ACA for snowbirds?

[qwerty3656]

What are people doing when they live part of the year in another state? My situation is slightly different, I live in one state, but right on the border of another state and all of our doctors are located in the other state.

I thought I could get an exception/pre-approval for the other states doctors, but now I'm finding out that anything in the other state will be treated as out-of-network

 

[Helen]

That's so weird you posted this because I had just been thinking of this. I have Federal BCBS so I am covered throughout the US. We rainbird from the PNW to Palm Springs in the winter and I am blessed to have nationwide coverage.

Really, it is terrible that people pay into premiums year round but only have full coverage when they are within X number of miles from home.

 

[qwerty3656]

That's so weird you posted this because I had just been thinking of this. I have Federal BCBS so I am covered throughout the US. We rainbird from the PNW to Palm Springs in the winter and I am blessed to have nationwide coverage.

Really, it is terrible that people pay into premiums year round but only have full coverage when they are within X number of miles from home.

Its worse than that. I live 1/2 mile from the state border and cannot use those doctors. There are not any big cities near me on my side of the border.

 

[MichaelB]

Have you checked to see if there any plans offered in your state that have broader, nation wide networks?

 

[Aerides]

BCBS has more flexibility than most carriers (at least out of network has coverage, vs. nada), but any insurer is going to have their coverage set in your state of residence. Cross-state portability is not really a thing, unfortunately.

 

[pb4uski]

Its worse than that. I live 1/2 mile from the state border and cannot use those doctors. There are not any big cities near me on my side of the border.

That is very different from my experience.

Where we live in Vermont we are close to two major medical centers; the University of Vermont Medical School in Burlington, VT and the Dartmouth Medical School in Hanover, NH. Dartmouth is actually a tad closer to where we live.

People that I know in our area use both, and DW says that when we were on ACA that she used medical providers in both Vermont and New Hampshire.

I know that Dartmouth Hitchcock Medical Center has locations in both New Hampshire and Vermont since the main hospital is less than a mile from the Vermont border. Similarly, the UVM Medical Network whose main hospital is only a couple miles from the VT/NY border has facilities in both Vermont and New York.

I agree with Aerides... I think that BCBS has more flexibility on that score than other carriers.

 

[qwerty3656]

Have you checked to see if there any plans offered in your state that have broader, nation wide networks?

BCBS has more flexibility than most carriers (at least out of network has coverage, vs. nada), but any insurer is going to have their coverage set in your state of residence. Cross-state portability is not really a thing, unfortunately.

That is very different from my experience.

Where we live in Vermont we are close to two major medical centers; the University of Vermont Medical School in Burlington, VT and the Dartmouth Medical School in Hanover, NH. Dartmouth is actually a tad closer to where we live.

People that I know in our area use both, and DW says that when we were on ACA that she used medical providers in both Vermont and New Hampshire.

I know that Dartmouth Hitchcock Medical Center has locations in both New Hampshire and Vermont since the main hospital is less than a mile from the Vermont border. Similarly, the UVM Medical Network whose main hospital is only a couple miles from the VT/NY border has facilities in both Vermont and New York.

I agree with Aerides... I think that BCBS has more flexibility on that score than other carriers.

Really the only ACA option for me is BCBS and they are saying it has to be in-state

 

[Aerides]

Really the only ACA option for me is BCBS and they are saying it has to be in-state

In-state for In-Network yes. But their out-of-network coverage is still better than you'll find with most other carriers. I haven't heard of any ACA private plan that allows for nationwide In-Network coverage.

For example, we have an In-network deductible of $7k. And then a separate out-of for $14k. So we know our worst-case cap. If we travel, or find ourselves needing out-of-network services, our number is both deductibles. It's huge, yes, but far less than finding you need to spend days in the hospital with no coverage at all.

Most other plans don't even give you out-of-network if out of state. You are not covered at all. So if BCBS is saying your non-home medical things get covered as out-of-network, I think that's the best you'll find. Just enroll at the place you live the most.

 

[pb4uski]

Its worse than that. I live 1/2 mile from the state border and cannot use those doctors. There are not any big cities near me on my side of the border.

Really the only ACA option for me is BCBS and they are saying it has to be in-state

Sounds silly I know, but would you consider moving to the other state?

WIth respect to the title of the thread, we were snowbirds with BCBS ACA until last year and never had a problem... and we used health care services in both places.

I would call and talk with a manager because what you are being told doesn't sound right in my experience.

If you do snowbird, then if you came a resident of your snowbird state and bought an ACA policy there would it cover you in Michigan?

 

[PaunchyPirate]

There are no ACA restrictions or requirements on insurance companies to provide multi-state or National coverage. Some of the companies are simply choosing to. Some choose not to. They are not required to, and apparently, their business plan doesn’t need to offer wide coverage in order to make money.

In 2021, my only ACA options were HMOs or highly restricted EPO networks. This included BCBS. I was not covered out of state for anything but emergencies. Luckily, for 2022, for some reason, the local BCBS decided to offer a PPO (at multiple medal color levels) in my county. I now will have true out of network coverage as well as in network coverage under BCBS’s BlueCard national network. They appear to want to increase market share in the county. I’m happily paying them more than I paid their competitor in 2021 for better coverage.

Just because your local BCBC offers out of network coverage, do not assume they all do. It varies by company and location.

I don’t see this mess ending anytime soon.

 

[sengsational]

The back of my BCBS NC card says "Providers should send claims to their local BlueCross Blue Shield Plan."

I hadn't notice that text before, but as I was trying to find a world-class specialist, I called out of state and they asked about my insurance. They asked if the card said that thing about "sending to the local plan".

My ACA plan is limited network because that's all they sell. You pick from limited network medicalMega "A" or limited network medicalMega "B". Megas A and B have bought-up pretty much every practice in the city and surrounding suburbs.

But the point of this note was that the out of state provider said that they accept my insurance! I asked several people, because I couldn't believe it. So when shopping on the HC.gov site, there are zero policies that say they support a national network, including the one I have. But in practice, at least this one instance, the out of state practice would accept the insurance and would be considered in-network.

 

[conversationalphrase]

Travel insurance is the only option we've found to get medical coverage away from our home ACA network. We used World Nomads this year. Watch out for maximum trip length requirements. Many are 90 days.

Also you can used "teladoc" type services anywhere and have prescriptions mailed.

 

[littleb]

My BCBS plan under the ACA never covered out of area Dr's or hospitals even emergencies. However, after ending up in different hospitals in other cities in the past few years BC paid my claims.

I had to research the coverage and situation extensively and push my BCBS to pay the claims in network. Basically, the BCBS network is nationwide and if you look at your BCBS card and have a small suitcase on your ID card you have in network coverage in other states. (Confirm this with your local BC) We downloaded the BCBS app to our phone which provides out of area Dr's and hospitals when we travel.

I know BCBS coverage is specific to the area where you reside so they may or may not cover out of area unless emergency room only. My plan has NO out of area network coverage but my situations both times were emergencies.

 

[teej1985]

A lot of states just have really crappy ACA plans. That's just the way it goes. Consider moving somewhere with better insurance until you're 65.

 

[MichaelB]

When I was using the ACA plans Florida BSBC had an option that included their BlueCard Network, which is nation wide. The plan had a higher premium but it gave us comprehensive coverage for the half year we spent in a seasonal location.