Healthcare Options Living in 2 States

[TreyLagger]

My head is about to explode after spending several hours on the phone with people from the exchange, a local "expert", and our current provider. No-one was able to provide assistance for what I think is a somewhat common issue:

We have 2 residences - 1 in Indiana (summer home) and 1 in South Carolina (winter home). The SC home was recently purchased and we're planning on becoming SC residents due to high property taxes for non-residents.

However, we want to continue seeing all of our doctors in IN. We have to update our ACA info showing the new residency, which then makes our preferred doctors out-of-network. We are both under 65 (63 and 57).

For those that maintain 2 residences, how do you handle this? I found the following article https://www.verywellhealth.com/health-insurance-for-multiple-states-4584359 that states:

"If you split your time between your summer home and your winter home, you have the option to establish residency in either state or both."

"You can opt instead to establish residency in both states and buy a new health insurance plan each time you move from one house to another. This would ensure that you always have a plan with an adequate provider network in the area where you're currently living.

The United States Department of Health and Human Services (HHS) has clarified that your move counts as a "permanent move" because you intend to reside in the area for at least "an entire season or other long period of time."

Very interested in learning how others have handled this - thanks in advance!

 

[MichaelB]

When we had an ACA policy we chose one from BCBS that had a “BlueCard” nationwide network, so we were able to get healthcare all around the country.

 

[TreyLagger]

When we had an ACA policy we chose one from BCBS that had a “BlueCard” nationwide network, so we were able to get healthcare all around the country.

Thanks Michael. Did you still qualify for a subsidy with that plan?

 

[MichaelB]

Thanks Michael. Did you still qualify for a subsidy with that plan?

We were not eligible for subsidy regardless of the plan. Not all states have PPO plans with expanded networks. Many of the BCBS PPO plans do have this feature, however.

Here’s a thread that has a bit more info on this https://www.early-retirement.org/forums/f38/extended-travel-with-aca-102292.html

 

[Bamaman]

Check into BCBS Anthem. I think it may be a nationwide program.

We have United Healthcare Medicare Plan F, and we live 5 miles from the state line. We have no problem going to hospitals or doctors in both states.

 

[PaunchyPirate]

Thanks Michael. Did you still qualify for a subsidy with that plan?

Whether you qualify for a subsidy is independent of the Blue Card option on SOME BCBS offerings.

The regional BCBS companies simply don’t all offer Blue Card in all markets. They also don’t offer it in all plans they offer in a market. And there can be different levels of coverage with the Blue Card.

In my location, some of the BCBS plans offer the Blue Card feature, but others do not. And in the fine print, you will find that only the higher end PPO plans cover routine care at in-network prices. The lower end plans with Blue Card will cover emergency issues at in-network prices, but not routine care. Blue Card was only introduced to plans in my location in 2022. But I’m happy to see it remains for 2023.

I choose to pay for the high end PPO plan to get this higher level of Blue Card coverage when I travel domestically. I also qualify for an ACA subsidy.

 

[TreyLagger]

Thanks all for the replies and advice!

I'm curious if we can simply change residency every 6 months so we're in network at both locations. Really only matters for IN as those are the drs. we want to see.

A 2016 DHHS document seems to suggest we can: "FAQs on the Marketplace Residency Requirement and the Special Enrollment Period due to a Permanent Move".

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.

 

[Pluperfect]

I'm curious if we can simply change residency every 6 months so we're in network at both locations. Really only matters for IN as those are the drs. we want to see.

I've spent way too many hours of my life diving deep into health insurance for people who don't stay in one location all the time. Here's the link for the 2016 DHHS document you quoted from:

https://regtap.cms.gov/uploads/library/ENR_FAQ_ResidencyPermanentMove_SEP_5CR_011916.pdf

It clearly says you can do just what you're suggesting--have a South Carolina policy when you're in South Carolina, and change to an Indiana policy when you go to Indiana, and change back to a South Carolina policy when you go back to South Carolina, etc.

