my monthly pension just for the coverage, not counting all the out of pocket and deductibles. Another 5 years I’ll have zero pension. Can I make it to 65? 10 more years to go…
It’s a heavy burden indeed 🙁
Nina
Excellent, Nina!
If such a thing existed (it doesn’t) and I had the power to grant such a thing (I don’t), I would bestow upon you an ‘Honorary Insurance License’–but I’m sure you would wisely decline it 🙂
Once again you has written a fantastic “Layman’s Guide” to healthcare options for RVers. I dare say it’s better than ours for ease of reading without feeling like your head will explode.
The ONLY clarifiactions I would make are in your reference to the Off-Exchange option. I probably have not made these facts clear enough in my guide but,
1) this plan is not a “Cigna Plan”. Although Cigna Open Access Plus is the provider network utilized in this plan, the reinsurer is actually AMALGAMATED UNDERWRITERS and,
2) you state that “plan prices increase significantly as you age” for this plan; but this plan actually does not age-rate. So the rates are what they are regardless of age. That may make this option more appealing to those in their 50’s who do not qualify for a subsidy and/or want nationwide major medical health insurance. I might as well add here that this plan does have a health questionnaire and a requirement that the primary applicant works 30+ hrs/week to qualify.
Thank you for those clarifications! I’ll update my post (likely tomorrow as my brain is shot tonight) to include those points.
Nina
Kyle are you giving advice for health insurance again? My legal domicile is WA which is not an exchange state but I also have land and an address in ND as well as income.
I believe he’s offering a concierge (advice) service through RVer Insurance now. See here: http://www.rverinsurance.com/2-enrollment-options-individualfamily-health-insurance/
Nina
One thing you might want to clarify – the Cigna PPO being offered off-exchange is ONLY for those who are not fully retired – the applicant must work a minimum of 30 hours/week, although it can be self-employment or home-based business. There are also health questions to answer. It’s not going to be an option everyone can qualify for.
You are absolutely right. I’ve updated the post to clarify.
Nina
Questions: Prices in those examples look far better than our Bronze price here in CO. Is that price for a single person, or for domestic partnership? Also, I wonder if the pricing has a significant age component? I am 63, my DW 62, and our Bronze plan for 2018 is estimated to be $1770, with 6500 deductable/person. Up $500 over last year.
For that much $$, we might sell our home and move to FL, no just kidding, but really, that is a huge difference.
The prices I listed were for Paul and I, so a couple in our late 40’s. There is definitely an age factor to all this. Plan prices increase as you get closer to that magical 65 age, so if you price out for FL I’m sure you’ll get something higher than what I listed.
I’d recommend playing around with HealthSherpa.com. You can input age and zip code and it’ll spit out plans and prices for you (there’s no commitment to sign up).
Nina
Ah, thanks for everything in this post. It is the age factor, you kids are young. 🙂 I took a look at healthsherpa, but they do not have plans in the system yet for CO. No problem, our state health exchange is up and running, and it has been one of the best in past year.
Take care.
Sorry I totally missed the fact that you are in CO which runs their own exchange. Healthsherpa only pulls data from the government-run Exchange site (I believe) so it works for FL, TX & SD, but it may not pull up anything CO plans? Hope you find some decent options for next year.
Nina
Awesome work Nina! Thank you for all your helpful information. We have no idea what we are going to do and we are fortunate that we don’t have to make a change right now if we choose not to but your very thorough post, gets us talking about Healthcare and researching an option that may better suit our needs.
When our paths cross, beers on us for sure!
Cheers, Lisa and Jason Reich
I had heard rumors of copper plans with higher deductibles that would be similar to the catastrophic plans that 20 year olds are allowed to purchase but don’t see that in healthsherpa.
I qualify for a subsidy but am concerned my income may be too low if I volunteer instead of workamping and will be required to apply to Medicaid which I believe does not allow out of state coverage. The figures I put in as a single much below $17000 gives me a message I may qualify for Medicaid but your single income figures go down to 12000.
Indeed, if your income is too low you may go into the dreaded Medicaid insurance gap. This is a particular problem for the states that chose not to expand Medicaid (which includes FL, SD and TX). Basically if your income is above Medicaid eligibility limits, but below the lower limit for Marketplace premium tax credits you’re in the gap. Hopefully you won’t end up there.
