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Switching ACA plan mid year?
Old 09-08-2018, 05:00 PM   #1
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Switching ACA plan mid year?

I am wondering if a semi-nomadic individual could switch their ACA plan everytime they moved to a new location? For example, could a retired couple that spends half the year at their northern home and the other half at their coastal home get on a new local plan when they move every 6 months (and cancel their old plan)?

This would be one way to make sure you have in network medical facilities wherever you are. Obviously this would be too burdensome if you moved around a lot, but might work if you only had to sign up for 2 plans a year (and cancel 2 plans a year). What do you think?
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Old 09-08-2018, 05:58 PM   #2
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look at the ACA moving page
It looks like you can get a special enrollment period for moving. I don't know if you would reset your deductible or not.
I'm not sure if you are talking about truly moving or travelling.
You may want to see if you can get an ACA plan with a national network. These are hard to find now of days.
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Old 09-08-2018, 06:27 PM   #3
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I don't know of anywhere I can get an ACA plan with a Nationwide network. If I knew of a place with good plans, I might move there.
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Old 09-08-2018, 10:12 PM   #4
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Since your ACA plan is part of your federal tax filing I'd think the address of issue would need to match your state of residence for tax purposes.
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Old 09-08-2018, 10:19 PM   #5
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So I would need my tax filing address and health insurance address to be the same place on December. 31st?
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Old 09-09-2018, 01:54 AM   #6
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Hmm, seems like maybe I would need to hire a CPA to make sure I don't get myself in trouble with the IRS or ACA. It kind of sucks all the crazy ideas I am having to think up just so I can work for part time, for myself, while still having decent health insurance in the US.

I wonder if you can use a PO Box for your ACA/tax return address? I would really like to become a snowbird during the winter but might not have a good permanent address.

My other options are to keep working full time for a large employer just for decent health insurance (until I hit Medicare if it is still around in the 2040's) or leave/partially retire from the US for another country with affordable healthcare.

I thought about trying to go back to college part time to get health insurance that way, but most colleges don't have decent plans anymore or they are severely restricting what type of students they will give policies to.

Are there any good options left in the US that I don't know about? Do I sound desperate?
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Old 09-09-2018, 05:53 AM   #7
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Quote:
Originally Posted by Dreaming of Freedom View Post
For example, could a retired couple that spends half the year at their northern home and the other half at their coastal home get on a new local plan when they move every 6 months (and cancel their old plan)?
Yes, as long as you can provide a document (internet activation is popular) confirming you are at the new address. The ACA 'change in primary place of living' threshold is lower than the state residency threshold. The deductible and OOP will reset to $0 met at each plan change and the start of each calendar year. While the following refers to moving for seasonal work, it applies to any seasonal move.

Quote:
Situation 3. Change in primary place of living

A seasonal worker moving to or from the place he or she lives and works

Reference: https://marketplace.cms.gov/outreach...-consumers.pdf

Submit a document to confirm your move

Bills or financial statements that show a change of address or newly started services at your new address, including:

* Mail from a financial institution or a bank statement.
* An internet, cable, phone, or other public utility (like gas or water) bill or service communication. This should show the date that your new utilities or services started.

Or, U.S. Postal Service change of address confirmation letter that includes the mail forwarding date and the address the mail will be forwarded to.

Reference: https://www.healthcare.gov/help/prove-move/
Quote:
What about people with more than one residence?

A person who has homes in more than one location is allowed to switch back and forth between QHPs in each area. HHS notes that brief trips away from one’s primary home do not count, but spending “an entire season or other long period of time” at a second residence would make the person eligible to establish residency in the second location and enroll in a new QHP while living there.

This scenario might apply to an early retiree – not yet eligible for Medicare – who lives half the year in one state, and half in another. The best option in this case might be a single plan with a nationwide network that the enrollee can maintain year-round in order to have a single out-of-pocket maximum that applies for the full year.

But such plans are not available in all areas, and enrollees might find that the plan they have in one state doesn’t offer out-of-network coverage and provides little value at their second home. The option to switch to a different plan with each move is thus valuable, although enrollees should be aware that each plan change will reset their annual out-of-pocket costs back to zero.

