off-marketplace insurance and moving states: timeline?

[BarbWire]

I can't get a consistent answer from FL-BCBS. Five calls, five CSRs, five answers....


PROBLEM STATEMENT: I have an off-marketplace HD plan from FL-BCBS. It is "Blue Select" so it is PPO anywhere in the nation -- perfect for nomads.

I plan to move my domicile from FL to TX in mid-March -- let's say March 17. This triggers a 60-day SEP for enrolling in a new plan in Texas -- or until May 15. I understand the rules to be:

* If I enroll in a new plan between March 17 and April 14, then the new start date is May 1.

* If I enroll in a new plan between April 15 and May 15 (ie, in the second half of my SEP) then the start date will be June 1.

So far so good. But what I cannot get a consistent and firm answer on is:


THE ISSUE/ QUESTION:

1) does FL-BCBS terminate my coverage at the end of the month in which I move away from FL (ie, on March 31), because I am no longer a FL resident, thus leaving me without insurance? or,

2) can I pay for FL-BCBS for April and May, even though I have changed domicile state, and thus have coverage until my new TX-based insurance begins on June 1?


THE WRINKLE:

The insurance that will begin on June 1 is Medicare (yay!) based at my Texas address. I really don't want to have to find an individual health plan for 1 or 2 months.

Help!

 

[chassis]

Have you exhaustively read your plan documents for your current coverage? You are asking about the terms (legal word) for termination (legal word) of coverage.

Search for the legal words listed above, in your plan documents.

 

[PaunchyPirate]

As chassis indicates, only your FL-BCBS company can tell you for sure (via their agents or documents).

My thinking is that the intent is that you are supposed to line up coverage in your new location to be effective on the date of your establishing your residence in the new location.

In other words, you should buy Texas insurance to start on March 17. If they won’t start it that day, then I think you should buy it from March 1st. You may need to pay for the full month of coverage in both states.

I am mostly familiar with ACA exchange plans. On the ACA, the 60-day SEP does not begin on the day you move. It actually is a 120-day period that starts 60 days prior to when you will lose coverage and extends to 60 days after you lose coverage. So you could line up your coverage change in advance of your move to be effective on March 1st. I’m assuming the same applies for off-exchange plans, but could be wrong.

Personally, I would time my “official” change of residency to be on the first of a month.

 

[BarbWire]

Thanks for the replies.

I have read the "Eligibility" and "Termination" sections of the FL BCBS policy, and they don't shed light on this as they cover eligibility to enroll (eg, legal resident of the state) and grounds for the insurance company to terminate the contract, not cancellation by me.

I contacted an insurance company in Texas and the chat rep said that a person is not eligible to apply a new policy under the SEP provision until *after* moving. And that the SEP (the period in which to apply/enroll, but not necessarily start coverage) is 60 days from the event (which is loss of coverage due to moving, not the official move? He wasn't sure).

So that still leaves me with the question of when do I lose coverage in FL after moving, and can I carry it until the new coverage in Texas begins.

Since the FL BCBS CSRs don't seem to have a clue, my next step may be to contact a licensed agent for FLBlue to see if I can get a consistent answer.

 

[MBSC]

Preferred Option: You call BCBS-FL on May 31 and tell them to cancel the policy at COB. If you have premium autopay set up, you want to log into your account AFTER the May premium payment has processed and turn off autopay so you will not be charged for June. You can temporarily add a TX mailing address to the BCBS-FL plan, if needed.

There is no problem with having the off-exchange ACA compliant PPO plan from 3/17-5/31. Since it's a BCBS-FL policy, it is connected to the BlueCard national provider network. This means any TX provider in the BCBS-TX GROUP network will be in-network if you actually spend some time there. If you switch to a BCBS-TX individual plan, you will be on a smaller provider network while in Texas.

* If I enroll in a new plan between March 17 and April 14, then the new start date is May 1.

1) does FL-BCBS terminate my coverage at the end of the month in which I move away from FL (ie, on March 31), because I am no longer a FL resident, thus leaving me without insurance?

Under this option, you call BCBS-FL on 4/29 and tell them to cancel the policy 4/30. At no time are you without coverage.

P.S. Medigap policies are cheaper in TX than FL so it's a good change from that perspective.

How does the SEP work?

You have 60 days from the date of your move to enroll in a new plan, on or off-exchange. The exchange has the option of providing coverage effective the first of the month after you enroll, or following the regular effective date guidelines. In most states, that means enrollments completed by the 15th of the month will result in coverage effective the first of the following month (as of 2022, the federally-run exchange — HealthCare.gov, which is used in 36 states as of 2021 — will no longer impose a 15th-of-the-month deadline; policies will simply take effect the first of the month after the SEP enrollment is completed).

Exchanges have the option of offering the SEP for a permanent move in advance of the move, giving people 60 days prior to the move during which they could select a health plan in the new location. This was intended to become mandatory as of January 2017, but HHS reversed course in 2016, keeping the advance access to the SEP optional at the discretion of the exchange.

Source: https://www.healthinsurance.org/special-enrollment-guide/how-your-big-move-can-trigger-an-sep/

 

[chassis]

Is the potential and unlikely lapse in coverage material? You won’t be moving to TX in the middle of a heart transplant will you?

 

[BarbWire]

Is the potential and unlikely lapse in coverage material? You won’t be moving to TX in the middle of a heart transplant will you?

Uhm, no. No heart transplant, or chemo, or dialysis, or .... thank goodness. And knock on wood.

But if I have an accident of some sort -- say, fly off my mountain bike and and have significant injuries -- a lapse in coverage is a big problem.

Having a lapse in coverage for ANY reason is a risk I find unacceptable. That's why I am trying to get this absolutely nailed down.

 

[BarbWire]

MBSC, I was hoping you would reply! Your posts on health insurance and the ACA (on and off marketplace) have helped me enormously since I first dealt with it in 2015!

Like many domestic / global nomads and ex-pats, in 2016 I moved my domicile from TX [CMRA] to FL [CMRA] for much better insurance with a FL-BCBS PPO. FL-BCBS has accepted my TX mailing address for years, and that is the address to which I will "return" for my legal domicile and Medicare/Medigap coverage.

Your "preferred option" is exactly the strategy I want to play: move domicile to TX in late March, cancel FL-BCBS effective May 31, start TX Medicare/Medigap Plan G on June 1.


My only concern is that if -- for an urgent issue -- I use my FL-BCBS policy between March 17 and May 31 and show a TX DL, FL-BCBS will deny coverage since I would obviously not be a FL resident at that point. I'll try to make sure that doesn't happen.

BTW, I found the healthinsurance.org article you cite late last night; it is very good -- much clearer on the subject that any "official" writing!


Again, MBSC, thank you so much for all of your posts over the years helping us navigate the murky waters of the ACA!