Need specific suggestions on insurance for ACA person for snowbirding

[NXR7]

My wife will transition to ACA in December due to the loss of COBRA coverage. We typically spend about four and a half months in a warmer climate and the NE Ohio ACA plans are all local HMO's only.

So she will need some kind of travel insurance or similar for health care coverage for a US resident spending the winter in the US. If you know of a company that provides this type of insurance please post your suggestion. She (currently) has no significant health problems and she went the first eight months without spending a dime of her deductible but life happens.

I guess she will need to pay for ACA at the same time but whatev.

Thanks,

Ray

 

[bearkeley]

Check with your provider. We have a local HMO through Anthem in Va but they allow us to have coverage on a temporary basis in Florida. If you snowbird out of the country, GEOBlue plans are awesome!

 

[NXR7]

Check with your provider. We have a local HMO through Anthem in Va but they allow us to have coverage on a temporary basis in Florida. If you snowbird out of the country, GEOBlue plans are awesome!

Thanks. It appears we may have an option. OSCAR is one of the choices and our insurance broker told us it was only good up here but from www.hioscar.com they do have facilities in Florida. Most are around Orlando, which is some hours from where we will be but may be good enough for a on-emergency.

Your suggestion to ask is what made me decide to look closer.

Ray

 

[SecondCor521]

You may look into seeing if you can switch your ACA coverage twice a year - so be on an Ohio plan for 8 months of the year and a FL (guessing) plan for 4 months of the year.

This would require a special enrollment period twice a year unless your travels happened to line up with annual enrollment, in which case it might require a special enrollment period once a year.

You can qualify for a special enrollment period under a number of circumstances, one of which is moving.

https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/ scroll down to Changes in Residence about halfway down the page.

 

[MBSC]

Here is an article on snowbirds changing ACA residency: https://www.verywellhealth.com/health-insurance-for-multiple-states-4584359

A majority of BCBS EPO/HMO plans participate in the "Away From Home" program for snowbirds/students. You become a temporary member of the other BCBS company without going through the ACA Marketplace to make the change.

Please note: There are 19 states, in addition to Puerto Rico, that do not participate in this program: Alabama, Alaska, Idaho, Iowa, Kansas, Mississippi, Montana, Nebraska, North Dakota, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia and Wyoming. States that are covered are not always covered statewide, and some areas of a covered state may not be available.

Reference: https://www11.anthem.com/provider/va/f5/s1/t0/pw_e234927.pdf?refer=ahpemployer

The BCBS EPO plans in my state do not participate in the program and are connected to the BlueCard national provider network for life-threatening emergencies only. Tele-visits are always in-network regardless of location. For other non-emergencies, I pay the greatly reduced local BCBS negotiated rate instead of the billed charge.

[From my plan]: With our individual plans, your providers are in a local network and you don’t have out-of-network coverage except in emergency situations.

TIP: If you need non-emergent care while away from your network, look for providers that are in the local Blue Cross or Blue Shield network. You will have to pay the entire bill, but it usually is at the Blue discounted rate. [99% of hospitals and 86% of physicians nationwide are in-network.]

BlueCard out-of-area: Urgent/Emergency Care Only

Regarding travel insurance, AIG Travelguard is popular. You can set the destination to USA and trip cost to $1 to just have $50k (Preferred Plan) or $100k (Deluxe Plan) medical coverage. If the destination state is Florida, be aware they have regulations preventing balance billing by medical providers but it only applies to major medical plans, not travel insurance or indemnity plans.

 

[MrsHaloFIRE]

What about travel insurance. Can buy fir your trip length it an annual policy. Good anytime 100 miles away from home. Some exclusions of course

 

[PaunchyPirate]

Also, be aware that if you're not of an income that qualifies for ACA subsidized premiums, you do not have to purchase your insurance on the ACA Healthcare.gov exchange. You can purchase directly from an insurance company. In my county, the policies purchased directly from the insurance company often have more robust networks.

