Yet another health insurance shopper

[Martha]

WAIT! The Multi-State Plan designation is confusing and I don't think means what you think it does. It's too complicated for me to try and explain, especially since I don't fully understand all the ramifications and intentions of including them in the exchanges (I think much of it is political).

Most importantly though is that you need a plan with a large provider network across the nation (yes, this sound like multi-state but isn't necessarily). I think that typically any of the 'Blues' (Blue Cross or Blue Shield plans) will offer their full nationwide network on their plans. Do you have a non multi-state Blue plan available to you? If so, call the company offering the plan(s) and ask about their network (on the plan(s) offered) in Florida or Texas or wherever you may be going. I think you may be pleasantly surprised.

We have had a private Blue plan for the last few years and have found in-network providers in both Florida and Arizona to be plentiful. When I called the (different) Blue company offering plans on our state's exchange I was told that the network will be the same.

When I asked about Multi-State plans I was told that the only difference besides the $1 per month price difference is that the MSP doesn't offer elective abortions. That's it as far as our state is concerned.

Just FYI, the customer service rep for our states exchange was totally clueless about what an MSP is. I had to call the company offering the plans on the exchange to get any sort of answer at all. Even then I didn't get a full explanation of the MSP's purpose (a lot of Googling will get you lots of confusing stuff to read) but I did get the answer that is pertinent to today's plan choices.

Oh, and I also understand the ER services are covered under ALL ACA plans no matter where you are - but that isn't good enough as far as I'm concerned if one travel a lot.

Did look at this. It appears that the BCBS plan in Minnesota, which is not a multi state plan treats out of state providers as out of network, except for a few providers close to the border in Wisconsin, the Dakotas, and Iowa. I am having an agent double check for me.

There is a BCBS plan outside of the exchange which does in fact cover you outside of the state with the large BCBS network. But, I may be eligible for subsidies so I don't want that plan.

I have been told by agents that the multi state plans will have "network" providers throughout the US but they could be wrong. I do understand the "multi state' is not a reference to coverage but the nature of the plan and licensing issues.

 

[NoMoreJob]

Did look at this. It appears that the BCBS plan in Minnesota, which is not a multi state plan treats out of state providers as out of network, except for a few providers close to the border in Wisconsin, the Dakotas, and Iowa. I am having an agent double check for me.

I have been told by agents that the multi state plans will have "network" providers throughout the US but they could be wrong. I do understand the "multi state' is not a reference to coverage but the nature of the plan and licensing issues.

I believe your are correct that Multi-State plans will have nationwide networks. But that does not necessarily mean that non Multi-State plans will not have nationwide networks.

What I found in our state exchange was that the multi-state BC network was exactly the same as the non Multi-State BC plan's network - large and nationwide. Another company (Lifewise) in our state is owned by the same parent as the BC plan and also has a large, nationwide network on the non Multi-State plans they offer. The private plan that I've had for the last few years with another Blue plan (not offering plans on the exchange) is also nationwide.

Your broker may very well be correct about the network being restricted out-of-state, but if it were me I'd contact the BCBS company offering the plan directly and ask them. I also wouldn't assume that other non multi-state plans offered on your exchange do not have nationwide coverage - they may.

P.S. In my experience it pays to triangulate. No one - company reps, brokers and surely navigators nor forum participants - knows everything. ;-)

 

[NoMoreJob]

Navigators don't know squat. I am talking to actual agents.

Very, very true. The navigators I've spoken to just know the basics. I'm waaayyyyyy ahead of them. When I questioned a 'navigator' about Multi-State plan offerings she was completely flummoxed.

 

[M Paquette]

This is absurd.

Welcome to the current (pre-ACA) world of insurance. A few years ago in my quest for coverage, I found a great plan, with all these low prices and nice payment rates for in-network care, but... There was a page that would let me look at all the in-network providers within a specified distance on a pop-up list.