One problem with this, however, is that your deductible and out-of-pocket maximum will reset each time you change, as well as on January 1 of each year. Then again, each time these get reset, you would get a new batch of low-copay doctor visits if your policy provides those. Regardless, you will have to be aware of timing issues to avoid double coverage or lapses in coverage as you change. That's not ideal, but it's a way to insure against financial ruin due to medical bills.

One way around this would be to buy a policy in Indiana and keep it year-round.

South Carolina is going to become your domicile. For most people, domicile and residence are the same thing, but not for you--for part of the year, you will be domiciled in South Carolina and residing in South Carolina, and for the other part of the year you'll be domiciled in South Carolina and residing in Indiana. And your residence is what matters for health insurance.

The ACA allows you to pick either of your two residences to base your health insurance on. Unfortunately, as far as I can tell, neither Indiana nor South Carolina has Anthem/Blue Cross PPO policies that include Blue Card access to a nationwide network of providers for routine (non-emergency) care, so if you keep an Indiana Anthem/Blue Cross policy year-round, or any other policy that doesn't have any in-network providers in South Carolina, you'll be insured only for ER visits while you're there. That's obviously not ideal.

However, there's may be another possibility--Ambetter. Your first step would be to use their provider finder to see if your doctors are in their network. Go here, and pick Indiana as your state:

https://guide.ambetterhealth.com/#homestate-1

And then select the year 2023, and Bronze | Silver | Gold 2023 as the network, if there is more than one choice. Ambetter describes this as their "broadest network offering of health care providers and hospitals."

See if it includes your providers. If it does, then that policy would work for you in Indiana and it might work for you in South Carolina, as well. A while back I did some testing of their provider network and used a Florida policy to look for in-network hospitals in Houston, and there were 44 of them. That indicates that Ambetter might indeed provide in-network coverage in states other than the one in which a policy was purchased, and it could be that the Bronze | Silver | Gold 2023 network applies to all policies that have that network. I just don't know. (Ambetter doesn't offer insurance in every state, but it does in the two that matter to you.)

If the Ambetter network for an Indiana policy does include your Indiana providers, then change your search to look for providers in the zip code you live in in South Carolina, to see if the network has a presence there.

If it does, then do the reverse--use South Carolina as the state, and see if your Indiana providers are in network for the South Carolina Bronze | Silver | Gold 2023 network. I suggest this only because while I have no doubt the ACA allows you to buy health insurance based on your Indiana residence, it would be "cleaner" to use your South Carolina residence, where you'll presumably have the various indicia of domicile and just add your health insurance to the mix. But the ACA does let you buy a policy in Indiana.

If your Indiana providers are in network for both an Indiana Ambetter policy and a South Carolina Ambetter policy, and there are network providers available in South Carolina, you can then decide whether to buy it in Indiana or South Carolina. South Carolina will be your domicile (which is what fulltime RV travelers do--get insurance based on their domicile), but you might be more comfortable having an Indiana policy because then you'll be using "local" providers. Or that might not even matter.

Whatever you do, you should call Ambetter to verify the results you're getting from using their online provider locator. The trick there will be that they probably won't understand what you're doing (you'll be in the position I usually am when I call customer service--I almost always know more than they do), so you'll have to guide the conversation.

Maybe you could ask a general question about their Bronze | Silver | Gold 2023 network, and whether it's as broad as it appears from using their provider locator, without getting into specifics about your situation, and seeing where it goes.

The bottom line is that you can do what you said--change policies to match where you're currently residing--but it's not ideal because of the resetting deductible and out-of-pocket limit, plus the hassle factor. The usual option for people who are in more than one location, Blue Cross, isn't available to you. But you might be able to get something similar from Ambetter.

 

[Echard]

I've spent way too many hours of my life diving deep into health insurance for people who don't stay in one location all the time. Here's the link for the 2016 DHHS document you quoted from:

https://regtap.cms.gov/uploads/library/ENR_FAQ_ResidencyPermanentMove_SEP_5CR_011916.pdf

It clearly says you can do just what you're suggesting--have a South Carolina policy when you're in South Carolina, and change to an Indiana policy when you go to Indiana, and change back to a South Carolina policy when you go back to South Carolina, etc.

