Self Insuring for Healthcare

[Big_Hitter]

If he drops coverage and goes to a state exchange doesn't the employer have to pay a penalty?

 

[sengsational]

I only read half the thread.... but I would just buy the lowest cost bronze plan and call it a day....

That's the right choice for us too. I looked at Silver w/cost sharing, but even if doctor visits were free, that wouldn't save enough to make up the premium difference. Of course the math doesn't work that way if you have a lot of doctor visits, but we don't. The catastrophic policy would probably be better, since what I'm buying is the negotiated rates and the max out of pocket. The process to get the over 30 catastrophic put me off the last couple of open enrollments. Maybe I'll look into it again.

 

[Gerbil Wheel]

Can insurers deny coverage if you have a hotel’s address as your home address on your policy but aren’t living in the hotel at the time of the claim?

Let’s say you’re an RV’er or permanent traveler. You find the most inexpensive policy in a particular state. You enroll for coverage and list a hotel address in that zip code as your home address and your virtual mail service address (in the same state, but with a different zip code) as your mailing address (the ACA application has separate home address and mailing address sections). At the time of the application, you may or may not actually stay at the hotel.

Enrollment complete, your paper mail from ACA and your insurer should go to the virtual mailbox where you can have it scanned or forwarded to yourself, which you could do to get your insurance cards. You keep the hotel address as the home address on your policy.

Then you incur medical costs. Would the insurance company try to deny you coverage for gaming the system like this? I understand they have entire departments that seek out ways to deny claims.

Or say someone like the OP applies for a cheaper policy on the other side of his state using a hotel as his home address and his physical home as his mailing address. Would the insurance company try to deny coverage in that case? How would they even know about the scheme in either case?

 

[Alan]

Can insurers deny coverage if you have a hotel’s address as your home address on your policy but aren’t living in the hotel at the time of the claim?

Let’s say you’re an RV’er or permanent traveler. You find the most inexpensive policy in a particular state. You enroll for coverage and list a hotel address in that zip code as your home address and your virtual mail service address (in the same state, but with a different zip code) as your mailing address (the ACA application has separate home address and mailing address sections). At the time of the application, you may or may not actually stay at the hotel.

Enrollment complete, your paper mail from ACA and your insurer should go to the virtual mailbox where you can have it scanned or forwarded to yourself, which you could do to get your insurance cards. You keep the hotel address as the home address on your policy.

Then you incur medical costs. Would the insurance company try to deny you coverage for gaming the system like this? I understand they have entire departments that seek out ways to deny claims.

Or say someone like the OP applies for a cheaper policy on the other side of his state using a hotel as his home address and his physical home as his mailing address. Would the insurance company try to deny coverage in that case? How would they even know about the scheme in either case?

I would think you would need to have a PPO plan if you are a perpetual traveler so imo the address you use on your tax return would be the valid address to use, but in any case if you have a PPO plan what does it matter where you have treatment as long as you are in network.

I don't know the answer, just speculating as I am someone who travels 6 months a year so need to have a PPO for decent coverage.

 

[MichaelB]

Can insurers deny coverage if you have a hotel’s address as your home address on your policy but aren’t living in the hotel at the time of the claim?

They can deny coverage if they can show that any part of the application process was misrepresented. Residency is pretty easy to challenge if your driver's license, voting registration and banking records show a different domicile than the one used for health care.

I would think you would need to have a PPO plan if you are a perpetual traveler so imo the address you use on your tax return would be the valid address to use, but in any case if you have a PPO plan what does it matter where you have treatment as long as you are in network.

I don't know the answer, just speculating as I am someone who travels 6 months a year so need to have a PPO for decent coverage.

+1

Insurers are even building PPO networks that are limited in scope. It is critical to familiarize ourselves with the specifics of network coverage, a mistake here will be very costly. Based on the past two years of policy offerings, this is where the insurers are focusing their efforts, and the broad national network policies are quite expensive, but basically mandatory for those of us that spend time in different locations throughout the year.

 

[MBSC]

Or say someone like the OP applies for a cheaper policy on the other side of his state using a hotel as his home address and his physical home as his mailing address. Would the insurance company try to deny coverage in that case? How would they even know about the scheme in either case?

Most Blue Cross Blue Shield plans participate in the BlueCard Program which extends the provider network nationwide.

When you apply on an exchange the submitted information, including address, is 'pinged' against various government agencies (IRS, SSA, DMV, etc.) and any inconsistencies suspend the application process. If you apply off the exchange, I can only speak to the dominant insurer in my state. They 'ping' one of the three major credit reporting agencies and any inconsistencies suspend the application process.

