Any Health Insurance Plans that are not limited to a small region?

kite_rider

Recycles dryer sheets
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Apr 4, 2013
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So I've been FIRE'd for over 10 years and have enjoyed a slightly subsidized ACA plan by keeping my MAGI under the 400% of the FPL. But things have changed.. kids have moved on so the family size is smaller (making the 400% FPL harder to maintain) and with a booming stock market I'll be doing some portfolio rebalancing that will for sure knock us over the 400% FPL cliff.

Now that I'm domiciled in south Texas I assume I should only buy ACA plans from the Texas marketplace (someone please let me know what the rules are about this - if there are any..). These plans don't seem to be as nice as the plan I had in Oregon. The biggest issue for me is that they are all HMO's with a pretty narrow 'in network' service area. Retirement allows me to travel all over and if something bad happens to me or DW, I don't necessarily want to be stuck here getting care in the middle of a crazy hot summer.

So even though I appreciate the protections that an ACA plan would provide; the sky-high unsubsidized cost and limited service network has me shopping for alternatives. Ideally, a 'catastrophic' sort of plan that would protect against a terrible accident or a sudden expensive illness that wasn't very expensive would be perfect. Note; we have no pre-existing conditions and use very little health care in a typical year. Anyone else have a plan like this that they LOVE? Thanks
 
So I've been FIRE'd for over 10 years and have enjoyed a slightly subsidized ACA plan by keeping my MAGI under the 400% of the FPL. But things have changed.. kids have moved on so the family size is smaller (making the 400% FPL harder to maintain) and with a booming stock market I'll be doing some portfolio rebalancing that will for sure knock us over the 400% FPL cliff.

Now that I'm domiciled in south Texas I assume I should only buy ACA plans from the Texas marketplace (someone please let me know what the rules are about this - if there are any..). These plans don't seem to be as nice as the plan I had in Oregon. The biggest issue for me is that they are all HMO's with a pretty narrow 'in network' service area. Retirement allows me to travel all over and if something bad happens to me or DW, I don't necessarily want to be stuck here getting care in the middle of a crazy hot summer.

So even though I appreciate the protections that an ACA plan would provide; the sky-high unsubsidized cost and limited service network has me shopping for alternatives. Ideally, a 'catastrophic' sort of plan that would protect against a terrible accident or a sudden expensive illness that wasn't very expensive would be perfect. Note; we have no pre-existing conditions and use very little health care in a typical year. Anyone else have a plan like this that they LOVE? Thanks
There is no Texas marketplace, you have to use Federal if you expect to get subsidies. Otherwise if no subsidy you can research plans and buy the ACA plan directly from the insurer which is what we did before Medicare.

Yes, all HMOs even though I had a Bronze HMO+ plan from BCBS and fortunately the BCBSTX extensive network was still available and all my doctors were in it. So I didn’t have issues other than requiring referrals from my PCP.
 
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Oregonian to Cal person here. We've stayed with Kaiser Permanente, which really limits us for health care if we are looking for six months one place and six another. Some friends who ping pong all over the states - Cal, NV, Ore, TN - use Blue/Blue Shield. They are pretty savvy ex-school system administrators.
 
I'd say you're lucky to have Kaiser - especially if you have coverage in both Oregon and Cal on the same plan. I have 'Regence BC/BS' which is the closest thing to 'BC/BS' that you can get in Central Oregon. There is a BC/BS down here in S Texas, but NO overlapping coverage at all with my Regence plan. Seems like lots of people go from state to state over the year, not sure what they do (except for the Medicare crowd who probably doesn't know how good they've got it..).
 
Now that I'm domiciled in south Texas... Retirement allows me to travel all over...
Many under 65 full-time RVers needing health insurance choose to domicile in Florida for the Florida Blue ACA plans with BlueCard national provider network.

From my plan documents:
BlueCard provider network: Largest network in the country; 96% of hospitals and 83% of physicians nationwide.

Like many domestic / global nomads and ex-pats, in 2016 I moved my domicile from TX [CMRA] to FL [CMRA] for much better insurance with a FL-BCBS PPO. FL-BCBS has accepted my TX mailing address for years, and that is the address to which I will "return" for my legal domicile and Medicare/Medigap coverage.


Best State for RVer Health Insurance: Florida!

...two types of Florida Blue EPO/PPO plans (Blue Select & Blue Options) act as EPO in-state, but take advantage of an extensive and highly reputable “Blue Card” network that will function out of state as well, making them PPO out of state. That makes it a great option for full-time RVer health insurance.

 
^ I'm surprised Florida still has the blue card. A lot of states have been nerfing it.
 
FYI--when you reach Medicare age be sure you get traditional Medicare with a supplement, that will cover you nationwide. The Medicare Advantage plans are state specific so avoid those.
 
Thanks for the tip on the 'Blue Card'. This whole domicile concept is sort of nebulas to begin with. What would prevent me from just signing up on the Florida exchange (Healthcare.gov) ? I suppose I'd need a mailing address, which is a problem that the many full-time RV's address with a mailing service. Something I'll look into..
 
A couple of years ago I assisted the young adult daughter of a friend find ACA coverage in Texas. I was surprised to see the difference in the types of plans offered to what is offered where I live (Pittsburgh, PA). We have two major players here, and that's all you can get. But the number and variety of plans they offer is wonderful. In Texas where my young friend lived (Austin area), there were more providers, but much less variety in the types of plans.
 
I don't live in Texas, but I went with retiree health coverage over ACA because our ACA only had HMOs. I have a HDHP PPO with my retiree health coverage. It is only a few thousand more a year for my family, but it provides great peace of mind, especially while traveling and having kids go off to college.
 
Please check if you have United Healthcare in ACA. If not, you need to check for off-exchange private individual health insurance for United Healthcare. They may or may not sell in the Texas market. United Healthcare has a wide network across the US where you can see their listed doctors and be covered by your health insurance. I buy an off-exchange private individual health insurance (EPO) Sierra Health and Life plan (parent is United Healthcare). I pay more than ACA prices and obviously not get a subsidy. I only learned about this network of doctors when my doctor referred me to a rheumatologist in UCLA (Santa Monica) and I was willing to pay out of pocket. However, when I called UCLA, they said yep, they took my plan. Surprise, surprise! I went back to read up on the literature, and there is a link for PCPs and specialists all over the US that are covered by my health insurance, i.e. as long as they are United Healthcare plans. I spend 3 months a year outside of my state and I have peace of mind knowing that there are doctors that will take my plan, subject to the same co-pay and max OOP.
 
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