ACA plan for snowbirds?

[jabbahop]

Starting next year, we will be splitting time between two states. Any snowbirds on ACA medical plans to cover care in both states? How did you choose which state to buy from or did you buy from Federal site?

Thanks

 

[MichaelB]

You must choose your health insurance in the location where you are a resident. Being a snowbird, you need to look for a policy that has a nation-wide network, such as BCBS BlueCard or Humana National POS.

 

[gauss]

Just speculating here, but I think if you only have one drivers license then this would likely be the state in which you purchase insurance.

Your state overall will determine if use the Federal exchange or a state run one.

-gauss

 

[W2R]

This topic is very interesting even to us non-snowbirds. I always wondered how snowbirds would deal with health insurance since they aren't in the same location all the time. Sounds like it is not much of an issue, which I didn't realize.

 

[Sunset]

Don't people who travel have the same issue, imagine visiting the grand canyon, taking a wrong step and the bill after going to the hospital for surgery/cast for a few days. All out of your network because you live in another State.

 

[sengsational]

Emergency treatment is considered in-network. But you might need to argue if it was really an emergency.

 

[MichaelB]

Typically someone on a trip will only need emergency care when away from home and can plan for their ongoing health care while at home. Most emergency care is covered across the country.

A snowbird, or anyone spending extended periods of time across different locations, may need normal (non-emergency) primary or specialized care while not at the "home location". This means the insurance coverage needs to be geographically broad.

Insurance companies design the reach of the provider networks, and these differ across the policy offerings. One way to create lower cost policies is to limit the networks. The large, nation-wide network policies offered by Aetna, BCBS, and Humana also have the highest premiums.

This applies to most private insurance in the US. Many group (especially small) and some Medicare Advantage policies also have limited networks. This is developing into a bigger issue for us ER types as the insurers pull back on their broad network offerings in the individual market.

 

[Alan]

Since retiring I've had a group PPO insurance plan with BCBS through my ex employer. Before going on long trips, including overseas, I go onto their website and select the country and cities where we will be staying and look for doctors and hospitals that are in-network, then take screen shots of the details and have them available during our trip.

Fortunately we have not needed to use any health services while traveling.

I looked at ACA plans for 2016 but there were no PPO offerings so had to use the more expensive Group plan. (I didn't look into the private insurance non ACA options)

 

[bjorn2bwild]

How did you choose which state to buy from or did you buy from Federal site?

Hopefully your legal domicile will have a multi-state PPO plan -

Domicile is an important legal term. Each person may have only one domicile at any time. “Legal residence" is often used in place of domicile. Domicile is the place where we pay taxes and conduct business. This is our true, fixed, and permanent abode and the place where, when absent from it, we intend to return. The establishment of a domicile requires meeting legal requirements of the new state and voiding of the domicile in the previous state

Full-time RVers face a similar dilemma, this resource might be helpful -

RVer Insurance Exchange

 

[MBSC]

If you do not qualify for exchange subsidies and have a spouse who also needs coverage, ask an independent agent if "two person group plans" are available in your legal residence area and if their provider network is broader.

 

[Fermion]

I guess you could call us snowbirds (seems like now we are chasing 90 degree weather everywhere we go by accident).

In our home state (where we last had a sticks and bricks home) we have a blue cross blue shield Premera ACA silver plan. The network is pretty dang broad but I will call if there is something we need on the road like an ultrasound (non emergency) to make sure it is covered. In the rare event we needed extensive long term treatment I think we would probably just turn our RV back toward Washington state to guarantee there are no issues.

We have a $250 deductible and yet have not had enough expenses this year to even meet that. This is why you retire in your mid 40s instead of 60s

Alaska will be a different beast. We may change domicile when we go up there for a couple years.

 

[brucethebroker]

We are snowbirds, and considered that when we purchased our plan 3 years ago. We schedule Dr. visits when home and have not had to use the emergency benefits out of state.

We have united health care PPO, but they are dropping our home state. Will begin shopping when new plans/rates are announced.

 

[Jack_Pine]

My understanding is this is the same issue for medicare supplement plans when you get to that point. If snow birding you need to choose a supplement with broad geographic coverage. Just something to keep in mind.

 

[MichaelB]

My understanding is this is the same issue for medicare supplement plans when you get to that point. If snow birding you need to choose a supplement with broad geographic coverage. Just something to keep in mind.

It would be an issue with Medicare Advantage, which offer networks designed by the insurers. Medicare Select Supplemental plans also will have network limitations. Traditional Medicare supplemental plans will include the same provider networks as Medicare A & B.

 

[Freedom56]

Starting next year, we will be splitting time between two states. Any snowbirds on ACA medical plans to cover care in both states? How did you choose which state to buy from or did you buy from Federal site?

