Before I posted this as a separate post, I saw this thread and thought maybe this answers my questions. Does it?
Curious as to how those that are have "early retired" handle traveling outside of your ACA Health Insurance Providers Network whether domestically or internationally. As my DW and I contemplate early retirement in 2022, we notice that many, if not all, of the plan documents indicate "not covered" under the "Out of Network Provider" column. We are 58, live in MO and obviously part of plans to retire early are to travel and explore while we are still healthy and active to do so. I suppose we can supplement our coverage with a "supplemental plan" (i.e., Aflac or similar) or take out specific travel insurance to cover an unforeseen emergency or illness.). Curious as to what others do to mitigate that risk? Anyone experience an illness/or injury using an ACA plan out of network?
Well, as you’re finding out, many (but not all ACA plans) do not include out of network (and/or outside a geographic region) coverage. It’s not an ACA requirement that they do or do not. But a lot of the insurance companies have chosen not to offer that coverage. It varies greatly by geographic area what plan coverages are offered and by what insurers.
It IS an ACA requirement that plans cover true emergency care in out of network situation within the USA. You are expected to quickly get to medical help, get treated, and get out without fear of out-of-network expenses.
But it is always a gray area as to when emergency care turns into non-emergency additional care (which isn’t covered without out-of-network coverage). So one risks a back and forth battle with insurers and providers in these situations.
So, when you travel in the USA, you’re covered in a true emergency. But after that, it will depend on how lucky you are to have a good plan in your location.
Internationally, you almost certainly want to consider additional travel insurance. Domestic travel insurance isn’t all that common, but you can find it.
For the first 2 years of my early retirement, I was able to pay higher premiums to get a PPO plan that had true out of network coverage (at higher copays, deductible, coshares, etc., of course). In my 3rd year, that company went all-HMO in my location. And the only other ACA insurer didn’t offer a PPO either. 10 miles away, in another county, both of them continued to offer a full PPO. So last year, I had added risk. I just risked only having the emergency care when I traveled.
Luckily, this year, one of the insurers has again offered out of network coverage by again offering a PPO. It’s the BC/BS affiliate, and they also offer their Blue Card feature in this plan. This means that care at most hospitals around the country that take BC/BS are actually billed at in-network rates. So I’m much happier this year.
All you can do is research, research, research and supplement if you feel the need.