As long as you stay above the $12,060 level however you *should* be eligible to buy insurance through the exchange (and with subsidies it’s likely to be very cheap or even free!). Read more here:
https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-if-you-are-low-income/
And yes, if you do go on Medicaid it generally doesn’t cover you out-of-State.
Nina
P.S. The catastrophic plans you’re looking for only exist for folks under 30 or those who qualify for a “hardship exemption.” I don’t know of any Bronze plans that are like that. Read more here: https://www.ehealthinsurance.com/health-plans/catastrophic-insurance
Actually Nina, the $12k minimum income to qualify for subsidies only applies to non-expansion states. If you’re in a state that expanded Medicare, they use the higher income figure ($16k for an individual). So, if you make less than $16k in an expansion state (and don’t want Medicaid) or less than $12k in a non-expansion state, you’re screwed. There is one way to boost your income quickly at the end of the year if you fall short. If you happen to have a traditional IRA or 401k account, you can convert whatever amount you need to a Roth IRA. Yes, you’ll need to pay taxes on that (but you’ll never have to pay taxes again). It will also be counted as “income” and help you keep your subsidy dollars. I had to do this last year when I sold my house (and lost my rental income), but didn’t get the money reinvested fast enough so it left me below the income threshold for the ACA subsidies I was getting. A quick transfer of some IRA money to a Roth solved that problem immediately. You can make multiple transfers over multiple years— no need to convert 100% of you Traditional to Roth.
Wow, thanks very much for that clarification Lynn. That’s a detail I had not understood. None of the “Big 3” expanded Medicaid so the $12k figure should apply to them, but that larger number will be an issue in the states that did.
And thank you also for that Roth trick. I know several RV folks who’ve struggled meeting the income requirements for subsidies, so that will be very helpful indeed. Thank you again!
Nina
Yes thank you
I was afraid I would have to take money out of investments just to qualify for a subsidy instead of Medicaid. The Roth conversion is a great idea.
OMG, is this (could this) really be true????? I have a Roth and a traditional IRA already. I have enough in my traditional to last a long long time if I need to just transfer the balance to get me to the FPL ($12,060 for 2018).
Is it really that simple to do the conversion?
Is it just regular income taxes (no penalties, SS, Medicare taxes)?
I thought a while back when I did a conversion to a Roth I did it to avoid something the IRS was temporarily allowing without extra fees.
I am more than willing to pay the taxes if there will be any due to my income being so low.
You may have made me a really happy person…
Go, Miss Nina! This was an excellent article! Kudos for so deftly explaining the ACA in a nutshell! A well deserved umbrella drink ( from my husband’s private stash…) Whenever we meet up! ( Currently stationed with family in Augusta, ME….AND THOROUGHLY LOVE YOUR BLOG!!!)
Great info, had not considered the subsidies in determining our healthcare costs for our future RV budget in the first 2 1/2 years out… after that we will both be on Medicare. Sounds like we might have lower costs than I have put in our healthcare placeholder. Fingers crossed and I have to get a better picture of this important budget item.
Subsidies are huge! Of course there’s no way to know if they will still exist after 2018. As things stand today the entire healthcare landscape will likely change again in 2019.
Nina
Great recap Nina,
I’ve now had FL Blue Select for the last 2 years (worrying each year that it might not be offered the next year), but surprisingly, FL Blue keeps offering it so I’ll stay with them!
This year, I’ve had over $500k in medical bills (all outside the state of FL) including 3 weeks in a Mexican hospital for emergency back surgery. To my amazement, FL Blue has paid every bill! No BS about non-network providers (in fact, FL is one of the few states left who requires their exchange insurers to cap BOTH in and out-of-network out-of-pocket expenses. Most other states allow insurers unlimited billing of out of network (balance billing) charges. This could be catastrophic to a traveling RVer’s nest egg.
