Obamacare and out of state student

[gbstack]

My daughter is currently on my Obamacare policy! She will be going to school out of state soon and I was looking at signing up for the college health insurance because of the lack of out of network care except for emergencies! I would also like to keep her on my Obamacare policy for the remainder of this year.



Do you know if this would be allowed if I’m receiving a subsidy?

 

[papadad111]

She can stay on your policy but the out of state out of network exclusions will apply.

Given her change of state status, I suspect she can qualify for a "life event" and get onto her own new state policy before year's end.

Why keep her on your policy thru year end ...just curious.

As a side bar- My son goes off to school in about a month too. In state, but we also looked at the university offered health insurance vs continuing to cover him under our non-subsidized Obama bronze plan. However we found out the university has discontinued their own cover and points students toward the healthcare.gov exchange based plans.

 

[gbstack]

She can stay on your policy but the out of state out of network exclusions will apply.

Given her change of state status, I suspect she can qualify for a "life event" and get onto her own new state policy before year's end.

Why keep her on your policy thru year end ...just curious.

As a side bar- My son goes off to school in about a month too. In state, but we also looked at the university offered health insurance vs continuing to cover him under our non-subsidized Obama bronze plan. However we found out the university has discontinued their own cover and points students toward the healthcare.gov exchange based plans.

I was keeping her on mine for the better coverage when she is home and she has very little income this year so my rates would stay low!

 

[MBSC]

(snip)...Given her change of state status, I suspect she can qualify for a "life event" and get onto her own new state policy before year's end.

It is a qualifying "life event" only if the move to college is a permanent address change. If she will not be getting a new driver's license in the new state, she may not be considered a permanent resident.

She has little income and based on information in another thread, the new state is ND so a permanent move would place her into their expanded Medicaid program.

Someone suggested a catastrophic plan. For a temporary relocation it would need to be obtained in her current state of residency. Most Cat plans are single state so it's likely to be a network similar to the current family plan.

A person can have multiple health plans, one will be considered primary and other secondary. This link is for California but should apply to other states as well. It appears to indicate that a person cannot have both student insurance and subsidies at the same time. The portion of the family plan premium allocated to the child would be eliminated from subsidy consideration but the subsidy for the parents would continue as this link explains.

You may want to research the economics of switching to a PPO or Multi-State family plan with coverage in both states in 2016.

 

[papadad111]

Snip......A person can have multiple health plans, one will be considered primary and other secondary..

You may want to research the economics of switching to a PPO or Multi-State family plan with coverage in both states in 2016.

Do such multi state plans exist via the federal exchange, or only via brokers ? Would be no different for students than,say, for those who enjoy leisure time in an RV etc... Or snowbird from the north to Florida each winter. Yet I hear most ACA policies are state specific.

 

[MBSC]

Do such multi state plans exist via the federal exchange, or only via brokers ? Would be no different for students than,say, for those who enjoy leisure time in an RV etc... Or snowbird from the north to Florida each winter. Yet I hear most ACA policies are state specific.

Exactly, a student at school in another state part of the year is like a snowbird in another state a few months. The vast majority of exchange plans are single state, but most states offer at least one multi-state plan (MSP) on the exchange but they change each year as plans come and go. The link below has a map of those states and more information. As always, review the network provider directory and drug formulary to see if the plan meets your needs.

It is especially important to check the network provider coverage on multi-state plans because some offer a broad network in the "home" state but very few network providers in other states and it's almost a shame that they can call themselves multi-state. The out-of-network coverage of a PPO plan is better in some cases.

From the FAQ tab in the link: "Some Multi-State Plan options offer in-network care outside of your service area, but not all. If you live in one State and work, go to college, or spend a lot of time in another State, carefully check the provider directories of the plans you’re considering buying. See if their networks have doctors, hospitals, and other healthcare providers in the places you’ll be."

Link: https://www.opm.gov/healthcare-insurance/multi-state-plan-program/consumer/#url=Overview

Also: Health Reform FAQs | The Henry J. Kaiser Family Foundation

If I sign up for a multi-state plan and then need to get care while I’m in a different state, can I count on being able to find in-network providers in another state?

Not necessarily. Some multi-state plans offer regional or national provider networks and will reimburse as “in-network” care rendered by providers in other states, but others may not. This information should be provided in the description of the multi-state plan’s features on your state’s health insurance Marketplace.

 

[MichaelB]

The multistate plan is not well named. It does not guarantee that the provider network covers multiple states. It does mean that the exact same plan with the exact same terms and conditions is available in multiple states. This is of interest to employers that want to offer one plan to employees in different states or locations around the country.

For the question in the OP, an insurance plan that has a broad network of providers that covers much of the university location is what is needed. Several insurers offer such PPO plans - BCBS, Aetna, Humana.

