Silver, bronze, or catastrophic?

[Fermion]

For the past few years, because of our location, we only have access to a few providers on the health exchange. None of them have a large network and zero cover anything out of network.

We qualify, based on income projections, for a subsidized silver plan for 2020 as we have in the past, but I am trying to figure out if that is the best way to go.

Yes, our deductibles and max oop are low ($600 individual, $1200 family) but it is only valid if we visit the local hospitals and doctors.

You don't get to contribute to a HSA with these silver plans.

If you travel, they are near worthless.

I am curious what you guys have come up with, or do you just self insure for travel and keep the silver plan for longer term health issues, like major non emergency surgery or expensive drug treatments?

For example, if you are traveling on the east coast, and your health plan is on the west coast with the only in network hospitals there, what do you do for something inbetween minor and major, but is not life threatening? Do you just absorb it as a cost of travel or do you book a flight for you and your spouse back to your home state to get treatment?

 

[pb4uski]

Are you talking about traveling in the US? Our BCBS catastophic policy covers us whereever we are (but I understand that not all BCBS policies do so YMMV).

From what I have seen, if one is in good health then the premium savings of a bronze or catastrophic plan exceed what one would pay in dedcutible in a normal year... so we take our chances and go with a high deductible policy and it has worked out well... we don't use much in health care and the premiums savings are much higher than our deductible costs.

 

[Fermion]

Yes, travel in the USA, for which you can't really purchase travel insurance but sometimes it can be quite a hardship to get back to your ACA plan network.

We don't have any blue cross plans available for our area. One option would be to change our permanent address, which is pretty easy since we don't own a home. Not super easy though and it strikes me as rather drastic to keep moving around each year to find a plan with a national network.

 

[Aerides]

If traveling outside your home state, but still domestically, your plan may still have coverage to some extent, if your provider has local plans in that market. For example, while I have Florida Blue, under the overall BCBS network I can see docs if I travel. Probably not as convenient or as wide in options, but not nothing.

But if your provider is only regional, and you're completely out of their region, you might want to check if they have other partnerships. If they basically say "nope, nothing on the east coast" then...sounds like a trip home.

I'd only ever need to have travel coverage for emergencies/accidents I'm guessing.

I have a bronze HD/HSA plan.

 

[Spock]

If its not worthy of a trip to ER (which is covered by the plans), I don't go.

 

[Willers]

If its not worthy of a trip to ER (which is covered by the plans), I don't go.

Same here. I've never thought about treating anything short of an ER-worthy issue on vacation.

About what kind of conditions are you thinking?

 

[Fermion]

If its not worthy of a trip to ER (which is covered by the plans), I don't go.

So if you cut your hand on a trip and bandaged it yourself, but a couple of days later noticed some swelling and red streaks, you would:

Go to ER (where maybe it is covered if the insurance determine it was an actual emergency...if not, it might be thousands out of pocket for you)

Go to urgent care (not covered but cheaper out of pocket than ER)

Fly home ($600 round trip ticket, maybe $1200 for you and spouse, plus missing out on vacation plans)

 

[pb4uski]

I'd go to urgent care... it would probably be covered and at least at our local urgent care it would be reasonably affordable (not thousands of $$$)... if you aren't willing to take the risk then stay home.

 

[Spock]

So if you cut your hand on a trip and bandaged it yourself, but a couple of days later noticed some swelling and red streaks, you would:

Go to ER (where maybe it is covered if the insurance determine it was an actual emergency...if not, it might be thousands out of pocket for you)

Go to urgent care (not covered but cheaper out of pocket than ER)

Fly home ($600 round trip ticket, maybe $1200 for you and spouse, plus missing out on vacation plans)

Red streaks = blood poisoning. That would be covered under ER.

 

[Fermion]

What if you are a woman on vacation (say it is a 3 month trip to the Florida Keys) where you have booked a rental.

It is two weeks into the first month and you feel a small bump in your left breast.

Go to ER?

Try to make an appointment with local doctor? How many tests are you going to do before you rack up so many expenses that you feel you should have flown home to get tested?


I may just be a worry wart but as we travel around the country I think about these things.

The answer might be just to self insure and fly home for major treatments. Figure that you probably won't be out of pocket more than $5,000 or so even if you have to have a few tests run.

 

[Chuckanut]

How much do state laws affect ACA plans?

 

[Spock]

What if you are a woman on vacation (say it is a 3 month trip to the Florida Keys) where you have booked a rental.

It is two weeks into the first month and you feel a small bump in your left breast.

Go to ER?

Try to make an appointment with local doctor? How many tests are you going to do before you rack up so many expenses that you feel you should have flown home to get tested?