Thanks

If you select a PPO plan such as from Anthem Blue Cross from your state of primary residence you are covered at any hospital in the US for emergencies. If you need to see a doctor in the state you are visiting, you can call in for pre-approval to determine which providers are in network. We bought our plan in California but we have a residence in Florida that we visit several times per year. I was told by Anthem and other insurance companies to buy a PPO and avoid HMOs although by law HMOs have to cover emergencies in other states. Anthem also covers emergencies out of country but you need to call in for pre-authorization.

 

[ctbktb]

In our case, we cancel our home policy. And, since we are moving to another State, notify the ACA/Healthcare.gov folks about our change in status. Then we select a new plan. Repeat for any and all moves, as often as necessary. (Twice per year for us, with AZ on he docket in a week)

ctbktb

 

[harley]

In our case, we cancel our home policy. And, since we are moving to another State, notify the ACA/Healthcare.gov folks about our change in status. Then we select a new plan. Repeat for any and all moves, as often as necessary. (Twice per year for us, with AZ on he docket in a week)

ctbktb

So, do you change your residence twice a year, getting new drivers licenses and all? It seems like that would be a real PITA as opposed to just picking a plan with nationwide coverage. It would also involve paying state taxes in multiple states, assuming there are income taxes. The only reason I can see to do this would be if there was a particular local plan you really liked (like Kaiser Permanente) and wanted to have it when you are in it's region, and then chose some other plan when you were out of the area so you didn't have to go through the emergency treatment process. I'm curious as to your reasoning for doing it your way.

 

[ctbktb]

Hello Harley,

We are Florida residents for the majority of a calendar year.

Our experience is the PITA factor is not great at all (notifying healthcare.gov and filing out a new app. Maybe 30 minutes all in. But I was a Navigator, so getting around in the program is easy for me). While the cost differential between a nationwide plan compared to a local plan is worth my time. Additionally, the hard work or PITA is finding the right doctor, which we have now accomplished by revisiting the States we enjoy.

ctbktb

 

[MBSC]

Effective 7/11/16, the marketplace may request documentation to support the move due to abuse by those reporting moves to gain access to health insurance. Generally, the amount applied to deductibles and OOP will not carry over from one plan to another.

HHS/CMS Final Rule: https://www.regulations.gov/document?D=CMS-2016-0070-0003

 

[45th Birthday]

We became legal residents of Florida. At the time, we split our year among three places. In our original domicile, Illinois, most broad network PPOs are no longer available. Luckily, there is much more choice in FL with BCBS. We can still get a broad network PPO at just slightly less than ridiculous prices. We now split time between two places, the other of which is not Illinois.


The hidden secret of BCBS plans (maybe others, don't know) is that even if you have a narrow PPO in your home state, the network is much broader for you if you go out of state. Since we have insurance primarily for catastrophic events, and can realistically go near either home for that care, we don't necessarily have to pay for broad coverage in FL. For example, if one of us gets cancer, we probably won't stay in FL for treatment anyway, much better medical care in Boston.

 

[pb4uski]

But wouldn't BCBS/FL expect that you have treatment for a major illness like cancer be in their network? I would think they might object if all the bills came from outside FL, especially if it is more expensive.

 

[RetireAge50]

I don't know jack but aren't people fairly healthy before age 65 so just buy healthcare from the cheapest place? Then just get physicals and such when you are in the area? If you get a major illness just move permanently back? If you break a leg or some fluke thing like that it would be covered as an emergency right (wherever you are)?

 

[Just_Steve]

But wouldn't BCBS/FL expect that you have treatment for a major illness like cancer be in their network? I would think they might object if all the bills came from outside FL, especially if it is more expensive.

Not sure about ACA plans but with my employer/retiree insurance makes exceptions for major illness such as cancer, they allowed out of network as in network coverage for cancer care provided the location had a "Centers of Excellence" designation. I could have gone to MD Anderson in Texas, Dana Farber in Boston, Sloan Kettering in NY plus a whole bunch of other top notch choices and they would have been considered in network for the treatment and followup.
This was with United Health Care and BCBS NY.

 

[MBSC]

But wouldn't BCBS/FL expect that you have treatment for a major illness like cancer be in their network? I would think they might object if all the bills came from outside FL, especially if it is more expensive.

I believe the reference is to the BlueCard national provider network, as mentioned by MichaelB in post #2.

 

[45th Birthday]

But wouldn't BCBS/FL expect that you have treatment for a major illness like cancer be in their network? I would think they might object if all the bills came from outside FL, especially if it is more expensive.

The thing is, while the network in state might be very restricted (for example the FL branches of Mayo, Cleveland Clinic, Florida Hospital Orlando are out of network), outside of FL the great hospitals are part of the network. Same thing works for physicians. In IL, my previous doc was not in network for any PPO sold by BCBS there because they are only selling individual PPOs with very restricted networks. However, I was able to go back to him for a physical with my FL plan and he was in network.