ACA, ER and relocation- logistics of it all

[Floralscent]

We are relocating to another state in mid-late 2025 and will be going from an amazing employer provided health ins plan to an ACA plan as we will be in ER.

The plan is to leave employment with 30 days of paid employer based health ins left, and since we will be relocating, any care needed during that time would be considered out of network but I figure that at least we would have coverage. I have looked at ACA plans for our likely new state/zip code and have an eye on a few plans and am grateful we will qualify for subsidy. I have a few questions and am grateful for any advice- the good, bad and ugly.

1. Does anyone have suggestions on how to handle the transition from employer based coverage to ACA without having a gap in coverage and with relocation?
2. When should I apply for ACA coverage and how long does it take for coverage to kick in once application is complete/approved?
3. Is it best to apply on the ACA website or do you find it valuable to use an agent that may be able to help with coverage selection and give possible advice on choosing a plan? Sometime involving others that may have an incentive to sell you something is not the best idea.
4. We obviously don't have a PCP in our new state yet so any tips on navigating plans without knowing what facility we will get our care from?

Is ACA coverage only valid in the area (or state?) in which you live? I am understanding it that way and it seems out of network coverage is only available in an 'emergency situation'- is that correct? We plan on traveling the US pretty extensively in ER and am wondering if anyone has advice on obtaining health ins during travel. Do people opt for travel insurance and if yes, any advice or tips would be simply amazing as I know from experience how expensive travel insurance can be.

I feel so spoiled for having amazingly priced health ins with great coverage through my employer for decades and for not even having to think about finding a good plan. As a result, I am finding the ins piece of the ER/relocation to be the most stressful part of it all. Maybe I am stressing for no reason?

Thank you-

 

[PaunchyPirate]

@Floralscent, the answer to some of these questions will differ based on the state in which you are setting up your new life. And some may vary even based upon a particular region within a state. Where are you moving to?

1. Some states have their own ACA-compliant exchange and some use the Federal healthcare.gov exchange. Some states offer some benefits above and beyond those offered by other states.

2. The coverage area of the plans will also vary by state and even within some zip codes within a state. In my location in PA, for example, I have narrow-network (geographically and provider) plans and wide, national network (geographically and provider) plans available to me. Obviously, I have to pay more for my Gold nationwide Blue Cross/Blue Shield plan than I would for the HMO plan at a regional hospital system.

3. You need to find the exact day of the month that your employer coverage will end. Some employers give till the end of your last month. Other employers end coverage on the last day of your employment.

4. You can generally apply for your upcoming ACA coverage up to 60 days in advance of your last day of coverage from the employer. This may vary in some states. I would apply at least 45 days prior to your last day of work. Coverage generally begins on the first day of a month. So if your employer coverage will end on say, the 15th of the month, you might need to look into a way to cover 15 days. Don't fret, we can help with that if needed. Just circle back if that's the case.

5. You need to apply via the appropriate ACA exchange if you intend to qualify for subsidies. That's the only way to get them. Even if the insurance company sells the same plan on their own site, you need to go via the exchange site for the subsidies to be in place.

6. Even if you choose to use with an insurance broker, they should be able to sign you up via the ACA exchange site. Make sure they do that if you go with one. Some people feel more comfortable getting some guidance from a broker. You won't pay more if you use one. However, it's possible they MAY want to steer you toward one particular insurance company for whatever reason they may want to (likely commission $). I would do your own research and ask questions here. Then you can still go to a broker for validation and the actual help in signing up. I have just always done it myself. I have found the exchange sites easy to figure out. I've used both the Federal site (before PA had their own) and then the Pennsylvania site when it went active. Both were easy enough for me. But, it's perfectly fine to go with a broker too.

7. You really should probably start your research by determining the lay of the land of healthcare options in your new location. Figure out the hospitals. Is it a bunch of independents? Is there one or more dominant insurance systems? etc. Then once you figure that out, you can start to research the individual insurance plans and see how they cover those providers. I would even try to pick a few potential PCPs or at least know what networks most of them are in (or not). This really is key to knowing which plan to pick.

8. You should do the same with your expected prescriptions, if any. You can get an idea of how much you will have to pay for prescriptions on any plan if you know the drugs you will need. All of this info is usually available via links from the plan details on the exchanges.