I may just be a worry wart but as we travel around the country I think about these things.

The answer might be just to self insure and fly home for major treatments. Figure that you probably won't be out of pocket more than $5,000 or so even if you have to have a few tests run.

To continue with the example; If it is cancer, are you going to stay "on the road" while you have it treated or return home first?? Since I'd return home to have something like that treated, I'd return home to have it checked out.

 

[pb4uski]

What if you are a woman on vacation (say it is a 3 month trip to the Florida Keys) where you have booked a rental.

It is two weeks into the first month and you feel a small bump in your left breast.

Go to ER?

Try to make an appointment with local doctor? How many tests are you going to do before you rack up so many expenses that you feel you should have flown home to get tested?


I may just be a worry wart but as we travel around the country I think about these things.

The answer might be just to self insure and fly home for major treatments. Figure that you probably won't be out of pocket more than $5,000 or so even if you have to have a few tests run.

1. Call your insurer. 2. Go to urgent care. Or perhaps the other way around.

 

[agh1]

My available ACA plans only provide narrow network coverage basically in my county. No out of network coverage except for the ER. I asked the agent what would be covered if I broke my arm in another state across the country. He said I would have to fly home before getting any treatment or pay completely out of my pocket (without the charges applying to my max out of pocket limit) as that injury would not be considered life threatening.

I am also wondering what the answer is as there seems to be no way to purchase coverage and I hate the idea of postponing all travel until I reach Medicare age.

 

[pb4uski]

I would question the answer that you were given that you need to fly home.... a broken arm is an emergency.

I’m having an emergency. Should I go straight to the hospital or do I need to call my insurer first?

In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

What does it mean that insurance companies can’t charge me more?

Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/

Sometimes you only get what you are due if you are persistent and insist on it.

 

[agh1]

I would question the answer that you were given that you need to fly home.... a broken arm is an emergency.



https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/

Sometimes you only get what you are due if you are persistent and insist on it.

He said it must be a LIFE THREATENING emergency. He also said if I had a heart attack in another state and went to the ER it would only be covered until stable in the ER. If I was admitted to the hospital that would NOT be covered at all.

 

[Fermion]

He said it must be a LIFE THREATENING emergency. He also said if I had a heart attack in another state and went to the ER it would only be covered until stable in the ER. If I was admitted to the hospital that would NOT be covered at all.

This is my understanding as well. They stabilize you but I am not even sure if the emergency room has to get you to the point where you can safely take a flight home. You might need hospital stay that is not covered and that would be thousands per day.

 

[bolt]

What if you are a woman on vacation (say it is a 3 month trip to the Florida Keys) where you have booked a rental.

It is two weeks into the first month and you feel a small bump in your left breast.

Go to ER?

Try to make an appointment with local doctor? How many tests are you going to do before you rack up so many expenses that you feel you should have flown home to get tested?


I may just be a worry wart but as we travel around the country I think about these things.


The answer might be just to self insure and fly home for major treatments. Figure that you probably won't be out of pocket more than $5,000 or so even if you have to have a few tests run.

A bump in your breast is not ER event!

You have Fishermans hospital in the mid keys on Marathon or go back to the mainland.
Or, as you mentioned you're a snowbird/tourist, you do not live there.
If its that bad just go up to MIAs Medical community,
You can certainly go home and worry wart yourself out of a vacation

Or, you can be a man about it! j/k
I'm male with numerous Lypoma's!*(fat deposits)NBDeal.

HONEST ERs like the many horrific head on auto accidents on Overseas hwy's 100mi cow path go back to MIA via. helicopter, ..unless Fishermans can handle it.
Thats costly transportation via helicopter from Fishermans.....>15k, ..CCard only.

Best wishes...

 

[agh1]

This is my understanding as well. They stabilize you but I am not even sure if the emergency room has to get you to the point where you can safely take a flight home. You might need hospital stay that is not covered and that would be thousands per day.

You are correct. Coverage is minimal. They do NOT have to stabilize you to the point that you can be transported home. They also would not pay for the medical flight to bring you home.

I confirmed by talking to 3 different Blue Cross agents who also gave the same answer. They said you could appeal the denied claims and that would be reviewed on a case by case basis. It did not sound likely that anything would be paid.

I think what we are looking for is national coverage and/or out of network coverage like we had when employed but this cannot be purchased at any price for individuals living in my county.

 

[Fermion]

You are correct. Coverage is minimal. They do NOT have to stabilize you to the point that you can be transported home. They also would not pay for the medical flight to bring you home.

I confirmed by talking to 3 different Blue Cross agents who also gave the same answer. They said you could appeal the denied claims and that would be reviewed on a case by case basis. It did not sound likely that anything would be paid.