"5 Miles"... Nothing
"10 Miles"... Nada
"25 Miles"... Zip
"50 Miles"... Nope

They'd reimburse me some fraction of their (unpublished) in-network "usual and customary" price, which surprisingly enough, had no relationship whatsoever with the real world price, and would certainly not be available to me.

With this set of unknown unknowns, just try comparison shopping. This makes comparison shopping among Bronze, Silver, Gold plans look like a piece of cake.

 

[M Paquette]

Very, very true. The navigators I've spoken to just know the basics. I'm waaayyyyyy ahead of them. When I questioned a 'navigator' about Multi-State plan offerings she was completely flummoxed.

The navigators are just trained on how to get people through the health exchange signup process, online, over the phone, or by paper. They really don't get training on insurance plans beyond the generic Bronze/Silver/Gold stuff, and are prohibited from suggesting specific plans. On the flip side, agents can know all about the plans that they sell, but are prohibited from providing navigator services. Seems some folks were worried about a conflict of interest in there somewhere...

 

[Martha]

Did look at this. It appears that the BCBS plan in Minnesota, which is not a multi state plan treats out of state providers as out of network, except for a few providers close to the border in Wisconsin, the Dakotas, and Iowa. I am having an agent double check for me.

There is a BCBS plan outside of the exchange which does in fact cover you outside of the state with the large BCBS network. But, I may be eligible for subsidies so I don't want that plan.

I have been told by agents that the multi state plans will have "network" providers throughout the US but they could be wrong. I do understand the "multi state' is not a reference to coverage but the nature of the plan and licensing issues.

Your broker may very well be correct about the network being restricted out-of-state, but if it were me I'd contact the BCBS company offering the plan directly and ask them. I also wouldn't assume that other non multi-state plans offered on your exchange do not have nationwide coverage - they may.

P.S. In my experience it pays to triangulate. No one - company reps, brokers and surely navigators nor forum participants - knows everything. ;-)

The agent and MNsure was wrong. I talked to BCBS and they said despite what the MNsure site says when we are out of state we are covered under the Blue whatever it is called "network." Traveling is not a problem.

The cost of use for the silver plan is about what we pay on the risk pool but the deductible is less. The bronze plan is cheaper of course.

I think I am about done shopping for next year.

 

[Martha]

We also need multistate coverage, which is not available in Florida (our residence) but is in Illinois (our part time hang out) The MSP are all Blue Cross Blue Shield, so I spent about an hour yesterday on the phone with Florida BCBS, basically trying to get an answer to just one question:

If I have a Florida BCBS policy and am in another state and need non-emergency health care, and I use a provider in that state's BCBS network, will they charge me 1) the local BCBS in network price, 2) another price, higher than in-network but negotiated and lower than their "retail price", or 3) whatever wild random price they care to charge.

They wouldn't (or couldn't) answer, and kept on insisting that the BCBS insurers and networks are all separate entities. That BCBS combines these same entities to offer one multistate policy in some states didn't make any sense to them.

I have no doubt we all will find a way to deal with this, but will need to wait until the rush subsides. Too many new and inexperienced service reps are on the phones right now dealing with more basic issues. This may mean we have to deal with an agent.

In four years multistate coverage will be available in all states.

Michael, I emailed Florida BCBS and this is what they said in response to my inquiry about coverage when out of state:
Good Afternoon and thank you for contacting Florida Blue, your Blue Cross and Blue Shield Plan - We are here for you!

The short answer to your question is yes, we do! Our PPO network offers you “nationwide coverage” in that you can be in network in any state, so long as you visit a provider who accepts the Blue Cross and Blue Shield plan of that state. If the provider is “in network” under the Blue Cross and Blue Shield Plan of that state, it is just like you were seeing them in the state of Florida.

We offer a variety of options within all of Florida’s 67 counties for both Under 65 applicants and Medicare Beneficiaries. To provide you with more specific coverage options, we would need to get more information regarding your family demographics (gender, date of birth, smoking status, residential zip code), as well as the features and benefits you would want in your new Florida Blue plan.

