Pre-Medicare US RVers -> Time To Think About Health Insurance for 2019!
We’re still here in Europe, waiting anxiously for our new RV (we’re days away now, fingers crossed), but in the meantime I haven’t forgotten about my RVing friends back in the USA.
You see it’s that time of year again, open enrollment on the ACA!
For younger (pre-Medicare) RVers this means it’s time to think about health insurance, and you’ve only got around 6 weeks to figure it all out. Open enrollment runs from Nov 1st to Dec 15th, so if you want to sign-up for a plan starting Jan 1st, you’ve got to get on this now!
Official Disclaimer: Before we start this whole thing you need to know that I am not a qualified health insurance broker, nor am I in the medical field. This is simply a layman’s view of health care options, as I see them. Please consult an expert before you buy.
What’s Changed For 2019?
I’ve got lots of older articles on health insurance, including what the ACA is and how it works, so if you want that background take a read HERE. This year the ACA is pretty much exactly the same, except there’s been 2 massive changes in health care law that might affect your choices:
- The elimination of the “individual mandate” penalty – this was the tax penalty you paid if you chose not to get insured or bought a non-ACA-compliant plan. As of Jan 1st, 2019 you’ll no longer have to pay it.
- New rules for short-term health insurance plans which now allows them to be sold up to 364 days at a time, with renewals for up to 36 months. Previously these could only be bought for 3 months at a time.
In addition, early next year new rules expanding access to Association Health Plans (AHPs) are coming into effect. This is super interesting, especially for younger, working RVers and will be a space to watch going forward.
All of this means more possibilities for younger (pre-Medicare) RVers, depending on your income levels, your health (whether you have pre-existing conditions or not), and your personal needs.
Why Am I Even Thinking About All This?
You might wonder why I’m even thinking about all this stuff, now that none of it applies to us anymore. Well, one reason might be that I’m crazy (not far off the truth), but the real reason is that the fab folks over at Xscapers kindly asked me to write an article about it. So I spent several weeks doing my thing, investigating everything in detail and coming up with my “layman’s” view of what the best options are for pre-Medicare, working RVers.
The final article is ~4,500 words and covers everything I can think of from a “top-level” basis, including what is available for the self-employed today and how to decide which option makes the most sense for you. So, instead of writing a long post on here (like I usually do), I hope you’ll check it out the article on Xscapers:
Health Insurance Options for The Self-Employed RVer
For those wanting to read more there are TONS of other great articles out there on Health Insurance, but for younger, working RVers these are the four I’ve found most useful:
- 2019 RVer Guide To Health Plans – From RVer Insurance Exchange. Good general guidance.
- Health Insurance Time -> 2018 Considerations For Pre-Medicare RVers – Yes, this is my own blog article from LAST year, but it’s got a ton of details about ACA and how insurance costs, options & subsidies vary by state & county. Many details are identical to this year so it’s worth a re-look.
- Tax Reform & Health Insurance: New Options For the Self-Employed and Early Retiree – From physicianonfire.com. Good information about Catastrophic Health plans, in particular.
- 10 Things to Know About Association Health Plans, a Potential Solution to Entrepreneurs’ Healthcare Problem – From entrepreneur.com. Detailed article about AHP’s and how they may well become the go-to plan of the future for younger, self-employed folk.
What Would Wheelingit Be Doing If We Were Still In USA?
This is an interesting thought process and worth a few extra words. What plan would we be buying right now if we were still in the USA?
As those of you who follow the blog know, we changed our domicile from South Dakota to Florida right before we left the USA earlier this year. We did this for a bunch of reasons, mostly related family and our move to France, but as it so happens if we’d stayed RVing in USA, it would have been a great choice for health insurance too!
You see Florida is the only one left of the “big three” RV domicile states (FL, TX, SD) that still offers a health insurance plan with a solid nationwide network on the ACA, through Florida Blue. If you qualify for subsidies (meaning your Modified Adjusted Gross Income falls between 100-400% of the Federal Poverty Level), the rates can be very attractive. Without subsidies it’s expensive, but it’s still a very solid insurance plan. This is honestly the best option out there and would be our #1 choice if we’d stayed in the USA.