Two points I’d like to suggest— 1. Even though TX & FL might be closely priced after subsidies, because of the excellent “in-network” nationwide (and international) coverage, as well as the cap on ALL out of pocket costs, the FL Blue plan is a substantially better value for traveling RVers. 2. I’m just as gunshy about Health Sharing Ministries (unless you’re ONLY looking to avoid the tax penalty and never planning to use the plan), but I’m equally gunshy about non-Exchange or short term plans with pre-existing condition clauses and caps on annual/lifetime claims. Had I had $500k in claims on one of these plans I can’t help but think they would have denied or been more difficult to get payment from (vs BCBS plan following the Exchange rules).
One more thing to think about— even though domain changes are a pain in the butt and can have some expense, for folks coming from states that charge state income tax, moving your domicile to FL for even 1 year might be financially advantageous due to the lack of state tax in FL. This was the case for me when I moved from IL in 2015. Here’s the post I did back then on how to move to FL (you don’t even need to bring your vehicles!). https://winnieviews.blogspot.com/2015/12/how-to-move-to-florida-in-1-hour.html?m=1
Your expertise in this area is invaluable Lynn. As much as I wish you’d never had to go through any claims at all (I think of you often), the information you’ve learned confirms the importance of a good nationwide network AND a solid insurance plan. I’m very glad that FL Blue has come through for you, and continue to do so. Thank you again for sharing all your knowledge and experience.
Nina
We live in Texas and plan to use San Antonio as our home base. There are plans in our zip code with Oscar. Anyone reading Nina’s blog use Oscar for fulltime rving? Just curious about your thoughts.
Thank you so much for this post. It is very informative. You have taken a very complex system and made it layman ready (understanding your caveats apply).
Your work is greatly appreciated.
As usual a very well thought out blog….how lucky everyone is that you do this….
Nice write up and thanks for it. I am in FL and yep my insurance went up some 23%. For me this is big as I just “retired”. Income for the next few years was going to be low low low (below FPL) so I don’t qualify for a subsidy in FL nor Medicaid. I am going to have to find some income to get me to the FPL to get a subsidy. PT job or maybe some sort of business. Not sure yet. In 2017 I thought you had to have a silver plan to qualify for a subsidy. Is that true and still true for 2018?
Thanks again
So sorry to hear this Joe. The Medicaid gap is just horrible, and unfortunately I know many retired folk who’ve been ended up there.
As for your other question, ALL metal levels qualify for subsidy. It’s not limited to Silver. There are EXTRA savings for lower income folk on Silver plans called “cost sharing reductions” so if you qualify it actually makes more sense for you to buy a Silver plan instead of a Bronze. You can read more here:
https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/
But bottom line is there’s no requirement to buy Silver. Your subsidies will apply to ANY plan on the ACA Exchange.
Nina
In the comment above, you said, “As for your other question, ALL metal levels qualify for subsidy. It’s not limited to Silver. There are EXTRA savings for lower income folk on Silver plans called ‘cost sharing reductions’ so if you qualify it might actually make more sense for you to buy a Silver plan instead of a Bronze.”
I’d say if a person qualifies for CSRs, he’d be crazy to buy a bronze plan instead of a silver one. A deductible of $0 instead of $6,000 is as important as getting a subsidy that lowers premiums. On the BlueSelect Silver 1443 plan you referenced, a person with $17,000 income who gets CSRs by putting that income in the appropriate box when buying on the exchange would pay $1 for doctor visits, while a person with that plan but without CSRs will pay $100 after the $6,350 deductible is satisfied. That’s HUGE.
The link you posted about CSRs right above this is good–maybe you should incorporate it into the body of your post. The only reason most people even know they exist is because of the kerfuffle with the executive order and skyrocketing premiums, and almost nobody knows how they actually work or how important they can be.
And I’ll note that you can pay full price for a policy on the exchange, and if it turns out you qualified for a subsidy, you can claim it on the next year’s income tax return–it doesn’t have to be applied to your monthly premium. (This is only if you got your plan through the exchange.)
However, if you qualify for CSRs, there’s no retroactivity–it’s the policy itself that changes, and that has to be done when you sign up for the policy, and you have to let the exchange know if your income changes during the year, because the actual terms of your policy (not just the subsidy/premium) are based on your income.
It’s confusing as hell, but very very important.