9. ACA plans all cover true emergency situations anywhere in the USA. But not likely internationally. However, all plans do not have to cover routine coverage outside the network of the plan. And even if you get some emergency work done out of state, that might quickly turn into non-emergency needs if you have to stay in the area for followups or even possibly for hospitalization. You just need to read the details of the available plans and find out what they will cover out of the network. Many cover a lot. Many don't. It varies wildly by geographic location.

Don't stress over it. But also don't take it lightly and don't wait until the last minute to look into this. You are correct to begin planning your strategy now. Feel free to ask more questions and we're happy to help.

For what it's worth, my ACA plan coverages have been as good or better than what I had from my employer. Not all ACA plans are bad. But in some locations, there aren't necessarily many good ones either.

 

[Aerides]

The plan is to leave employment with 30 days of paid employer based health ins left

Please be sure to double check this with your current employment insurance. A lot of folks think their policy lasts till the end of the month, but this is not always the case. With mine it ended on the last day of employment.

As a stop gap, you can look into Cobra, but you must stay on that thru the end of the year if you opt onto it. You can then enroll in the ACA during the normal open enrollment. Yes, Cobra is expensive, but so is most Unsubsidized ACA coverage, which might be the case since you will have a half a year of full-time income for 2025. Another benefit of cobra is any charges you've made towards your deductible will apply, vs. an ACA plan that will start fresh on day 1.

 

[EastWest Gal]

Another bit of information: Some ACA plans, have nation-wide network, which can help. Also, be sure the specific plan is accepted by your local hospital networks in your new location. Here in central PA, one of the Blue Cross plans was accepted by the major hospital networks, while another plan was not. Same company. So research the hospitals and doctors you'll likely be using-go to the hospital systems website and search for the insurance they accept.

You'll be either renewing or changing plans each November 1-Dec 15th after that, which gives you a change to review and change your coverage.

Once you've picked your plan, you need to pay the first premium before the end of the month that your ACA coverage begins.

 

[thod]

In my case, my last day of work was end of November, we would switch to a plan through my wife's employer in January.

We planned ahead to have no need (beyond emergency) to use any medical during December. But the backup was that you could do the Cobra a little retroactively. Basically, I could opt in for the whole month at any point in time during the month. So if a real emergency had occurred, we would have just had to pay the Cobra for that one month.

I would check with your specific plan first to see if that is possible. I am also not sure we could have done it for 2 or 3 months. Especially since invoking the Cobra would be retroactive to the beginning, I think.

 

[orchid55]

You may know this already but the ACA bases the subsidies on your income for the entire year, not just the part of the year when you need the ACA coverage. Some people have found that the amount of money they have made before they quit substantially reduces the subsidy they receive the first year they are retired.

 

[NedSaid]

@Floralscent, the answer to some of these questions will differ based on the state in which you are setting up your new life. And some may vary even based upon a particular region within a state. Where are you moving to?

1. Some states have their own ACA-compliant exchange and some use the Federal healthcare.gov exchange. Some states offer some benefits above and beyond those offered by other states.

2. The coverage area of the plans will also vary by state and even within some zip codes within a state. In my location in PA, for example, I have narrow-network (geographically and provider) plans and wide, national network (geographically and provider) plans available to me. Obviously, I have to pay more for my Gold nationwide Blue Cross/Blue Shield plan than I would for the HMO plan at a regional hospital system.

3. You need to find the exact day of the month that your employer coverage will end. Some employers give till the end of your last month. Other employers end coverage on the last day of your employment.

4. You can generally apply for your upcoming ACA coverage up to 60 days in advance of your last day of coverage from the employer. This may vary in some states. I would apply at least 45 days prior to your last day of work. Coverage generally begins on the first day of a month. So if your employer coverage will end on say, the 15th of the month, you might need to look into a way to cover 15 days. Don't fret, we can help with that if needed. Just circle back if that's the case.

5. You need to apply via the appropriate ACA exchange if you intend to qualify for subsidies. That's the only way to get them. Even if the insurance company sells the same plan on their own site, you need to go via the exchange site for the subsidies to be in place.

6. Even if you choose to use with an insurance broker, they should be able to sign you up via the ACA exchange site. Make sure they do that if you go with one. Some people feel more comfortable getting some guidance from a broker. You won't pay more if you use one. However, it's possible they MAY want to steer you toward one particular insurance company for whatever reason they may want to (likely commission $). I would do your own research and ask questions here. Then you can still go to a broker for validation and the actual help in signing up. I have just always done it myself. I have found the exchange sites easy to figure out. I've used both the Federal site (before PA had their own) and then the Pennsylvania site when it went active. Both were easy enough for me. But, it's perfectly fine to go with a broker too.

