ER, New Mexico and health insurance?

[BarbWire]

Sorry -- not really sure which sub-forum this belongs in: FIRE? Health? Where to live?

Finally I am free to go wherever I want: FIRE'd at the end of 2012, five years of eldercare done, estates closed. Finally footloose! (And currently on a 3-month flash packing trip in Asia...)

Age 59, solo, no dependents. No retirement health care benefit, so for the past four years I have been buying an individual plan, (one year on exchange, three years off-exchange)

As a native New Mexican my plan has been to return to northern NM, but when I look at the health insurance options for the Santa Fe area I am flummoxed. I will travel a lot -- at least six months per year on the road, much outside the US. I have no health issues and last had a prescription (other than anti-malaria) more than a decade ago. An HMO with a very limited network does me little good.

So how do I proceed? Move to NM and spend several hundred dollars a month on insurance that does me little good? Buy the least expensive HSA eligible policy I can, and then plan to self-insure for just about anything that happens when I am away from my "home" county? (That is what I currently do)

Or move to another state -- in which I have no interest in spending time -- because the health insurance offerings are not dreadful?

All the other financial pieces fall into place as planned for an ER move home to northern NM -- except that I really do not know what to do about health insurance.

I suspect potential ER's to Arizona have similar issues. Ditto for Colorado.

Advice on how to proceed -- or even how to *think* about this problem in a bigger FIRE and financial planning context-- would be gratefully received. I have hit analysis-paralysis.

(And apologies in advance for being slow in following this thread -- in SE Asia I have both time zone and Internet accessibility challenges!)

Thank you!

 

[socca]

Short-term insurance might work for you. The advantage is that you would only buy coverage for the months you're in the US. With no pre-existing conditions, you shouldn't have any trouble obtaining coverage. The gov't moved to restrict the maximum term to 4 months in a bid to force healthy people into Obamacare, but I don't know the latest status of this rule, which was supposed to take effect in April 2017. Google 'short term insurance' for more info. My underwriter is National General and my local provider network is Aetna.

 

[brewer12345]

I would suggest you buy the cheapest, high deductible HSA plan you could find and self-insure while you are outside the US. Southeast asia? Doesn't a heart transplant cost like 20 bucks in Thailand?

 

[cathy63]

Look into GeoBlue for coverage while outside the U.S. I think you have to come back every 70 days, but this plus the cheapest HMO in NM might be your best choice.

 

[bingybear]

Doesn't GeoBlue require you have an an underlying US plan?

 

[BarbWire]

Thanks, all. at this point my inclination is to go ahead with my plan to move to NM, buy the cheapest HSA eligible plan available (which means throwing away $500+ / month because the networks and coverage for non-employer based plans are apalling), and simply assume that I will self insure for everything, inside the US and out, so that I have a choice in the quality of care I get, not that which is provided by the lowest bidder.

Which feels a lot like having no medical insurance and no financial safety net at all.

But more generally, in the bigger picture of financial planning, how does one think about options? especially when what is on offer is basically very limited prepaid health care, rather than insurance against a massive financial hit?

Let's say I have a 5% chance of developing a catastrophic illness or injury each year -- say cancer or an extremely nasty accident -- that will cost hundreds of thousands of dollars to treat -- then I have a 77% chance of NOT having a super-major medical event before I qualify for Medicare.

Or I have a 23% chance of having a massive financial hit.

Sorry for being gloomy but I am still trying to figure out how to *think* about how to fit this into a responsible FIRE plan. This is a curve ball I never anticipated as I worked towards ER.

 

[bingybear]

I guess I don't always see it as "lowest bidder". In my case the doctors are the same ones that participate in the high end employer plans.. The issue is the network is heavily restricted.
I was really considered healthy until I had a pacemaker installed 4 years ago. I don't really consider myself to be unhealthy. I just had an electrical problem. One never knows when something will crop up.
My way of dealing with this.... I budget for heath insurance and paying max out of pocket for both of us every year. If I don't spend it on health care, I can spend it else where if I like.

 

[zinger1457]

Every policy (HSA HDHP) that I have purchased through the ACA marketplace covered emergencies while traveling overseas. I don't believe it's an ACA requirement so at a minimum I would make sure it's included in any policy I purchased. If all of your overseas travel is in one country then you might be able to purchase a local short term health insurance policy. Even in a country like Thailand I wouldn't feel comfortable without some type of emergency coverage, the cost can still add up quickly.