Reference: https://www.healthinsurance.org/spec...rigger-an-sep/
Also, see the posts from member ctbktb below.
Quote:
Originally Posted by ctbktb View Post
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)
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Originally Posted by ctbktb View Post
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.
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Originally Posted by Dreaming of Freedom View Post
I don't know of anywhere I can get an ACA plan with a Nationwide network. If I knew of a place with good plans, I might move there.
Some Florida Blue (BCBS) plans are connected to the BlueCard national provider network.
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Originally Posted by NoMoreJob View Post
Since your ACA plan is part of your federal tax filing I'd think the address of issue would need to match your state of residence for tax purposes.
This is incorrect.
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Old 09-09-2018, 05:56 AM   #8
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Quote:
Originally Posted by Dreaming of Freedom View Post
Hmm, seems like maybe I would need to hire a CPA to make sure I don't get myself in trouble with the IRS or ACA. It kind of sucks all the crazy ideas I am having to think up just so I can work for part time, for myself, while still having decent health insurance in the US.

I wonder if you can use a PO Box for your ACA/tax return address? I would really like to become a snowbird during the winter but might not have a good permanent address.

My other options are to keep working full time for a large employer just for decent health insurance (until I hit Medicare if it is still around in the 2040's) or leave/partially retire from the US for another country with affordable healthcare.

I thought about trying to go back to college part time to get health insurance that way, but most colleges don't have decent plans anymore or they are severely restricting what type of students they will give policies to.

Are there any good options left in the US that I don't know about? Do I sound desperate?
The plan to move and take out a new policy every 6 months requires you to first establish new state residency each time. That can be done, but it is difficult and you run the risk of an insurer challenging your eligibility when it comes time to pay.

Some state BCBS insurers offer policies with broad national networks (BlueCard) - I have one from Florida BCBS. The name of the policy is “Blue Options” and other BCBS around the country offer it as well, using the same name. Humana offers a policy in some states that also has a broad, national provider network.
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Old 09-09-2018, 07:14 AM   #9
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I think an important question is are you moving back and forth between your own properties?


if so, then I would say you are not moving as far as the ACA is concerned... you have two residents.... one of my sisters is doing this now but she is on Medicare....
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Old 09-09-2018, 07:23 AM   #10
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What are you trying to protect against?

If you can find a PPO plan on the ACA that may solve your issue. The last time I saw them here was a few years ago.

Maybe some snowbirds can chime in on how they deal with insurance and 2 places they live. You could also search for that. I recall some threads on that topic that I paid little attention as it is not relevant to me.

Not sure, but you may be able to use a PO box as a return mailing address, but would not think you could use it as a filing address (domicile address).

When I travel (at least internationally) I usually buy travel insurance for the trip that includes some medical coverage. I'm sure you can buy this for US travel too. If you are looking at significant travel internationally then look at geoBlue.

Make sure you understand what you are buying and what requirements must be met.

If you don't have pre-existing conditions, then you may other options.

Do you sound desperate? You sound like you want to make the ACA do something that it may not support anymore. Why don't you take a step back and define the underlying problem instead of the solution you want.
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Old 09-09-2018, 07:45 AM   #11
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Quote:
Originally Posted by NoMoreJob View Post
Since your ACA plan is part of your federal tax filing I'd think the address of issue would need to match your state of residence for tax purposes.
I moved out of state in 4rd quarter of '16 and kept my old plan. I was at max OOP and could get emergency medical care. OK for three months.

Taxes were no problem with non-matching states.
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Old 09-09-2018, 09:46 AM   #12
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Originally Posted by Texas Proud View Post
I think an important question is are you moving back and forth between your own properties?

if so, then I would say you are not moving as far as the ACA is concerned... you have two residents..
The following should provide clarification.
Quote:
What about people with more than one residence?

A person who has homes in more than one location is allowed to switch back and forth between QHPs in each area. HHS notes that brief trips away from one’s primary home do not count, but spending “an entire season or other long period of time” at a second residence would make the person eligible to enroll in a new QHP while living there.

This scenario might apply to an early retiree – not yet eligible for Medicare – who lives half the year in one state, and half in another. The best option in this case might be a single plan with a nationwide network that the enrollee can maintain year-round in order to have a single out-of-pocket maximum that applies for the full year.

But such plans are not available in all areas, and enrollees might find that the plan they have in one state doesn’t offer out-of-network coverage and provides little value at their second home. The option to switch to a different plan with each move is thus valuable, although enrollees should be aware that each plan change will reset their annual out-of-pocket costs back to zero.

Reference: https://www.healthinsurance.org/spec...rigger-an-sep/
Quote:
FAQs on the Marketplace Residency Requirement and the Special Enrollment Period

Q11. If an individual travels between homes in different Exchange services areas throughout the year, where is an individual’s residence for the purposes of Marketplace coverage?