My office hours and contact information are listed below, and I would be more than happy to assist you with the next step. If you would like to schedule a time to further discuss how Florida Blue can help you and your family meet your health care needs, please don’t hesitate to let me know. Share your contact information and best times to reach you (I am in the office weekdays from 8:30 am to 4:00 pm), and I will be more than happy to give you a call.

Alternatively, our agents are available to assist you daily from 8:00 am until 8:00 pm via our call center at (877) 465-1125. Feel free to call into this main number at any time, and one of our licensed agents will be more than happy to assist you. You can also visit us online at http://www.FloridaBlue.com. For questions relating specifically to Health Care Reform, more information is available at Florida Blue Health Care Reform.

Thank you for choosing Florida Blue, your Blue Cross and Blue Shield Plan. We are here for you and look forward to hearing from you soon,

 

[brewer12345]

Martha, it is really interesting to see how fulsome a response you got from BCBS. I have the luxury of waiting to shop until later (will need coverage as of Feb 1), but I have picked out a plan that looks really good. If I have questions about it, I will be calling or emailing the insurer.

 

[MichaelB]

Martha, that is amazing. I've been on the phone within them 4 times and haven't made it past "huh?". If their network in other states is still "in network" for us then there's nothing more to see, the choice is made.

Yesterday afternoon I did review their 85 plans, narrowed it down to around 30 that would apply to us, and built a spreadsheet with all the numbers. I'll call today. Thanks.

 

[KB]

The Blue Cross/Blue Shield out of area program used to be called BlueCard when I worked for Blue Shield of CA. It allowed BCBS members to use the out of state network and access their discounts and negotiated rates as if they were local in state members. They may have changed the cards since them, but the membership card had a little suitcase logo on them to show the out of area program.

Every BCBS plan had to belong to this program to retain their Blue Cross/Blue Shield membership. I still have former co-workers that work on the BlueCard program for Blue Shield of CA so I know it still exists.

 

[Jack_Pine]

Martha,

Great work. This is one of our largest issues as well (snow birding WI/FL). We don't have to buy for another year so hopefully things will settle down by then.

So am I understanding correctly that "multi-state" has nothing to do with getting coverage across the country and the thing to ask is "nation wide coverage?"

 

[MichaelB]

According to BCBS Fl telephone support, the category that allows in-network access to the Blue Cross PPO network of other states is the "BlueOption" plans. Their other choices (BlueCare, BlueSelect) are more limited, no guarantee that a provider in another state BCBS network will be considered "in".

The phone rep would not confirm that this was part of "BlueCard" but I think this is as good as it will get for now.

A multi-state plan does not refer to coverage across the states, but instead that the plan is identical in all the states where it is sold. For practical purposes this implies coverage would extend to all the networks, but I am skeptical enough to need this to be confirmed.

Blue Cross has a decent online system to get quotes, so lots can be accomplished directly with them while the Healthcare.gov works out the kinks.

 

[NoMoreJob]

According to BCBS Fl telephone support, the category that allows in-network access to the Blue Cross PPO network of other states is the "BlueOption" plans. Their other choices (BlueCare, BlueSelect) are more limited, no guarantee that a provider in another state BCBS network will be considered "in".

The phone rep would not confirm that this was part of "BlueCard" but I think this is as good as it will get for now.

I think this all (network access, plan option, plan names, etc.) is dependent on the company selling the plans. BCBS is an association of independent entities all accessing the same networks (or parts of them) so although there is commonality there are also many differences. The following quote is from the Wikipedia BCBS entry...

Blue Cross and Blue Shield insurance companies are licensees, independent of the association (and traditionally of each other), offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state. They also act as administrators of Medicare in many states or regions of the US[10] and provide coverage to state government employees as well as to the federal government employees under a nationwide option of the Federal Employee Health Benefit Plan.[11]

So what one of us finds out about their BCBS options may be different elsewhere. In my experience it's best to ask questions directly to the insurance company you may be dealing with.