 

[Alan]

Most Blue Cross Blue Shield plans participate in the BlueCard Program which extends the provider network nationwide.

When you apply on an exchange the submitted information, including address, is 'pinged' against various government agencies (IRS, SSA, DMV, etc.) and any inconsistencies suspend the application process. If you apply off the exchange, I can only speak to the dominant insurer in my state. They 'ping' one of the three major credit reporting agencies and any inconsistencies suspend the application process.

I've heard that my retiree HI is doubling in 2016 and doubling again for 2017 so last week I enrolled in healthcare.gov to make an initial application to see what is on offer. As I have a credit freeze in place they could not verify my identity on-line so the website provided a reference number and an Experian phone number to call in order to verify the details of my application. After a series of questions over the phone the Experian rep said that my identity had been verified and when I logged back in to Healthcare.gov I was able to proceed with the application.

 

[nun]

I've heard that my retiree HI is doubling in 2016 and doubling again for 2017 so last week I enrolled in healthcare.gov to make an initial application to see what is on offer. As I have a credit freeze in place they could not verify my identity on-line so the website provided a reference number and an Experian phone number to call in order to verify the details of my application. After a series of questions over the phone the Experian rep said that my identity had been verified and when I logged back in to Healthcare.gov I was able to proceed with the application.

My state's health website never managed to verify my identity so I applied on paper. I did this to see if I could save money with an ACA plan rather than paying the full $450 premium for my ex-employer's plan. I didn't qualify for ACA because my income was too low so I got put on Medicaid and given a choice of paying nothing to go on Medicaid or take a $430/month subsidy check to stay on my ex-employer's Cadillac plan. I took the check. The ironic thing is my ex-employer is the state so with one hand they charge me and with the other they pay me.

 

[MichaelB]

Most Blue Cross Blue Shield plans participate in the BlueCard Program which extends the provider network nationwide.

BCBS Florida offers 27 plans for independent insurance, 20 of which are PPO. Half are called BlueSelect and the other half are called BlueOptions. The language BCBS uses to describes them never mentions Blue Card, and the network checking tool on their website is clumsy. The only way to verify that the BlueSelect network is not BlueCard and that a user of that policy has limited coverage outside the home state is by speaking with an agent and asking specific questions about the coverage. The terms they use on the website would easily lead an unsuspecting user to a different conclusion and an unfortunate surprise down the road.

The healthcare threads last October thru December seemed to conclude that in many states Blue Cross policies offered only restricted network policies, and access to BlueCard network policies was indeed limited.

 

[aja8888]

My state's health website never managed to verify my identity so I applied on paper. I did this to see if I could save money with an ACA plan rather than paying the full $450 premium for my ex-employer's plan. I didn't qualify for ACA because my income was too low so I got put on Medicaid and given a choice of paying nothing to go on Medicaid or take a $430/month subsidy check to stay on my ex-employer's Cadillac plan. I took the check. The ironic thing is my ex-employer is the state so with one hand they charge me and with the other they pay me.

A prime example of how screwed up our healthcare system is.

 

[nun]

A prime example of how screwed up our healthcare system is.

Not really, it just seems strange because I worked for the state and obviously they administer the Medicaid program. The reason behind the subsidy program is to keep low waged people off Medicaid and on employer health care if possible which I bet costs the state a lot less.

 

[jim584672]

My state has a similar program, I wish I would have known about such a thing earlier.

My current "UHC Community Plan" is better than the work plan I had, with the same doctors I use, so no loss.

 

[Elbata]

I remember getting a job (was it the 70s) and given the choices of which insurance I wanted, full coverage, for free.

In the near future $2000-$4000/month premiums will become the norm.

It just doesn't make sense. There's got to be some kind of low cost alternative that will come about.

 

[Texas Proud]

I remember getting a job (was it the 70s) and given the choices of which insurance I wanted, full coverage, for free.

In the near future $2000-$4000/month premiums will become the norm.

It just doesn't make sense. There's got to be some kind of low cost alternative that will come about.

Yes, you would think.... but not likely to happen as it will have to be a political fix which half the country does not want...