Also, there are BlueSelect and BlueOptions policies in Florida, and they are similar but not identical (even in the out-of-state coverage), and it can be hard to see the differences just by using the “compare” button on the website. You may not want to delve into that, but people should be aware that it’s an issue when selecting a plan.
And some suggested clarifications:
“Texas does not have ANY nationwide plans on their Exchange. There is only one provider (BCBS) and they only offer HMO plans for 2018.”
BCBS is the only on-exchange provider for the Escapees zip code. There are other providers on the exchange in other Texas counties, for people domiciled in those counties. However, all the PPO plans I’ve seen have have only a small local network and no out-of-network coverage, so they’re not what most traveling fulltimers would want. But they do exist.
“Avera [South Dakota] still offers a PPO, but if you look closely into the network you’ll find it has zero providers out of state (seriously none!) so it’s essentially just a SD HMO (I honestly don’t even know why they call it “PPO”).”
HMOs require a referal from your primary care physician to see a specialist. A PPO allows you to see a specialist without “permission” from your doctor. HMOs have traditionally had only local networks, and don’t provide out-of-network coverage. There are PPOs that are moving toward (or have arrived at) the same thing, but have the advantage of not requiring a referral. So HMOs and PPOs are becoming very similar except for the referral part.
“When shopping on the ACA IGNORE the multi-state plans!”
You should ignore the name “multi-state plan,” not necessarily the plan itself.
The problem with “multi-state” plans is only they name–they don’t necessarily do what their name makes it sound like they do (provide coverage in more than one state). There’s a chance a multi-state plan might work for a person, but it will have nothing to do with the fact that it’s named a “multi-state plan.”
So a “multi-state plan” should be evaluated exactly the same as any other plan should be evaluated.
“For Paul and I”
Gosh, I hate to do this, but it’s “For Paul and me.”
Thanks for all the details. Very good info indeed! I added the county detail to my TX plan info and also added some clarification to the “multi-state” designation. I’m still leaving it as “Paul and I” however coz that’s just too picky 🙂
Nina
Aah, but just a few keystrokes could help stop this growing assault on grammar.
Excellent summary, many thanks!!!
We did go with AlieraCare 5,000 Premium, with the bump up options, for 2017. We just would no longer pay the $22K with $6K deductible, that our BCBS from North Carolina (A Group Retirement Plan) would have cost. We’re South Dakota Domiciled, and as noted multiple times before by you and other’s, Pre 65 Health Care lack of PPO’s is one key area where the SD, FL, TX Domicile comparison has a negative ‘check mark’ for SD.
We always felt, and have a folder prepped and ready to go, that if something dramatic happened to one of us. We’d change Domicile to a different state, which would then allow us to sign of for an ACA plan. No preexisting restrictions.
Sure not our preferred way to go, but what we did.
For 2018, I’ll shift in Feb to Medicare. The DW will this year go to AlieraCare 10,000, with the extra riders. And then we’ve already worked with Kyle for the Accidental & Critical Illness Insurance to both ‘gap cover’ as well as hedge the costs of an Accident or Critical Illness.
AND YES. ALL OF THESE (Except Medicare for me starting in February.) ARE NOT INSURANCE – and that is not a real nice position to be. But no subsidy, and relatively goo health, has us on this path. The DW has 5 1/2 more years until Medicare. So each year, we’ll see what the ladies & gents of DC come up with.
What a can of worms this has become:)!
Best to you, and all,
Smitty
Well congrats on the big 65 benchmark. It’ll def get easier from here, at least for you. Hoping some new options show up next year for all of us.
Nina
You did a great job here,lots of research and putting it on paper. I wish you were my insurance agent ,you’d get the commission off my policy,whatever it will be. Thanks
Thank Nina for a most excellent summary. This is such a confusing subject and everyone’s situations can be different making all the more confusing! I have scheduled a consultation with the great folks at RVers Exchange as 2018 will be our first year off the corporate insurance nipple, so we really need some help navigating these crazy insurance waters.
Thanks again!!!
Great. I hope they help you find a good option. It really is a crazy landscape to negotiate.
