ACA -Vs- Temporary -Vs- Defined Benefit Plan

[audreyh1]

I noticed that BCBSTX offers this option for current ACA plans which are all HMO.

THE AWAY FROM HOME CARE® PROGRAM

Access for Extended Stays (Temporarily Residing Away From Home)

BCBSTX members who have HMO plans may become guests of an affiliated HMO when they are away from home for at least 90 days. The Away From Home Care Program is ideal for members who:

Have a child attending school out of state
Have family members who live in different service areas
Have a long-term work assignment in another state
This program allows ongoing access to contracting hospitals and doctors.

If you are already a BCBSTX member, log in to Blue Access for Members to get more information about Away From Home Care. Call the customer service number on the back of your member ID card to find out where the program is available.

 

[saydiver]

I was in the health insurance business for 28+ years of my working career and have seen way too many high dollar claims to even consider 2, 3, or 4 so for us we chose #1.

Also FL Blue is one of the few insurance companies in the US to still offer a PPO plan with a nationwide network if you're traveling or living elsewhere part of the year. Their non-HMO plans are both an EPO and a PPO plan. In state they're an EPO plan and when you're out of state the plan is a PPO. Blue Options plans have a larger network in state than Blue Select plans. There's also a difference in some ancillary services between the two plans.

 

[bmcgonig]

I was in the health insurance business for 28+ years of my working career and have seen way too many high dollar claims to even consider 2, 3, or 4 so for us we chose #1.

Also FL Blue is one of the few insurance companies in the US to still offer a PPO plan with a nationwide network if you're traveling or living elsewhere part of the year. Their non-HMO plans are both an EPO and a PPO plan. In state they're an EPO plan and when you're out of state the plan is a PPO. Blue Options plans have a larger network in state than Blue Select plans. There's also a difference in some ancillary services between the two plans.

I just got a notification from Blue Shield CA stating that they will no longer cover out of state except for emergencies.

 

[Dreaming of Freedom]

This information is very useful to me. My husband is 60 and I am 42, so there may never be a time when we will both be alive, retired, and safely on Medicare. He has had 3 skin cancer surgeries in the past year, so he has pre-existing conditions.

The plan right now is for me to work at my full time job for 3.5 years until we can go on my COBRA ($20,000/yr) until he is safely in Medicare. Like most Americans, we only have small network, crappy ACA plans available to us. I will still be on my own for health insurance in 5 years though, and I am scared to death. How much is a good amount of cushion for unforseen out of network or balance billing expenses? $250,000? $500,000?

My other idea is to go back to school for another undergrad degree and go on a PPO student healthcare plan, if those are even around by then. Or maybe I can talk my husband into retiring to Mexico where we can obtain insurance for most health problems, and self insure for the pre-existing conditions.

I wonder, if one has had 2 A1c readings in the prediabetic range, but current A1c readings have been good, would they even offer me a plan? Combining Options 2&3 sound like they could work for me if I could buy the policies in the first place. I have done enough research to know that option 4 is too risky and not for me.

Thanks for all this great information!

 

[arno]

I noticed that BCBSTX offers this option for current ACA plans which are all HMO.

Audreyh1 - We were unaware of this option from BCBS. It isn’t available in every state but in our particular situation would work well based on talking to Anthem and looking at the coverage. It still may not be for everyone.

In our case what happens is that when you are “away from home” for 90-180 days you can be hosted by another BCBS plan. It is almost as if you have another plan in the other state - in fact, you have different rules/copayment/deductibles and they don’t carry over to your native plan. For example, we will have an HDHP HSA plan in our state and a relatively low out of pocket max w/10% copay on everything in the host state. Even if we hit the out of pocket max in the host state, we start from zero in our native state when we return.

In our case, this isn’t as good as the PPO we once were able to purchase but is so much better than the alternative. Thanks audreyh1!

 

[Pluperfect]

Do you have personal knowledge of STM"s denying people coverage under these circumstances? This is a big deal if there is hard evidence to back it up.

See below.

Despite showing evidence she was unaware of the cancer when she bought the policy, the insurer didn’t pay for Jones’s treatment, leaving her with a $400,000 medical bill.

But the judge sided with Golden Rule and dismissed the case in August, finding the policy agreement clearly stated that preexisting conditions wouldn’t be covered, even if the customer was unaware of the condition. Jones wasn’t diagnosed until after she bought her policy.

Reference: http://www.post-gazette.com/busines...health-plans-Trump-backs/stories/201710160252

See also: https://www.protectourcare.org/fact-sheet-short-term-junk-plans/

The case about Dawn Jones (the woman denied by Golden Rule) is much more complicated than stated in the article. She had an inconclusive mammogram which her doctor said she should check out further. Then she bought the insurance, then she found out she had cancer on the next mammogram. I’m not trying to defend the insurance company - only saying that the facts are more complicated than presented in the posted article.

Actually, she didn't know the results of the "inconclusive" mammogram when she bought her Golden Rule policy. She had requested the results from her doctor, but no report was forthcoming. She applied with Golden Rule about two months after the mammogram, and got the report a couple of weeks after that (by going in person to the doctor's office).

Also, and more important, the judge's decision was reversed on August 23, 2018. And not only reversed, but the appellate court granted summary judgment to Dawn Jones even though she didn't ask for summary judgment at either the district court level or the appellate court level--an unusual move that cut off any further fact-finding. It was strongly criticized in the dissent.

So Dawn Jones won big (assuming no further appeal). Of course, she had to spend a ton of money to get there, but this is not an example of insurance companies getting away with denying coverage based on determining cancer was already inside someone when she applied for coverage.

For one, that's not really what they did, but regardless of the details, the insurance company got slapped down hard.

The appellate decision is here:
http://media.ca11.uscourts.gov/opinions/unpub/files/201713952.pdf