 

[cathy63]

Doesn't GeoBlue require you have an an underlying US plan?

Yes, but if he also has the cheapest plan in NM, then that would meet the requirement. It's hard to know whether it's necessary to have both plans, but I would think it's worth looking into to see if it's worth the cost.

 

[ivinsfan]

Well I wouldn't move to another state in the current situation. Living in MN where we had many good options 2 years ago, to where some parts of the state have no "good" options, tells me moving for insurance coverage is a losing proposition.

 

[Chuckanut]

Have you considered talking to an insurance agent? Policies vary a lot and I seem to recall the overseas coverage may have time limits on it - perhaps a trip can be no longer than 90 days. I would think talking to a a professional who knows the health insurance industry might be time well spent.

 

[Fermion]

I think realistically you need to return to your home state in the case of a major hospitalization or something like cancer.

Unless you can't be moved, which IMO would fall under emergency care and would be covered by most policies?

 

[lhamo]

Does Regence BCBS serve NM? Here in WA they have a plan that is a PPO locally (I have used the version linked to U Washington Medicine to ensure access to best specialists in case of cancer, etc), but also includes emergency treatment at any hospital in the BCBS global network at in-network rates. The (very expensive) hospital we use in Beijing is included, as are many others (probably Bumrungrad in Bangkok, etc.). It won't cover preventative care outside your local area, but is there for emergencies.

The Premera BCBS plan does NOT include this option -- you have to look at each of the plans to see if they have the international coverage.

 

[Dreaming of Freedom]

Maybe check out something different like Liberty HealthShare?

 

[kevink]

OK a different take here from a former New Mexico (now Arizona) resident who also lived as an expat in Mexico for 3 years and also knows Thailand reasonably well.

Obviously the whole health insurance thing is more of a moving target/train wreck/Russian (or Polish?) roulette thing (how's that for tortured mixed metaphors?) now than ever before given uncertainties in Washington.

My very hazy crystal ball says that given that well over half of NM's population is on Medicaid and moset of the rest heavily dependent on subsidized ACA plans AND that it's a very "blue" state that's uniquely good at getting everything it can from the federal government it will probably be one of the better states to (nominally, in your case) reside in going forward from a health insurance perspective. Couldn't be more different than where we are in AZ, which is sure to use any "let the state decide" leeway to slash and burn any benefits it can.

As long as the current ACA situation prevails - which may not even be for the rest of this year - the key is obviously to manage your MAGI carefully so as to be eligible for a highly subsidized plan. As for coverage outside the U.S., it depends totally on exactly where you're traveling. World Nomads given your relatively young age is worthwhile doing if you're going to be anywhere you don't know the lay of the land, while in Thailand or Mexico I would certainly self-insure IF I were going to be staying in areas like Chiana Mai/BKK (or gringo-oriented places in Mexico such as Lake Chapala, San Miguel de Allende) where access to bilingual doctors at great prices is easy.

You might want to check out The Trip Insurance Store (.com) as well for travel insurance quotes but usually for us anyway the basic Nomads plans have been sufficient.

 

[BarbWire]

Thanks again, all.

I'm not particularly worried about coverage when traveling OUTSIDE the US: between travel insurance (such as World Nomads or TIN) and the coverages on my Chase Sapphire Reserve card -- as well as the much more reasonable charges for health care outside the US -- I am fine.

My concern is thinking about the situation for when I am in the US and in need of medical care for something BIG -- especially when the health insurance offerings in a given state are so limited. It is not only a matter of the quality of resources in the limited networks, but what is NOT included: for example, last year in the urban Texas county where I resided when taking care of my parents, the only HD-HSA bronze plan available was an HMO, no out of network coverage, and for the hospital that was in network, there were no emergency docs, radiologists, pathologists or anaesthesiologists on contract ... So almost by definition going to the in-network ER would rack up out-of-network charges . And even with out-of-network coverage there is the double whammy of balance billing.

Serious (but not life threatening) injury while visiting Aunt Millie in Florida? Say, falling down a flight of stairs, breaking an arm, leg and collarbone, possible concussion so ER doc orders a CAT scan and lots of sutures? All out of network ...