 

[bingybear]

Do such multi state plans exist via the federal exchange, or only via brokers ? Would be no different for students than,say, for those who enjoy leisure time in an RV etc... Or snowbird from the north to Florida each winter. Yet I hear most ACA policies are state specific.

I believe the plans are offered by state as that is the construct of how the ACA was formed. However, at least for the last two years, some of the plans has significant nationwide networks. I think what you are asking about is not "State specific", but the extent of the underlying network... that is can you be in network nationwide. So the answer is yes, but you have to read the details of the plans.

That said, I've noticed some plans that limit network to the local metro area... not the full state. Note emergency care must be covered nationwide. But I agree this can be somewhat limiting for people who travel.

 

[gbstack]

It is a qualifying "life event" only if the move to college is a permanent address change. If she will not be getting a new driver's license in the new state, she may not be considered a permanent resident.

She has little income and based on information in another thread, the new state is ND so a permanent move would place her into their expanded Medicaid program.

Someone suggested a catastrophic plan. For a temporary relocation it would need to be obtained in her current state of residency. Most Cat plans are single state so it's likely to be a network similar to the current family plan.

A person can have multiple health plans, one will be considered primary and other secondary. This link is for California but should apply to other states as well. It appears to indicate that a person cannot have both student insurance and subsidies at the same time. The portion of the family plan premium allocated to the child would be eliminated from subsidy consideration but the subsidy for the parents would continue as this link explains.

You may want to research the economics of switching to a PPO or Multi-State family plan with coverage in both states in 2016.

I looked at the policies available and I did not see any PPO plans or plans that offered any out of state coverage except for emergency care! I’ll have to look again!

My daughter’s college has a great on campus clinic and my current coverage has the following statement!

Members at School Outside of Their Service Area
If you require Emergency Services while you are outside your Service Area enrolled as a full-time student
at a school or college, We will provide benefits for Covered Services in a Physician’s office, clinic, or
Hospital. You should seek emergency care services just as you would at home or inside your Service
Area.a


With the above coverage I feel OK – but Is it still Risky?

 

[MichaelB]

I looked at the policies available and I did not see any PPO plans or plans that offered any out of state coverage except for emergency care! I’ll have to look again!

My daughter’s college has a great on campus clinic and my current coverage has the following statement!

Members at School Outside of Their Service Area
If you require Emergency Services while you are outside your Service Area enrolled as a full-time student
at a school or college, We will provide benefits for Covered Services in a Physician’s office, clinic, or
Hospital. You should seek emergency care services just as you would at home or inside your Service
Area.a


With the above coverage I feel OK – but Is it still Risky?

Routine coverage by the campus clinic together with emergency coverage from your policy is a decent option. I think that's about as good as it's going to get unless you drop her from your policy and let her apply on the state exchange where she studies. For that you would not be able to record her as a dependent for tax purposes, and she would probably have the same problem (no out of state coverage) when she comes to visit you during breaks and vacations.

It might help to confirm with your insurance company that she continues to be covered even if she has a mandatory school policy. That is implied but not confirmed in the paragraph you quoted.

It might also be a good idea to review with her what to do - and not to do - if she needs health care while away at school.

 

[EastWest Gal]

Why not get a catastrophic plan in the state where she will be going to college? They allow primary care visits, generally with a copayment, which is usually enough for most college kids. If she gets very sick, God forbid, she'll come home anyway. In my state they're $100-150/mo.


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[MBSC]

My daughter’s college has a great on campus clinic and my current coverage has the following statement!

Members at School Outside of Their Service Area
If you require Emergency Services while you are outside your Service Area enrolled as a full-time student at a school or college, We will provide benefits for Covered Services in a Physician’s office, clinic, or Hospital. You should seek emergency care services just as you would at home or inside your Service Area.

With the above coverage I feel OK – but Is it still Risky?

Personally, I would want to know if there is a physician on staff at the student health clinic. If not, it may not meet the family plan's definition of reimbursable clinic and she would need to seek treatment off-campus or pay out of pocket for each visit to the student clinic. Note that routine care would not be covered at college based on that clause.

If you file a claim to the family plan by mail you will need to include a statement explaining the situation in order for it to be covered. If the clinic electronically files claims, expect it to be rejected as out of network first and then you file an appeal with the explanation.

I searched my BCBS EPO plan for a similar clause and found the following that could apply to college students and snowbirds.

If you are traveling outside of the BCBSSC network service area and need treatment, BCBS will cover initial treatment of emergency and urgent care. For non-emergency care, the suitcase in the bottom right hand corner of your card means you have the BlueCard® Network. You have benefits when you are away from home, when you see a provider that participates in the network. Choose national search on the Doctor and Hospital Finder to locate a participating network provider.