Outside of the ACA, the other option we’d be looking into would be Short Term Medical (STM) Health Insurance. We had one of these plans back in 2014 and we also bought one early this year (from Jan-Mar 2018) for the 3 months we were in Florida before we flew to France. Now that these are available to buy on a yearly basis again, they’re a viable possibility for RVers on a longer-term basis. The upside of STM plans is that they are generally cheap (much cheaper than non-subsidized ACA plans!), and can offer really good nationwide networks with very decent coverage. The downside of STM plans is that they do not cover pre-existing conditions and as we found out, this means payment of claims can be a tough process (see below). This would be the #2 option we’d be considering.
Our STM Claims Payment Ordeal: This is classic story about the problem of pre-existing conditions and how they affect the insurance claims process.
While we were in FL in Jan, we used our short-term plan for some minor doc appointments. The plan had a great network, so we had plenty of in-network docs to chose from. However payment was another matter. A few weeks after our visits, our claims were blocked by the insurance company for “pre-existing investigation”. This was basically a check to see if we had any pre-existing conditions (= grounds to deny the claim) and meant we had to give them the names and addresses of ALL doctors who had treated us over the past 5 years. Then they proceeded to contact every single one of these docs for our full medical records!
Since we’d been fulltime RVers, our docs were all over the USA, so many of these requests either got lost or ignored, and the claims process stalled. In the meantime one of our claims went to credit collection services (!) and the insurance company refused to do anything about it. In the end I had to get personally involved and start handling all the calls myself. All in all it took 9 MONTHS of calling, pushing & constant follow-up before I managed to get all the records sent and the insurance company to process our claims. The plan paid-up in the end (just a few weeks ago in fact!), but what a royal pain in the backside!!!
Moral of the story? Be aware what you’re buying into when you buy a plan that does not cover pre-existing conditions. They can be inexpensive & provide really good coverage, but you may well have to fight for MANY months for payment.
That’s It For Health Insurance
Hopefully all this gives all my US RVing friends some ideas for 2019. With any luck (fingers, paws and toes crossed) my next post with be be about our new RV in Europe….wheeeeeeee…..
I seriously can’t think of anyone better to write such a piece. So glad xscapers asked, heading over now to check it out. Thanks so much for being you…the excellent researcher and always willing to share person.
Loads of love from all of us!
Darn sweet of you to say Nikki. Hugs all around from us too.
Nina
I so agree with Nikki Wynn.
One note, it might just be because our plan with Florida Blue is a Medicare Advantage plan, but they have both PPO and HMO. Just make sure to choose PPO. My husband was two years ahead of me and had the PPO. I only realized at the last minute that they had almost put me into an HMO. The PPO will cover me anywhere in the states.
Yes, choosing a PPO is key. I go through this in the Xscapers article, and also my blog from last year, but it’s important and worth repeating again.
Nina
Excellent as always Nina! We’re thankful to still have the ACA FloridaBlue EPO option this year and already renewed with just a 9% premium increase over last year. We don’t qualify for subsidies – but even so, it was still *significantly* cheaper than the new self employed nationwide PPO options offered through RVerInsurance.
It’s great to see more and more options becoming available however for us roaming entrepreneurs!
That’s the plan we would be on if we were still in the US. Not cheap, but it’s an excellent plan. Thanks for chiming in with the update in costs.
Nina
Thanks to you I found my insurance policy last year (2018) after Anthem doubled my premium and lowered my benefits! I was so pleased when I saw you had written another blog about coverage for 2019! I can’t wait to check out this article. Thanks again and I can’t wait to see the new RV.
So very glad I could help out! I do hope you find a good plan this year too.
Nina
I too am looking forward to seeing the new wheels.
As for the health insurance essay/info/subject? Well, I’m easily confused as it is, and reading all of that information is kind of like trying to translate something written in Swahili or maybe Klingon.
Just well, what can I say, I’m Canadian.
BUT, we do “pay” for health insurance/coverage/whatever. But it’s the same way that the average American “pays” to have the street in front of their house paved, or I don’t know, have street lights. Somebody has to “pay”. Somehow though, the notion that being able to go to the hospital without it bankrupting ones family seems to translate into “socialism” for anyone south of the 49th. Just a mystery.
Anyway, I’ll stop now. I just find it *interesting* that “Health Insurance” can be an entire subject matter.
You are SO RIGHT!!