Nina
Wow thank you so much for all this great info! I am so frustrated right now! my husband is on Medicare but I am still a few months out. My residency is currently in VA in a county where I have only one available option and it’s going up significantly ($900.00 a month and $7300.00 deductible!)! We are not 100% full time RVers but we spend about 7 months away (3 months FL, 3-4 months Vermont, 1 month traveling around). I am interested in the Cigna plan, but concerned if it will not be in network in the places I spend time. Any reviews on this plan or anyone here had experience? Thank you Nina for this amazing, comprehensive blog. It’s the best I have read!
So unfortunately I have no reviews on the plan since it is a brand new offering from RVer Insurance. It’s actually a Group Insurance Plan that uses the Cigna PPO network (Cigna Open Access Plus) and I believe you can check for in-network doctors here:
https://hcpdirectory.cigna.com/web/public/providers
DO also read the other requirements for the plan. For example there’s a requirement for the primary on the plan to work 30+ hours/week (a home biz or blog would qualify I believe). Here’s more: http://www.rverinsurance.com/ppo/
Nina
Thanks! I emailed Kyle and he responded with some answers to my questions. We own our business and I do some work at home so I qualify for the 30 hours.
I haven’t read though your entire post Nina, but I plan to today as it looks excellent. But I choose Liberty Health Share because I am healthy and have no pre-existing conditions. I am mid 40’s, self employed. I am not really a religious person, basically agnostic. I have only been with LHS for about a year but so far so good. I just had one doctor appt so far and a annual health screening. I love that I can just choose any doctor I want, clinic, etc…. I can’t go straight to a specialist if I need to, etc…
There are some quirks. You have to talk to the billing dept at each doctor/clinic/hospital to make sure they will bill LHS, as not all have heard of them, and its kind of outside the box to have a health share, many will not have heard of it. Some will not bill LHS direct. Which is still not a deal killer as they can bill you and then you upload the bill to LHS.
When I did my research for LHS I did a lot of Google searching to see if I could find bad reviews and participated on some discussion forums about it and talked to some people that had used it. I didn’t find a lot of bad reviews out there. And the complaints I did find sounded like people who did not fully read up on the details of it, and went with LHS and had bills denied due to major pre-existing conditions. DO NOT go to LHS if you have major pre-existing conditions! They are very clear about this. For example, if someone has ever had cancer treatment, heart attack, major surgeries that are chronic, chronic diseases….LHS IS NOT the place for you. They are pretty clear about this before you sign up. But they will still cover up to $25k of pre-existing conditions year 2, $50k year 3…not sure after that. I have found them to be a very fair and rational company and I like how they do business.
There is a bit of risk with LHS. What if there was malfeasance in handling their financial books down the road and they ran out of money went bankrupt and couldn’t cover a major medical issue you had? What if they get too many claims and go bankrupt? I’m sure you can research this and maybe talk to their auditors. I was willing to take the chance.
All in all I thought it was worth the risk since I am healthy and single person. I pay $199/mo and have only a $500 deductible. This was SOOOO much better then anything I could find on ACA in WA State where I live. In WA State as a single person you had to get to $30k in income before you got any subsidy and the cheapest plans on the ACA exchange were terrible and had terrible reviews. And the customer service is SOOOO much better at LHS. It is less of a giant bureaucracy like big health insurance companies. And it is nice being with a well run tight ship non-profit organization where the CEO’s are NOT making $40 million a year like the giant corrupt USA health insurance companies. I also like that LHS ENCOURAGES people to be healthy. For example they do NOT accept smokers into their health share.
And a side not my mental health is much better now that I am NOT in ACA:) lol I wasn’t a fan of ACA overall and thought it was very financially abusive towards self-employed people who did not qualify for a subsidy. I thought it was very unfair and threw a lot of healthy self-employed people in front of the bus.
I appreciate your review of the “other side of the coin”.
The costs and the idea are compelling, but the bottom line is that these Health Shares are not insurance and there is no guarantee of payment. It is clearly stated in their legal statement that every bill is paid on a voluntary basis only, which means they can legally deny payment for any reason whatsoever at any time whatsoever. I’m sure that while the pool is mostly healthy (more healthy people paying in than taking out) this is not a problem, but what if more people in the pool get sick? Or financially the organization becomes nonviable & just choses not to pay your bills? I can’t live with that risk.
That said I’m very glad they’re working out for you and wish you continued good health and a good experience.
