ACA and Medicaid and Traveling

[DonL]

For those on an ACA or State Medicaid health plan, does it cover you in other states when traveling (I don't really expect to ever be in my home State). If it means you have to pay and get reimbursed, that's coverage to my mind.

 

[MichaelB]

Medicaid is a State program, which means each state implements based on it's own requirements. You need to find the specific coverage details offered by your state.

To determine the coverage outside of your local area you need to look at the specific policies available to you. Try going to your state insurance marketplace, doing a query to see what plans are available, and look at the network each has. Each insurer must have web based tool that lets you look at their network of healthcare providers.

 

[DonL]

I'm hoping for real user experience.

Maybe I should go look for an RV forum.

 

[REWahoo]

I'm hoping for real user experience.

Maybe I should go look for an RV forum.

Let us know what you find out.

 

[bingybear]

Not sure about medicaid, but I think the ACA will cover emergency care in the US...beyond your own state. I think this was an ACA requirement. Non-emergency is an other matter. Not sure about outside the US in general.

 

[jim584672]

From my UHC Community Plan (Medicaid Managed Care) member book:
Sounds like they cover urgent and emergency care only in the US.

"Care Outside of the United States

If you travel outside of the United States, you can get urgent and emergency care only in the
District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands and
American Samoa. If you need medical care while in any other country (including Canada and
Mexico), you will have to pay for it, and it will not be covered by UnitedHealthcare Community Plan."

 

[ERhoosier]

I'm hoping for real user experience.

Maybe I should go look for an RV forum.

Why not go to the source rather than internet hear-say? Full-time RVers come from all 50 states, so YMMV no matter what experiences they relate. As MichaelB said, best to check directly with your state's Medicaid office.

To quote the Feds- "States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines." This below link has an outline of mandatory vs state-optional Medicaid benefits. As you can see, there are many important services that Feds do not require Medicaid to cover (prescription drugs, clinics, respiratory (breathing) care, physical therapy, etc., etc.).

Benefits | Medicaid.gov

 

[jim584672]

Each state is different, in my state in almost every county, MAGI Medicaid folks are forced to choose a Managed Care plan and fee for service is not even an option.

Another thing to remember, traditional Medicaid and MAGI Medicaid are two different groups and may have different rules.

 

[bingybear]

From my UHC Community Plan (Medicaid Managed Care) member book:
Sounds like they cover urgent and emergency care only in the US.

"Care Outside of the United States

If you travel outside of the United States, you can get urgent and emergency care only in the
District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands and
American Samoa. If you need medical care while in any other country (including Canada and
Mexico), you will have to pay for it, and it will not be covered by UnitedHealthcare Community Plan."

My plan is to buy travel insurance with medical coverage to take care of trips outside of the US in general. You really do need to shop an understand you health plans now of days.
Not all plans in the ACA are really narrowly defined by network. But you also need to be really careful how deductibles are defined. Kind of sucks, but the only choice I see is to go back to work. I hear that I am still welcome anytime I want to.... not yet.

 

[MBSC]

Not sure about medicaid, but I think the ACA will cover emergency care in the US...beyond your own state. I think this was an ACA requirement. Non-emergency is an other matter. Not sure about outside the US in general.

This is true to a certain extent with the ACA. If the medical situation meets the plans definition of emergency, you are covered for emergency admissions until such time you can be transferred to an in-network facility.

If you are able to be treated in the emergency room without admission, the plan will pay the out of network hospital a "usual and customary fee" and the patient can be balance billed the difference unless state law prohibits out of network balance billing.

 

[NoMoreJob]

We purchase a Blue Cross Blue Shield ACA plan with a national network (and pay more for it) in order to assure that we can get care wherever we happen to be in the U.S. In our experience BCBS has the largest and best network. That doesn't mean that any doctor is included but most are - it still requires checking before going and we check with both the doctor and the insurance company because it is not always made crystal clear by either.

Word of caution...there are BCBS plans with local or regional networks so this requires verification prior to purchasing the plan also.

 

[photoguy]

I'm also on Blue Shield CA ACA plan with national network (PPO). I don't remember how much more it was than alternatives but I don't recall it being significant. Wife has used it see doctors / prescriptions / flu shots in our travels around the US and we didn't have any problems.

As NMJ recommends, check the provider listing. I have read news reports that they were "inflated" but have had no personal experience with this problem.

 

[papadad111]

This is a thread from earlier this year and insurance options and travel. It was targeted discussion for those traveling beyond USA borders but may have some useful nuggets for the RV types traversing the lower 48 as well.

http://www.early-retirement.org/forums/showthread.php?t=74606

 

[Mrs.LC]

Our ACA insurance has emergency only coverage outside of their network within the US. Cross the border and you are on your own. We purchase travel insurance when leaving the country.

 

[Bamaman]

And outside of the country also includes Canada. If you're going up into Canada very far, get travel insurance.


Our Medicare Supplement has coverage worldwide. If overseas, we'd have to charge our medical costs and be reimbursed upon returning home.

 

[DonL]

So it sounds that far as an ACA plan you need to chose a provider with a large network like Blue Cross for general medical needs, otherwise you all be charged out of network for emergency issues. While I intend to retire to a boat and travel and not really have a fixed home, this all seems doable to me.

 

[bingybear]

So it sounds that far as an ACA plan you need to chose a provider with a large network like Blue Cross for general medical needs, otherwise you all be charged out of network for emergency issues. While I intend to retire to a boat and travel and not really have a fixed home, this all seems doable to me.

Be very careful with the bolded generalization. In 2014 BCBS had a very narrow network in my state and it did not extend outside the local area. They did not have a national network. In 2015 BCBS improved their network greatly. What I'm saying is read the plan closely. Don't assume because of the big name company that the plan is like what you had through an employer. Hopefully this playing around will settle down soon in the ACA.

 

[photoguy]

And outside of the country also includes Canada. If you're going up into Canada very far, get travel insurance.

My ACA PPO plan covers emergency services outside of the US. Not sure how good it is (blue card program) but it least it's available.

Also, there's really not much in Canada outside of the narrow strip that borders the US unless you are visiting tundra

 

[MRG]

.. Snip...
What I'm saying is read the plan closely. Don't assume because of the big name company that the plan is like what you had through an employer.

Spot on bingybear. We have the "Select" and "Preferred" networks in this area. Select being more affordable, the network size was much smaller. Unfortunately the search tool had some quirks of operation. If you didn't know about them you could make the mistake of assuming the networks were the same. A call straighted me out, but I let them know about the search issue.