If an individual leaves his or her primary home to visit a secondary home for a short duration, the departure will be considered a temporary absence, and the individual will remain a resident of the service area of the primary home. During that time, the individual will not have an “intent to reside” in the location of the secondary home and will not meet the Marketplace residency standard for that location.

In contrast, if an individual has two primary homes where he or she spends time for an entire season or other long period of time, then the individual may live and intend to reside in both locations. In such situations, the individual may establish Marketplace residency in both locations.

Reference: https://www.regtap.info/uploads/libr...5CR_011916.pdf
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Old 09-09-2018, 09:39 PM   #13
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Originally Posted by bingybear View Post
What are you trying to protect against?

If you can find a PPO plan on the ACA that may solve your issue. The last time I saw them here was a few years ago.

Maybe some snowbirds can chime in on how they deal with insurance and 2 places they live. You could also search for that. I recall some threads on that topic that I paid little attention as it is not relevant to me.

Not sure, but you may be able to use a PO box as a return mailing address, but would not think you could use it as a filing address (domicile address).

When I travel (at least internationally) I usually buy travel insurance for the trip that includes some medical coverage. I'm sure you can buy this for US travel too. If you are looking at significant travel internationally then look at geoBlue.

Make sure you understand what you are buying and what requirements must be met.

If you don't have pre-existing conditions, then you may other options.

Do you sound desperate? You sound like you want to make the ACA do something that it may not support anymore. Why don't you take a step back and define the underlying problem instead of the solution you want.
What I would like is a health insurance plan similar to what I have through my current employer. I would like a health insurance plan that has a decent network outside of just one hospital system, and some out of network coverage. The only options in my metro area are non-PPO plans with tiny networks and no out of network coverage at all. It is like not having any coverage at all.

If you do have to go to the ER and the ER of the only hospital in your network is on bypass, then you have to go to an out of network ER. If your insurance company is nice enough to categorize the event as life-threatening (they probably won't initially), then they might pay the hospital a small amount of the charges, and then the hospital, doctors, and labs all send you the remainder of the bill (balance billing).

If you get cancer, there may not be any specialists in your insurance network. You can literally die or at least become terminally ill waiting for the insurance company to approve an out of network specialist. I feel like I can't go visit my family 3 hours away because there are no in network medical facilities once I leave the immediate area that I live in.

I would be willing to spend $20,000/year on insurance premiums just to not be so underinsured like the current policies do. The COBRA insurance option through my employer is currently $19,500/year, but I can only stay on it for 18 months.

Or should I just give up on finding a decent health insurance solution in the US and save $1,000,000 for out of network retirement healthcare expenses (plus another $1,000,000 for insurance premiums & regular expenses)? Saving $2,000,000 just for health insurance and out of network expenses seems crazy when we only need $1,000,000 to cover the rest of our $35,000/ year living expenses.

Do most people just not realize how bad the insurance situation is now or how at risk they are for financial ruin? Not having health insurance with a good network can also be a death sentence if you cannot find an specialty onocologist who will take an out of network patient.

There must be US states with much better health insurance options than the midwestern states? Right? I am scared to ever switch jobs at this point because I don't want to lose my fairly good United Healthcare PPO health insurance.

I feel very trapped in my job forever just for health insurance unless we leave the US. I keep hoping someone will say move to so and so city/state because they currently have and will have in the future good individual policies. Florida is the only state I know of that still has BCBS policies with a nationwide network and/or some out of network coverage. I fear those policies will also be gone next year, just like what happened in the midwest.
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Old 09-10-2018, 12:51 AM   #14
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The balance billing situation possibility would bother me also. If i was in your situation I think I would consider looking at states with good balance billing laws and which currently at least have a lot of ACA options. I might even consider a state that was likely to provide an opportunity for insurance even if the ACA goes away or is modified at some point.
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Old 09-10-2018, 03:56 AM   #15
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What I would like is a health insurance plan similar to what I have through my current employer.
OK, you want to insure for everything. The year I got my pacemaker I was working for a small company. After the health insurance and the HRA I think I was out about $300 for both of us. The HRA made a high deductible plan great. It had a nation wide BCBS network. Yes the ACA network have evolved into quite limiting.

If you have to insure to the limit you claim, stay with an employer that has a cadillac plan. I some times consider going back for the insurance..... and the team I worked with.

It sounds like you have made your decision.... unless you change your requirements. So, make your choice.
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