Nina
No question there is an element of risk and unknowns with health shares. I probably wouldn’t do it if I had a family to worry about. But some health shares have been around for 30 years. I would think if they were denying people coverage left and right, etc… there would be some really bad press and lawsuits out there. From what I understand their membership numbers are growing very quickly too. And as you said their membership pool is a lot healthier (no smokers, no pre-existing). I am very happy with the decision and the service so far. Really easy to use, goes with me to any state I move to, I can just go to any doctor or any clinic I want, etc… But yeah, there are uncertainties with these things. But I feel gut level OK with them. I feel like they will do the right thing. But that is just me:) Caveat Emptor and everyone should do their own research!
Excellent article and a great service to the RV community! THANKS!
I am sooooo glad Lisa is a early Ford retiree and we get covered that way. I would go nuts if I had to deal with this stuff! 🙁
Wow. You did some significant research here, and then presented it in a clear and concise manner. I am impressed by your work product. I’m now on Medicare, I wonder what that will be like.
My prediction? Much, much easier! Congrats by the way 🙂
Nina
Once again, I am so thankful that we picked Florida for our domicile when we decided to become traveling nomads in 2013. Our Florida Blue Select 1443 plan (a silver plan with cost sharing) has been a godsend to us, and has allowed us to get care at our previous doctors in NC as well as in other states while traveling. We never needed care while we spent a year in Mexico, but my understanding is that the Bluecard program might have paid for care there as well, if we’d used the right hospital/doctors. It looks like our subsidy will once again allow us to obtain this plan at a manageable cost for 2018. Thank you again for your helpful and informative posts on the ACA each year, Nina! They have provided so much information and once again reinforce our belief that being domiciled in Florida as pre-Medicare RVers is by far the best choice for us. Next year is up for grabs since my husband will be eligible for Medicare, and who knows what will happen with the ACA, but I at least feel confident in 2018! Thank you again!
When I was a kid we had a set of encyclopedias in a small bookcase to help with the mysteries of life. Now one of my most used references is Wheelinit. Thank You Nina for all your excellent work.
What a lovely compliment. Thanks so much {{blush}}
Nina
This post (like all of your posts) was packed with very valuable information. It is clear that you spent a lot of time researching the subject matter. Thank you! My wife and I are early retirees (and full time Rvers) that domicile in Florida. We have had good experience with Florida Blue. For readers that are attempting to manage their MAGI to stay within the subsidy levels, keep in mind that annual HSA contributions (associated with HSA compatible high deductible plans), reduce the MAGI that is used for subsidy level tests.
Hopefully some day, we may cross paths with you and Paul, so that we can express our appreciation for all the value that we gained from your work over the years.
Good tip about watching those HSA contributions. It’s so darn complicated to figure out what adds to MAGI income and what subtracts from it. Wish this was easier.
Nina
Nina,
We are entering the brave world of the individual health insurance market next year and I have a couple questions for you. Both questions are for plans without subsidies.
– I didn’t see you mention HSA’s (I didn’t read through all the comments though to see if it was mentioned there). What are your thoughts on using a HSA?
– I am also curious why would choose a Silver or Gold plan over a lower cost Bronze plan (either HSA or non HSA)?
As an example:
For us, a Bronze plan with a $6550 deductible (per person) costs $1562/mo. While the deductible is high, there are no co-payments, office visit charges, or Rx charges, once the deductible is reached. So the maximum we would likely pay in any one year would be $25,294 (assuming one person has minimal medical expenses).
Where a Gold plan, from the same company, with a $1000 deductible (per person), would cost us $2482/mo., yet has a 20% coinsurance charge and $20 office visit charge and a small amount for Rx even after the deductible is met until . For a maximum of $30,784 per year (assuming one person has fairly minimal medical expenses).
Both plans have a similar annual out of pocket max (within a couple hundred dollars) and as far as I can tell, everything else about the plans are the same.
So on the face of it, it would seem to me that it would be cheaper to go with the Bronze over the Gold if either we stay healthy or if something catastrophic happens to one of us (maybe not both of us though…but that is unlikely….knock on wood).
What am I missing here?
Your thoughts?