 

[Martha]

I called the Minnesota BCBS and they talked about all the Minnesota plans with me and said that all of them(there are three choices in Minnesota) would cover me out of state on their PPO network.

 

[MichaelB]

I called the Minnesota BCBS and they talked about all the Minnesota plans with me and said that all of them(there are three choices in Minnesota) would cover me out of state on their PPO network.

That's one difference with Florida BCBS. We have at least 8 separate plans, and multiple combinations of copay make more than 60 options to choose from. Plans with the same coverage but different names have up to 15% variation in premium, and this is probably attributable to network design.

 

[ERhoosier]

I think this all (network access, plan option, plan names, etc.) is dependent on the company selling the plans. BCBS is an association of independent entities all accessing the same networks (or parts of them) so although there is commonality there are also many differences. .....

So what one of us finds out about their BCBS options may be different elsewhere. In my experience it's best to ask questions directly to the insurance company you may be dealing with.

Outstanding point about BCBS being an association of affiliates rather than a single entity, and that networks may vary substantially between BCBS plans even in same state/region. Since HI issues are of critical import, I would suggest that any questions be asking & answered IN WRITING.

 

[modhatter]

It appears that those on here that have inquired into BCBS MSP are PPO plans. In my state it is an HMO. In fact there are no PPO's in my state available on the exchange at all (Nevada). They appear to all be HMO. The one multi state plan we have here is the most expensive plan on the exchange by a considerable amount, but when I go on line to look at hospitals for this plan, it lists only one University Hospital, which is hard to believe. I know I have to call agent.

Are any of your BCBS Multi State Plans HMO's?

 

[hs2inparadise]

I had BCBS of California when I was pregnant and moved to Hawaii. They had something called a travel plan or something like that. It allowed me to become a 'visiting member' of BCBS in Hawaii. I filled out a form and saw doctor's here but the California insurance covered the bills. It worked out fine with a few billing glitches that required a phone call or two to fix, but I didn't get stuck with any bills.
Quite a few people live in more than one state so it's not like this issue hasn't come up before. It's so frustrating to not be able to find the person who has the right answer.

 

[nvestysly]

I'm coming to this thread rather late but it sounds like you've figured out that multi-state / nationwide is not necessary for somebody that travels periodically or even many months of the year.

MichaelB had a link to multi-state in another thread and it cleared up the issue for me.

However, this subject does bring up a related point. Individual policies purchased in 2013 and earlier generally have lower premiums, broader provider networks and better (lower) OOP amounts when compared to PPACA plans. There are the obvious problems of pre-existing conditions if that applies to your situation but it did not affect us.

When DW and I FIREd two years ago we bought an individual policy from United Health Care. There were similar policies from Humana, BCBS and others but we chose UNH since our employer plan was with them and we felt like we received good service.

In researching PPACA plans I've found the unsubsidized premiums will be approximately $200 more than we currently pay. The subsidy will be about $100 per month for our income level. Coincidentally, we currently receive a $100 per month tax deduction every year for buying our own insurance. So in my mind, trading the subsidy for the tax deduction is a wash. The PPACA plan similar to ours has a larger OOP amount and it has less network coverage. What gives? I'm paying more for less in my mind.

I say all this because it's possible to still buy individual plans on the open marketplace until the end of December 2013. My understanding is that these individual plans (if chosen wisely) can be continued for many years to come as long as the premiums are paid on time. At least that's what I've been told in the letter I received from UNH for our policy.

Consequently, individuals without pre-existing conditions, and those who qualify for little or no subsidy, might be better off buying from an agent, directly from the insurer web site, or through ehealthinsurance.com and they may end up with a broader network and lower OOP.

Yes, every situation is different. Due diligence is required.

In a year or two, after the PPACA dust settles the situation may be different. For now I'm happy to have a robust, HDHP w/HSA.