One problem with this, however, is that your deductible and out-of-pocket maximum will reset each time you change, as well as on January 1 of each year. Then again, each time these get reset, you would get a new batch of low-copay doctor visits if your policy provides those. Regardless, you will have to be aware of timing issues to avoid double coverage or lapses in coverage as you change. That's not ideal, but it's a way to insure against financial ruin due to medical bills.

One way around this would be to buy a policy in Indiana and keep it year-round.

South Carolina is going to become your domicile. For most people, domicile and residence are the same thing, but not for you--for part of the year, you will be domiciled in South Carolina and residing in South Carolina, and for the other part of the year you'll be domiciled in South Carolina and residing in Indiana. And your residence is what matters for health insurance.

The ACA allows you to pick either of your two residences to base your health insurance on. Unfortunately, as far as I can tell, neither Indiana nor South Carolina has Anthem/Blue Cross PPO policies that include Blue Card access to a nationwide network of providers for routine (non-emergency) care, so if you keep an Indiana Anthem/Blue Cross policy year-round, or any other policy that doesn't have any in-network providers in South Carolina, you'll be insured only for ER visits while you're there. That's obviously not ideal.

However, there's may be another possibility--Ambetter. Your first step would be to use their provider finder to see if your doctors are in their network. Go here, and pick Indiana as your state:

https://guide.ambetterhealth.com/#homestate-1

And then select the year 2023, and Bronze | Silver | Gold 2023 as the network, if there is more than one choice. Ambetter describes this as their "broadest network offering of health care providers and hospitals."

See if it includes your providers. If it does, then that policy would work for you in Indiana and it might work for you in South Carolina, as well. A while back I did some testing of their provider network and used a Florida policy to look for in-network hospitals in Houston, and there were 44 of them. That indicates that Ambetter might indeed provide in-network coverage in states other than the one in which a policy was purchased, and it could be that the Bronze | Silver | Gold 2023 network applies to all policies that have that network. I just don't know. (Ambetter doesn't offer insurance in every state, but it does in the two that matter to you.)

If the Ambetter network for an Indiana policy does include your Indiana providers, then change your search to look for providers in the zip code you live in in South Carolina, to see if the network has a presence there.

If it does, then do the reverse--use South Carolina as the state, and see if your Indiana providers are in network for the South Carolina Bronze | Silver | Gold 2023 network. I suggest this only because while I have no doubt the ACA allows you to buy health insurance based on your Indiana residence, it would be "cleaner" to use your South Carolina residence, where you'll presumably have the various indicia of domicile and just add your health insurance to the mix. But the ACA does let you buy a policy in Indiana.

If your Indiana providers are in network for both an Indiana Ambetter policy and a South Carolina Ambetter policy, and there are network providers available in South Carolina, you can then decide whether to buy it in Indiana or South Carolina. South Carolina will be your domicile (which is what fulltime RV travelers do--get insurance based on their domicile), but you might be more comfortable having an Indiana policy because then you'll be using "local" providers. Or that might not even matter.

Whatever you do, you should call Ambetter to verify the results you're getting from using their online provider locator. The trick there will be that they probably won't understand what you're doing (you'll be in the position I usually am when I call customer service--I almost always know more than they do), so you'll have to guide the conversation.

Maybe you could ask a general question about their Bronze | Silver | Gold 2023 network, and whether it's as broad as it appears from using their provider locator, without getting into specifics about your situation, and seeing where it goes.

The bottom line is that you can do what you said--change policies to match where you're currently residing--but it's not ideal because of the resetting deductible and out-of-pocket limit, plus the hassle factor. The usual option for people who are in more than one location, Blue Cross, isn't available to you. But you might be able to get something similar from Ambetter.

We have the problem that in Texas no PPO's are offered. So we need a PPO that will support mostly Texas doctors. Could we find a state with the Blue Cross PPO and then use it for Texas doctors? Our main house has to remain Texas because of property taxes. Otherwise we lose a massive tax break. COuld we buy a place in another state, and use Blue Cross PPO with nationwide coverage?