Regards,
Steve
p.s.; we hope to be poking around in Arizona for a couple months this winter
We’ve always had an HSA-compatible health plan so that’s something we do prefer. Not all the plans on the ACA exchanage are HSA-compatible however (usually only a small selection are), so you have to be aware of that when you’re searching. For example in SD the plan that we were on this year (Avera Silver 4000) was the only HSA compatible plan on the exchange that year. There are a few more this year.
As for why we’d buy Silver instead of Bronze I did write about that in the post, and it’s specifically because of out-of-network care in SD (where we’re domiciled)*. In SD none of the ACA plans offer any out-of-State network BUT the Silver plans DO offer 40% coinsurance (after deductible) for out-of-network care, which at least means we have *some* kind of help with out-of-State (= out-of-Network) costs should something happen. It’s not much, but it’s something! Other than this little wrinkle there’s really no reason to go for the higher cost of a Silver plan unless you have on-going medical care and thus will benefit significantly from the lower deductible. Also, this year (2018) it may actually make more sense to go Gold simply because Silver prices have increased so much. With Gold you’ll get even lower deductibles for a small (or even negligible in some cases) increase in premium over the Silver plans.
*NOTE -> If you domicile in Florida and get a nationwide Florida Blue plan none of this matters since you’ll have coverage nationwide through the plan. The only reason it matters in SD is because the plans have no network out of state.
Hope that helps to explain it.
Nina
Got it. Thank you for explaining.
That does make sense for you guys.
Since we don’t full time, we would be unlikely to require medical services when traveling except in an emergency….which is covered.
There sure are a lot of options that need to be considered depending on your health and lifestyle.
Wonderful post Nina. Hubby and I are four years out from retirement. I will be 65 at that point; but he will be just 60. Health insurance is our biggest concern about retirement. We have a lock on everything else if the plan goes well; but we worry way too much about our future healthcare costs.
It is absolutely terrible that it has to be so complicated.
I am very glad someone put a link to your site on RV Village. I am adding it to my favorites. I will be looking over the site to see if I can find information on how domicile may affect those of us on Medicare supplement plans.
Thanks for putting together this site.
You said above that “After Dec 15th you will only be able to buy insurance on the ACA if you qualify for a Special Enrollment Period. As an RVer, moving your domicile to a new state qualifies for this.”
This is not quite right and potentially misleading because state residency requirements are NOT the same as ACA residency requirements.
The ACA is concerned where you actually reside, and not necessarily your domicile.
For example, if someone domiciling in Wisconsin, spends the Winter in Florida, then he probably qualifies for a Florida ACA plan.
You can find more information in the January 2016 Health & Human Services Department SEP FAQ:
https://www.regtap.info/uploads/library/ENR_FAQ_ResidencyPermanentMove_SEP_5CR_011916.pdf
But you need to have “intent to reside” and staying a winter in FL does not count. It’s stated pretty clearly in the document you attached:
“Individuals visiting an Exchange service area for a transitory purpose, for example, to attend to a business matter, obtain medical care, or for personal pleasure, do not have a present intent to reside, and do not meet the residency requirement for Marketplace coverage for the Marketplace service area they are visiting.”
For health insurance purposes it has to be somewhere you plan to setup permanent residence, which as a fulltime RVer means it has to be your domicile (it’s the only legal address we have for that purpose).
Nina
Thanks for the quick reply. However, look at the last paragraph Q11 in the H&HS FAQ link above:
“Q11. If an individual travels between homes in different Exchange services areas
throughout the year, where is an individual’s residence for the purposes of Marketplace
coverage?
If an individual leaves his or her primary home to visit a secondary home for a short duration, the
departure will be considered a temporary absence, and the individual will remain a resident of
the service area of the primary home. During that time, the individual will not have an “intent to
reside” in the location of the secondary home and will not meet the Marketplace residency
standard for that location.
In contrast, if an individual has two primary homes where he or she spends time for an entire
season or other long period of time, then the individual may live and intend to reside in both
locations. In such situations, the individual may establish residency in either or both locations. ”
So “intent to reside” is not as clear as you make it out to be. Otherwise, why would ACA need a 5-page memo?