However, if you're looking to reduce premium costs via the ACA subsidy, then you need to purchase through the ACA exchange for your state.

 

[NXR7]

Thanks, folks. Unfortunately BCBS offers no plans in this area. I looked over the special enrollment period criteria and she will qualify but just to get ACA coverage for December of this year. (She is five years younger than me, which is why I am not affected.)

Since she is pre-Medicare, obviously, she probably can get a stipend to help offset the cost of an ACA plan from her state firefighter pension plan so we're trying to go ACA. Until a year ago she would have been fully covered anywhere but the state pension plan had to change their pre-Medicare health plan due to the costs threatening to bankrupt the pension plan in less than ten years. Just a few years ago the pension plan had 30 years of assets on hand.

Yes, travel insurance is an option and that actually was a specific recommendation we were hoping for.

As an aside, we have new friends from Canada. They're in their 60's and had no idea what a "deductible" or "co-pay" was. They were appalled, especially when they heard what the COBRA cost was. And then they did the conversion into Canadian dollars.

 

[MrsHaloFIRE]

Search on this site for travel insurance and people have discussed options before. COVID will probably be an exclusion

 

[conversationalphrase]

With regard to travel insurance be sure to read the policy definition of "trip", some are 90 days maximum away from home.

 

[Scusan]

DGF has similar issue. She looked at what she might use the insurance for:

Routine Medical care: Do this in home state.

Serious medical condition (cancer, etc): Return to home state for care.

Injury/accident: This is probably the most probable use of medical insurance in our case. Her ACA policy covers life threatening emergencies while away from home (heart attack for example). The more likely event would be something like falling off a bike and breaking an arm. She mitigated her exposure here by purchasing a separate accident policy that has a limit of 25,000 or something similar.

That's still an imperfect solution, I realize. Example-- last winter, we tried to figure out how to handle it if one of us got sick (with Covid). The best answer we could come up with was to socially distance (more like isolate..) and if either one of us started to get seriously ill, head for home where she has coverage.

I think the Canadians we met down there carried some kind of extra policy, perhaps someone has information.

 

[MBSC]

Injury/accident: This is probably the most probable use of medical insurance in our case. Her ACA policy covers life threatening emergencies while away from home (heart attack for example).

Correct, but most ACA plans only cover emergency services in this situation. If the heart attack patient is admitted from the ER, it is outside the ACA requirement. Only a few ACA plans cover inpatient admissions from the ER so each snowbird should read their plan documents or call the plan for verification.

A bill was introduced in 2019 to correct this flaw in the ACA but it has gone nowhere.

(f) Coverage of out-of-network services for enrollees admitted after emergency services.—

(1) PROTECTION FOR ENROLLEES ADMITTED TO THE HOSPITAL FOR EMERGENCY SERVICES PRIOR TO STABILIZATION.—In the case of an enrollee in a group health plan or group or individual health insurance coverage who receives emergency services, or maternal care for a woman in labor, in the emergency department of an out-of-network facility and has not been stabilized (within the meaning of subsection (b)(2)(C)), if the patient is subsequently admitted to the out-of-network facility for care, the cost-sharing requirement (expressed as a copayment amount, coinsurance rate, or deductible) with respect to any out-of-network services provided to the enrollee prior to being stable and in a condition to receive information under (2), is the same requirement that would apply as under subsection (b)(2)(C)(ii)(II).

S.1895 - Lower Health Care Costs Act: https://www.congress.gov/bill/116th...5/text#toc-id1F65E74469274E52BB9B1F7BA174F5E1

 

[Splash]

WPS is a new ACA insurer in my area for 2021. Reading through the details of their plan offerings, I was stunned to find their POS plans offer in-network access to a number of providers across the US via First Health Network.

We've been on ACA for 4 years and this is the first time we've had an offering with coverage outside of WI. The policy will cost the two of us about $3000 more for the year but the peace of mind is worth it for these snowbirds. I'm not sure where WPS is all offered, but check the plan details if you have it available to you.