Well I don’t disagree with you there. Now that we’re based in Europe I don’t have to think about health costs anymore, which I have to admit is a huge relief. It’s been a very nice change!
Nina
Here! Here! For those of us Americans who are also in the health profession and have also lived overseas it is a complete mystery!
What did you use for short-term coverage? I plan to be in the USA most of the year – otherwise I would use Cigna but they limit to 180days in the US.
I bought the short term plan offered by RVer Insurance Exchange (through IHG group). Link here: https://www.rverinsurance.com
Nina
To add to confusion……An agent suggested to me since I travel to add accident insurance while I am traveling since this state only offers EPOs which even have a limited network in my state.
I think there are 3 types of supplemental insurance that one might consider on top of ACA (can’t believe that is needed)….short term med insurance, travel insurance (used GeoBLue when I was in Canada) and now this accident insurance that the agent is discussing that I am not a big fan of. Is that correct?
Accident insurance is an add-on option to consider, but if you buy a plan through the ACA you are covered for emergencies across the US (this is part of ACA law) whether or not the hospital you go to is in your network. So if you’re buying ACA insurance, I’d personally look at emergency relocation instead. This allows transport of you, your pets, your rig back to your home state in case you need it. It’s a good supplement for any traveler, especially once you are out of your emergency situation (which is covered by ACA law) and need after-care (which will not be covered if you are not in-network).
A good option for this is to join FMCA which only costs around $60. Once you join you’ll automatically get FMCAssist as part of the membership and that covers relocation in case you need it. It’s a very useful benefit: https://site.fmca.com/fmca-assist
As for short term medical, that’s actually a different type of insurance, which you would buy instead of an ACA plan (not in addition to). We had it as our primary form of insurance for several years (back when that was allowed), and might have considered it again this year. It’s an option to consider if you have no pre-existing conditions. That said, if you qualify for subsidies on an ACA plan and/or are happy with the one you have, I’d stick to that since you get better benefits overall. Florida Blue is an awesome plan and the one we’d be on if we were still in the States.
And yes, travel insurance for when you’re outside of the USA is key. GeoBlue is perfect for that!
Nina
As usual, my got to resource for health insurance (and where I send people if they ask). Hoping europe is treating you well!!
So glad I could help out! And yes Europe is treating us well so far.
Nina
Hey there, Nina….Didn’t you have someone that would counsel on insurance/Medicare questions and answers? Seems like they advertised on your blog?
Thanx,
Caryl~marie
I’ve worked with RVer Insurance before (RVerInsurance.com) for our own health insurance needs, and I’d recommend contacting them if you want to chat to someone. They’ve offered decent solutions for us over the years (we’re not affiliated or anything.).
Nina
Hi, Nina,
As always, thanks for helping make some sense of this crazy time. I’ll be having a big “Medicare Party” come next October, but in the mean time, I need nine months of coverage. I was planning to do the short term option, but after reading about your nightmare of payments to prove preexisting conditions, when I can’t even remember where I went to the Doc or when, I see it’s not an option for me. Thanks for pointing out the “gotcha” that I might not have seen otherwise.
I really appreciate you taking the time to write this article, as you always write in a way I can understand.
Suzanne
I’m glad I could help out on that choice! I have to admit that after battling with the insurance provider over the past 9 or so months, my appetite for short-term health insurance has waned…and I’m a meticulous record keeper! It really was a pain in the you-know-what.
Oh and congrats on aaaaalmost Medicare….whooo hooo!
Nina
Thank you for taking the time to research and share this information! I am wondering what “covered” entails. I have pre-existing conditions and can’t find information (google searching) on how on-going prescriptions are handled (the ins and outs of getting physician approval to choosing a pharmacy, etc). We are in CA right now, preparing to move to Florida to take advantage of the nationwide plan. I guess we should talk to a broker (?).
Thank you again!
Before you sign-up for a new insurance plan you should be able to check whether your existing doctor (and meds) are included in the network and prescription med option of the new plan. If yes, then you can just continue as-is, by using your exiting doc under your new insurance plan. IMO that’s really the best and easiest solution. If your doc is not part of the new plan, then you’ll need to re-start from scratch (register with a new doc) under your new plan who can prescribe you the necessary meds again. At least that’s my understanding of how it works. But yes, it’s worth it to talk to a broker.
Nina