For someone staying in FL for Winter (“an entire season”? 3, 4, 5 months?) who doesn’t have a national network health plan, don’t you think it would be worth their time to check out getting a better FL ACA plan while they’re in FL?
Finally, you do NOT need a permanent address to get an ACA health plan. Otherwise, homeless people would be ineligible, and they are eligible. If you need further proof, look at Q1, (2) in the H&HS FAQ: “where he or she “intends to reside” (including without a fixed address)”. Also, look at the ACA’s online application form (link below), page 1, STEP 1 Tell Us About Yourself, “Home address (leave blank if you don’t have one)”.
Well, RVers have no homes so we cannot declare 2 residences. By definition we travel fulltime. The only “permanent” address we have for legal purposes is our domicile and it is the only place where we actually declare intent to reside over the long-term (we had to formally declare it in SD, and also in FL when we moved our domicile here). How can you prove your intent to reside permanently in a place where you’re just renting an RV site for a few months? Where is your intent to reside? If you own property in two states and spend significant time in each place then I might be able to see an intent to reside, but a rental site for a season? I do not see it.
If you interperet the law differently then go ahead and apply wherever you want at whatever time you want. I do not personally see how staying a few months in an RV park can come anything close to declaring intent to reside & would not want to risk my health insurance (or getting paid claims) on that basis. I’ll leave this set of comments so folks can make their own decision, but I am closing this from further discussion.
Nina
All good questions, Nina, but proving residence (or domicile for that matter) can be challenging in ANY location.
For example, you asked “How can you prove your intent to reside permanently in a place where you’re just renting an RV site for a few months?” If you’re in an RV park, I would think a receipt from the park would do.
Yes proving residence is challenging as a fulltime RVer which is why I take NO risks with it and do everything I can to make sure I meet the requirements of legal domicile. It’s critical for my taxes, for voting, and for insurance (both car/RV and health). If you are happy using a receipt from an RV park as a legal basis for intent to reside then go ahead. Like I said I personally would not risk my health insurance on that basis.
Nina
I think the bottom line is what state you are obtaining your regular healthcare and if you have a high deductible you may only get a routine visit annually and pay out of pocket in various states for other care. I hear unless that care is actually life threatening like a heart attack some companies are cracking down on paying for emergency care anywhere.
I think circumstances could vary with work camping positions and/or land ownership in various states which gives you mailing addresses in multiple states. I had more income this year in the state I obtain healthcare but it is not my legal domicile. I had income in 3 states and one volunteer position and only 4 months in each state.
We have sold our home in Vermont and about to leave on a five year trip, taking our sweet time and covering most of the country. I am 61, wife is 57 she needs to take a couple regular medications (high blood pressure, anti- depressant) her primary care physician will only provide a one year prescription, and we have no plans to return to this part of the country during that travel time. Any suggestions as to how to make this work without returning to the east coast as we know everything about this part of the country and want to spend most of the time west of the Mississippi?
There are a couple of options:
1/ Talk to your current doc: Ask him/her if your wife can continue her prescription while you travel as long as she gets regular rechecks along the way. Ask what tests your current doc would need to accept this. She can then get tested wherever you folks happen to be at that time and have that physician send those results back to your primary in Vermont. I know many folks who travel like this. They simply get any blood tests (or physical tests) they need while they travel and have those results sent back to their primary so they can re-up their prescription.
2/ Renew along the way: 3-4 months before your wife runs out of her meds, find another physician to continue the prescription wherever you plan to be located at that time. Make sure you bring your wife’s FULL medical records with you (everything in a file), so get copies of EVERYTHING (tests, history etc.) from your primary physician before you leave Vermont. I recommend 3-4 months simply because it can take time (a month or more) to get in to see a new physician, and then there might be additional tests that physician needs before they can prescribe.
3/ Get a new primary: If you know you plan to spend most of your time in a given place (say, you fall in love with somewhere out West), then establish a new primary there. Again, bringing a copy of your wife’s FULL records with you will be really helpful to get this process started.
4/ Fly home once/year: there is always the option of taking a plane home once per year for rechecks with your primary. If you plan to see friends/family anyway, this can work.
But start with #1. It’s obviously best if you can stay with your existing doc, and if you explain the situation to him/her you may well be able to figure something out.
Nina