Any time you will be away for at least 90 days, you can become a guest member of an affiliated BCBS health plan near your destination. Just call BCBSSC and explain your situation. We’ll find the health plan near your travel location and have you complete a guest membership application. When you arrive at your destination, all you have to do is call the number we’ve provided to contact the health plan. A customer service representative will provide you with the information you need, including a list of doctors and benefits available to you.

 

[gbstack]

Routine coverage by the campus clinic together with emergency coverage from your policy is a decent option. I think that's about as good as it's going to get unless you drop her from your policy and let her apply on the state exchange where she studies. For that you would not be able to record her as a dependent for tax purposes, and she would probably have the same problem (no out of state coverage) when she comes to visit you during breaks and vacations.

It might help to confirm with your insurance company that she continues to be covered even if she has a mandatory school policy. That is implied but not confirmed in the paragraph you quoted.

It might also be a good idea to review with her what to do - and not to do - if she needs health care while away at school.

I agree this is a decent option! My only concern is being admitted to the hospital after emergency care - not sure how or if that would be covered!

 

[MichaelB]

My only concern is being admitted to the hospital after emergency care - not sure how or if that would be covered!

That's a tough one. When it comes to health insurance it pays to be skeptical.

Is there primary coverage of hospitalization after emergency care in the University HI policy? My recollection of University health coverage for my daughters was that it did extend to the local ER and hospital but otherwise was not comprehensive. In other words, it would cover a couple of days but anything chronic or that required more extensive care was back on the family. In that case whay might help is a Medevac type policy to bring her back home, if such a policy exists.

This is a low probability scenario for 99% of students. A family policy plus the University coverage should be enough.

 

[gbstack]

That's a tough one. When it comes to health insurance it pays to be skeptical.

Is there primary coverage of hospitalization after emergency care in the University HI policy? My recollection of University health coverage for my daughters was that it did extend to the local ER and hospital but otherwise was not comprehensive. In other words, it would cover a couple of days but anything chronic or that required more extensive care was back on the family. In that case whay might help is a Medevac type policy to bring her back home, if such a policy exists.

This is a low probability scenario for 99% of students. A family policy plus the University coverage should be enough.

I did not see any hospitalization coverage from the University clinic! I may switch her in January to the University Health Plan! I'm just hoping to make it the rest of this year on our current ACA plan! I like the Medevac idea, I'll see what I can find!

 

[gbstack]

That's a tough one. When it comes to health insurance it pays to be skeptical.

Is there primary coverage of hospitalization after emergency care in the University HI policy? My recollection of University health coverage for my daughters was that it did extend to the local ER and hospital but otherwise was not comprehensive. In other words, it would cover a couple of days but anything chronic or that required more extensive care was back on the family. In that case whay might help is a Medevac type policy to bring her back home, if such a policy exists.

This is a low probability scenario for 99% of students. A family policy plus the University coverage should be enough.

I did find the following Medevac Insurance from MedjetAssit for college students! I may sign up for this after I check out the company! It may help me sleep better! Thanks for suggesting the Medevac policy!

The Collegiate U.S. 48 Membership is specially priced protection available to U.S. students based within the contiguous U.S. 48 states. This special membership was designed for academic faculty and students attending university or other accredited educational programs who are traveling or attending school more than 150 miles from home and also within the contiguous U.S. 48 states.

In the event of an inpatient hospitalization while traveling more than 150 miles from home, for educational or leisure purposes, this membership provides for hospital of choice air medical transfer to a home hospital or specialty hospital within the contiguous 48 United States. No health questions, deductibles or claim forms are required.

Individual Membership - $185.00 per year

 

[MBSC]

I agree this is a decent option! My only concern is being admitted to the hospital after emergency care - not sure how or if that would be covered!

Umm...It sounds like you think "emergency care" is only the ER and not an emergency admission. All ACA compliant plans cover emergency care services. This benefit includes emergency admission to an out-of-network (OON) hospital until the patient is stable and can be transferred to an in-network facility. The transfer is coordinated between the two hospitals and insurer and does not require a separate plan. Follow-up care after discharge, such as removing stitches, is only covered within the HMO network. Please call your plan's customer service center and they will explain what is included in OON emergency care services.

ER visits for emergency care without an emergency admission may be balanced billed if the state does not prohibit OON balance billing.

 

[gbstack]

Umm...It sounds like you think "emergency care" is only the ER and not an emergency admission. All ACA compliant plans cover emergency care services. This benefit includes emergency admission to an out-of-network (OON) hospital until the patient is stable and can be transferred to an in-network facility. The transfer is coordinated between the two hospitals and insurer and does not require a separate plan. Follow-up care after discharge, such as removing stitches, is only covered within the HMO network. Please call your plan's customer service center and they will explain what is included in OON emergency care services.

ER visits for emergency care without an emergency admission may be balanced billed if the state does not prohibit OON balance billing.

You're correct! I checked with my provider and they said if you receive emergency care you stay with the emergency services until discharge! Thanks for your help!