Multi-State Plans - pros and cons?

[audreyh1]

Is there some advantage of a Multi-State plan over the single state plans? I'm not sure I understand the role/purpose of a Multi-State plan other than for employers with employees in multiple states?

I sense there is some attempt to create health care options that are uniform across multiple states and have some independence from state-by-state jurisdiction. [If a state has certain mandates above and beyond, they must fund them.]

Articles mention it's an attempt to create more competition. If that's true, there is a long term benefit, but I'm not sure what the immediate benefit might be to me or if I should be looking at them.

 

[Animorph]

I thought they had in-network coverage in multiple states. If you travelled a lot within the U.S. that would allow you to find in-network care "anywhere". Otherwise you might be stuck with out of network pricing and benefits.

 

[audreyh1]

I think that for people that are traveling, there is still some level of coverage if you are out of state, and even out of country if something happens and you need urgent care. You'll have to work with your insurance company to be directed to the right providers or work things out, but you aren't SOL.

I know that we had an emergency room visit out of state once, and we paid the standard copay.

So there must be more to it.

Of course if you live half the year in two different states then you might need routine care in both.

 

[NoMoreJob]

This is the best document I've found explaining multi-state plans....

http://www.healthreformgps.org/wp-c...ation_A80A0AAA-5056-9D20-3D25B59C65680B79.pdf

 

[Animorph]

I think that for people that are traveling, there is still some level of coverage if you are out of state, and even out of country if something happens and you need urgent care. You'll have to work with your insurance company to be directed to the right providers or work things out, but you aren't SOL.

I know that we had an emergency room visit out of state once, and we paid the standard copay.

So there must be more to it.

Of course if you live half the year in two different states then you might need routine care in both.

We're still getting insurance through DW's employer, though we just did our open enrollment exercise. ER visits was the one thing covered out of network with a simple copay.

If your insurer doesn't have network providers where you happen to need them, you get to pay the full sticker price, not a negotiated price. You insurer has no relationship with that provider, and no negotiated price. The insurer will help you out by paying something like 50% of their "reasonable and customary" price, which has no direct connection to your billed cost. I go out of network with my dentist and it occasionally costs me an extra buck. But if you've read some of the threads on medical "sticker prices" 5x higher than negotiated rates, you know you don't want to pay them.

All that aside, it looks like MSP's would be good for someone planning to move between states wanting to maintain the same insurer. And for adding a little competition for single-state plans. I don't think they're the only plans that offer national or regional networks.

 

[NoMoreJob]

You don't necessarily need a Multi-State Plan to have an extensive provider network. Multi-State plans may have nationwide networks but so may other 'regular' plans. In my experience Blue Cross / Blue Shield plans typically offer a very extensive network in every state.

 

[fisherman]

I called BCBS and asked about this. The answer I got was a multi-state plan was for people living near a state line and needing to use doctors in more than one state to make sure they were in network. The said while traveling their is an extensive in-network network for BCBS.

I would call them and ask the question to get the best answer. Also their plans end in E,S, or P. that indicates the network of coverage. E is the least broad and P is the most. I found all our doctors in the S network.

 

[NoMoreJob]

I called BCBS and asked about this. The answer I got was a multi-state plan was for people living near a state line and needing to use doctors in more than one state to make sure they were in network. The said while traveling their is an extensive in-network network for BCBS.

I would call them and ask the question to get the best answer. Also their plans end in E,S, or P. that indicates the network of coverage. E is the least broad and P is the most. I found all our doctors in the S network.

The BCBS plans on the exchange in our area - Multi-State and 'Regular' - have exactly the networks.

 

[MichaelB]

The George Washington U paper provides the best overview I have seen 'til now. Here is the MSP fact sheet OPM Multi-State Plan Program Fact Sheet
Even though it is not written anywhere, it looks like an effort to put on the exchange a health care policy offering similar to what federal employees have available. It will be eventually be available in all 50 states and DC, many of those states have little competition, so this policy may be of interest to people that want a high value offering.