Healthcare 40 years ago was not a big cost factor for most families... when I was young my dad did not have insurance... and when we had a medical need he just paid out of pocket... later my mom got insurance when she was a teacher... our out of pocket costs went down... I had a broken arm and IIRC the total cost to dad was $100... that was hospital, specialist, 6 follow up visits with X-rays etc. etc.... I would hate to see what it would cost today... heck, a dog bite was over $1,000... my cost was $150 co-pay, but they basically did nothing.... one X-ray to make sure it did nothing to the bone (heck, we knew that) and they 'cleaned out the wound'... which was squirting salt water in the holes.... that was it...


To keep the thread open, I will not say anything else which may start a back and forth...

 

[utrecht]

Regardless of what party is in office or what the fix is, there has to be some fix at some point. There is just no way possible we can continue to have 10-30%+ increases every year. We will literally have $5000 / month premiums 10 years from now at that rate.
There will be a revolution in this country if that happens. 90% of the population will have no insurance. What's the government going to do? Change the max annual income level for subsidy eligibility to $250,000?

 

[travelover]

Regardless of what party is in office or what the fix is, there has to be some fix at some point. There is just no way possible we can continue to have 10-30%+ increases every year. We will literally have $5000 / month premiums 10 years from now at that rate.
There will be a revolution in this country if that happens. 90% of the population will have no insurance. What's the government going to do? Change the max annual income level for subsidy eligibility to $250,000?

I agree. As Buffett says, trees don't grow to the sky. Nor can health care costs eventually eat the whole pie.

 

[bgscms]

I will be making these decisions soon and I was wondering if married couples should purchase their own policy separately or is there a benefit of the family plan together. thanks.


Sent from my iPad using Early Retirement Forum

 

[Animorph]

Regardless of what party is in office or what the fix is, there has to be some fix at some point. There is just no way possible we can continue to have 10-30%+ increases every year. We will literally have $5000 / month premiums 10 years from now at that rate.
There will be a revolution in this country if that happens. 90% of the population will have no insurance. What's the government going to do? Change the max annual income level for subsidy eligibility to $250,000?

There are a lot of new treatments that are very expensive, and I'm sure there will be many more. At some point there will have to be a limit that excludes the most expensive procedures from "normal" health insurance just to keep the cost reasonable. Not because they are "unproven", but simply because they cost too much.

 

[utrecht]

There are a lot of new treatments that are very expensive, and I'm sure there will be many more. At some point there will have to be a limit that excludes the most expensive procedures from "normal" health insurance just to keep the cost reasonable. Not because they are "unproven", but simply because they cost too much.

So, as a course of business, they are going to let people die because a treatment costs too much? I doubt that.

 

[Animorph]

So, as a course of business, they are going to let people die because a treatment costs too much? I doubt that.

Yes, that has to happen. What if they can cure cancer but it costs $10 million each? It simply can't be done for everyone. There is a limit, and I think we're getting close to it for some of the newer procedures. The alternative is that medical expenses continue growing faster than inflation until they take over the world. Probably going to be quite a few new procedures that succeed not because they are better but because they are cheaper, like Theranos and just about any non medical product.

 

[meierlde]

So, as a course of business, they are going to let people die because a treatment costs too much? I doubt that.

Society will have to decide as some countries in europe do how much an extra year of life is worth and not pay for treatments that do not demonstrate that cost effectiveness. For example $10 million for a year for one person might be out of bounds.
The first step might be to change the default treatment to hospice for some terminal conditions where you have to ask for aggressive treatment.

 

[utrecht]

I'm not talking about expensive treatments that cost $10 million, I talking about insurance premiums that cost $5000 per month. Hardly anyone costs an insurance company $10 million in their lifetime.

I hate to say this but I think eventually the government will take over healthcare in some form. If insurance companies were non profits, healthcare would cost many multiples less than it does. The same treatments and medicines cost many many multiples less in other countries than it does in the US and it doesn't have to.

 

[travelover]

.......... If insurance companies were non profits, healthcare would cost many multiples less than it does. The same treatments and medicines cost many many multiples less in other countries than it does in the US and it doesn't have to.

I don't think that insurance companies determine what medical procedures and drugs cost (at least not the initial bargaining price). In fact, without insurance you will pay more for the same procedure.

 

[NW-Bound]

I hate to say this but I think eventually the government will take over healthcare in some form. If insurance companies were non profits, healthcare would cost many multiples less than it does...

Not true. Insurance companies are required by law to pay out 80% of the premium they collect on healthcare services. They have to pay operating costs out of the remaining 20%, so their profits are not as high as what people think (else why don't people all buy insurance company stocks to share the loot?).

 

[utrecht]

Sorry. I meant that at some point the government may have to take over the entire health care industry. Not just health insurance.