I think what we are looking for is national coverage and/or out of network coverage like we had when employed but this cannot be purchased at any price for individuals living in my county.

The best you could do is to check yourself out of the emergency room, rent a car and drive as far as you can back home until you called for an ambulance again. I figure with 9 or 10 emergency room visits you could limp your way back to your home county with the advantage that you would really be sticking it to the insurance company.

(this is a bit tongue in cheek)

 

[agh1]

The best you could do is to check yourself out of the emergency room, rent a car and drive as far as you can back home until you called for an ambulance again. I figure with 9 or 10 emergency room visits you could limp your way back to your home county with the advantage that you would really be sticking it to the insurance company.

(this is a bit tongue in cheek)

LOL! I am the only member of my family living in my area. My closest family lives over 2,000 miles away and they are only cousins. That would be a very long, difficult journey. A cousin who is my age just had a surprise heart attack followed by quadruple bypass surgery. I would hate to speculate on the cost of having that happen at a facility where I had no insurance coverage. (Of course even after leaving the hospital 2-1/2 weeks later the cousin could not drive.)

 

[Fermion]

Yep, it is not a easy thing to solve.

I am accepting of the fact that the solution may just be to eat the costs and treat it as a life changing experience if it happens. I figure the absolute worst case would be about $50,000 out of pocket for the case you describe where I had a problem such as a heart attack while 3000 miles from home and it was not safe to fly.

I might try Uber. Wonder what happens if you request a ride from Florida to Washington with the Uber app?

 

[agh1]

Yep, it is not a easy thing to solve.

I am accepting of the fact that the solution may just be to eat the costs and treat it as a life changing experience if it happens. I figure the absolute worst case would be about $50,000 out of pocket for the case you describe where I had a problem such as a heart attack while 3000 miles from home and it was not safe to fly.

I might try Uber. Wonder what happens if you request a ride from Florida to Washington with the Uber app?

LOL! I have never tried Uber. Maybe depends on the driver?

I do not think there is any actual way currently to protect oneself from this risk. Actually even in home territory only one local hospital is in network. This is where they would likely take me if I were at home at the time. However, if I were at the mall, the grocery store, downtown, etc it is likely I would wind up at an out of network facility. Such is life. You can only do what you can do.

I suppose some could return to work for the benefits but I find the jobs offered these days are as a contractor/consultant with no insurance benefits rather than as a full time employee. And, speaking for myself, I want to stay retired so self-insurance seems to be the way to go.

 

[MichaelB]

Yep, it is not a easy thing to solve.

I am accepting of the fact that the solution may just be to eat the costs and treat it as a life changing experience if it happens. I figure the absolute worst case would be about $50,000 out of pocket for the case you describe where I had a problem such as a heart attack while 3000 miles from home and it was not safe to fly.

I might try Uber. Wonder what happens if you request a ride from Florida to Washington with the Uber app?

As already pointed out, your insurance covers emergencies across the country, so the heart attack is covered. It won’t cover getting you home for further treatment, and it may not cover your care out of network once the emergency has been treated, if you can’t grt home and need more care. Whether your policy is gold / silver / bronze doesn’t matter. The coverage is the same for all of them, they only differ un how much you pay of the total cost of health care services.

There are plans offering domestic travel medical insurance, such as this, but coverage is primarily for accidents, which you probably already have with your ACA policy.

If you can establish residency elsewhere, that’s a good option. BCBS of Florida offers policies with the BlueCard network, which spans the country.

Two more points.Uber won’t drive that route, and an uninsured heart attack in the US will cost somewhere between $100k-$500k.

 

[wompo]

I am working short term contracts (software engineer) now and have no employer health insurance for next year (using COBRA this year). I have searched everywhere for a place I can purchase a PPO plan like the one I have always had while working for a company. Does not seem to be possible. Also, looked at creating a business and getting a group plan that way, but that does not look like it will work either. I also looked at associations like the association for computing machinery that say they provide access to health insurance for members, but if you want an ACA compliant plan then they just bring up the same HMO plans that is on the state exchange. The lowest cost Anthem BC/BS HMO plan on the exchange (for me 57yo and wife 47yo) is a bronze plan for 898.00 a month (16,300 deductible and 16,300 OOP). I have no idea how the average self employed person making decent money but not a huge salary can afford these costs. For me it is not the cost of the insurance but just the fact that I cannot purchase insurance that allows me to control my heath instead of using an HMO with limited network and going thru a primary for everything. I realize that companies heavily subsidize their employees health costs but somehow the cost per month of my COBRA for a very good BC/BS PPO plan with a 4500.00 deductible this year is the same an the HMO 16,300 plan on the exchange.