7. You really should probably start your research by determining the lay of the land of healthcare options in your new location. Figure out the hospitals. Is it a bunch of independents? Is there one or more dominant insurance systems? etc. Then once you figure that out, you can start to research the individual insurance plans and see how they cover those providers. I would even try to pick a few potential PCPs or at least know what networks most of them are in (or not). This really is key to knowing which plan to pick.

8. You should do the same with your expected prescriptions, if any. You can get an idea of how much you will have to pay for prescriptions on any plan if you know the drugs you will need. All of this info is usually available via links from the plan details on the exchanges.

9. ACA plans all cover true emergency situations anywhere in the USA. But not likely internationally. However, all plans do not have to cover routine coverage outside the network of the plan. And even if you get some emergency work done out of state, that might quickly turn into non-emergency needs if you have to stay in the area for followups or even possibly for hospitalization. You just need to read the details of the available plans and find out what they will cover out of the network. Many cover a lot. Many don't. It varies wildly by geographic location.

Don't stress over it. But also don't take it lightly and don't wait until the last minute to look into this. You are correct to begin planning your strategy now. Feel free to ask more questions and we're happy to help.

For what it's worth, my ACA plan coverages have been as good or better than what I had from my employer. Not all ACA plans are bad. But in some locations, there aren't necessarily many good ones either.

This is a great summary and pretty much sums it up, based on my experience relocating to a different state and ER'ing last year. Everything really depends on where you are moving to. Here was our experience moving to Florida:

We looked on the healthcare.gov website and also various online message boards for our area, and concluded that we wanted to get Florida Blue (BCBS) insurance. However, they have multiple networks and we got confused on what the differences were between them. They have offices throughout our new area, so after we moved we made an appointment with one of their representatives. She was very helpful, walked us through all the options and (once we selected the option we wanted) she signed up on the Marketplace right there in the office. Insurance was available for our use the first day of the following month we signed up (ie right after our prior insurance ended), since (like you) we were applying for ACA following loss of prior insurance coverage. We could have actually signed up 60 days prior to the loss of coverage, but turns out for us that wasn't needed. We signed up only a few days before the end of the month and the insurance was effective the next month (ie only a few days later).

In our case, we went with a BlueSelect plan which includes in-network access to providers outside Florida. My understanding is that this is not typical relative to other states, but in my area in Florida it was quite common. The healthcare.gov website will typically provide a doctor lookup tool for the available options, and we found plenty of doctors (both primary care and specialists) that were in network for us. We ended up finding a PCP that was part of the Orlando Health network, and have had good service so far.

Overall, I highly recommend reaching out to a health insurance broker in your new state to help you select a plan and especially to do the actual sign up on the Exchange. You don't pay extra for that service, so why not get the help if it's free? You should be able to find independent brokers that can help you, but if you already know what specific company you want to use - just do what I did and contact the brokers associated with that specific company.

Best of luck with the move - ER is great!!

 

[engineernerd]

There can be a lot of plans to choose from on a given state exchange, so start trying to understand the options early.

I think it has become important to evaluate the companies first, before delving into the plan details.
Last year I was tempted to switch to the lowest-premium plan - until I looked at the offering company's Google reviews. OMG were they awful. Pre-approval hell.

Also know that hospitals in particular charge astronomical prices* these days, so pay attention to the out-of-pocket maximum.

* - for example, $93,000 for 2 nights in a hospital room and < 1 hour in the OR, not including the surgeon's fee and such (which paled by comparison). The insurance company didn't pay THAT much, it went into No Surprises Act negotiations and I don't know how it ended, but I feel certain it wasn't less than the plan out-of-pocket maximum.

BTW, I am not really surprised that this year some of the Silver plans are cheaper than the Bronze plan I chose. Those Silver plans have lower deductibles but - here's the key - higher out-of-pocket maximums than my plan. Unfortunately, ACA subsidies are based on the second-lowest Silver plan premium in your area.

 

[FlaGator]

Have looked at the possibility and cost of COBRA coverage? You may be eligible.

https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-coverage.pdf