So let me rephrase the question, again as a financial planning question: for domestic coverage that has a very limited local network and no out-of network coverage, how does one plan? Earmark a substantial portion of assets for a medical rainy-day fund? And then relax and celebrate when finally reaching the safety of Medicare?

Again, thanks to all who have replied. As you have probably surmised, I am feeling very flummoxed over how to handle this "insurance that isn't really insurance" budgeting/planning question. This duck is simply refusing to get in the row ....

 

[Hermit]

In my very limited experience, if an HMO cannot provide an in-plan specialist, they will authorize an out-of-plan specialist. I think a discussion with a New Mexico medical insurance specialist would help a bunch.

 

[BarbWire]

Hermit -- can you recommend a Colorado health insurance agent? Colorado is my other choice of state.

I tried finding an independent health insurance broker in Santa Fe when I was there for a couple of days in November: every one I contacted was no longer doing individual plans. The return wasn't worth their time, so they were only doing home, life, auto, umbrella liability ....

 

[Hermit]

Hermit -- can you recommend a Colorado health insurance agent? Colorado is my other choice of state.

I tried finding an independent health insurance broker in Santa Fe when I was there for a couple of days in November: every one I contacted was no longer doing individual plans. The return wasn't worth their time, so they were only doing home, life, auto, umbrella liability ....

Colorado has a program called SHIP. There is a good chance New Mexico has something similar. You call them up and they will help you with your insurance questions. I'm on Medicare, so my situation is way different than yours. If you locate to a large city in Colorado, you might be OK, but DD was having problems getting signed up this year.

 

[38Chevy454]

The official site for NM healthcare (ACA) is:
beWellnm | New Mexico Health Insurance Exchange | Official Site

I will say good luck in your pursuit of plans. I don't have any idea if the NM site will help you out, I am not on ACA and currently get my ins through employer.

Also understand I can't get *out* of NM soon enough. Crime here is bad out of control, the state has serious financial problems, essentially useless and corrupt state gov't, legal system is a joke, significant poverty, need I continue? Seems all of the surveys or evaluations, NM is on the bottom of the good lists and the top of the bad lists. I would seriously reconsider moving here. Visit for sure, but I think there are better places to be your new homebase.

 

[BarbWire]

I would seriously reconsider moving here. Visit for sure, but I think there are better places to be your new homebase.

Such as?

Yes, the property crime rate in NM is rising, and I wouldn't consider living in ABQ, but Santa Fe punches most of the "musts" on my list: well educated retiree community with a strong interest in the arts and the outdoors, beautiful location, culturally interesting. And as cities go, it is little.

I will never live in a big city again. I couldn't wait to get out of Austin (and Texas) the moment my parents' house was sold.

Maybe I will start another thread on the appropriate sub-forum looking for suggestions.

Thanks!

 

[ivinsfan]

OP you haven't mentioned the other post suggesting Liberty HealthShare, have you looked at that program? Premiums are lower and it should have the advantage of knocking down all charges to an in "network and insurance adjusted rate..by that I mean Liberty will work with your providers to lower your final charges. I suggest you spend a few minutes reading about the program.

 

[Hermit]

Such as?

Yes, the property crime rate in NM is rising, and I wouldn't consider living in ABQ, but Santa Fe punches most of the "musts" on my list: well educated retiree community with a strong interest in the arts and the outdoors, beautiful location, culturally interesting. And as cities go, it is little.

I will never live in a big city again. I couldn't wait to get out of Austin (and Texas) the moment my parents' house was sold.

Maybe I will start another thread on the appropriate sub-forum looking for suggestions.

Thanks!

If ABQ has the hospital and medical facilities lacking in Santa Fe, it may work for you. They are pretty close. The issue you have presented is the desire to live in a small town environment and also have good medical facilities that are in an HMO. IMHO, that may be difficult to achieve.

If Colorado is a consideration, Boulder may work for you.

 

[BarbWire]

Thanks for the inputs.

BTW, Liberty Shares has religious requirements which are significant and, in my mind, utterly and completely disqualifying. YMMV.

 

[brewer12345]

Thanks for the inputs.

BTW, Liberty Shares has religious requirements which are significant and, in my mind, utterly and completely disqualifying. YMMV.

It also is not insurance, so no regulatory oversight, capital requirements, etc. Just mumbo-jumbo and hoping for the best.