Silver, bronze, or catastrophic?

[Chuckanut]

He said it must be a LIFE THREATENING emergency. He also said if I had a heart attack in another state and went to the ER it would only be covered until stable in the ER. If I was admitted to the hospital that would NOT be covered at all.

You might need to add an emergency evacuation coverage. Something like MedJet Assist which will take you to the hospital of your choice in a true emergency situation.

 

[pb4uski]

He said it must be a LIFE THREATENING emergency. He also said if I had a heart attack in another state and went to the ER it would only be covered until stable in the ER. If I was admitted to the hospital that would NOT be covered at all.

Some broken arms would be an emergency anad other broken arms would not be an emergency.

When is a broken arm an emergency?
ANSWER

Get emergency care when you:

• Can see bone sticking out through the skin
• Have heavy bleeding from an open wound
• Can't move your arm at all or feel part of it
• Can tell that it looks very different than usual
• Pass out
• Have many other injuries

As a practical matter... go to the ER if above or urgent care if you break your arm and none of the above and get a diagnosis.... call insurer to see what they cover... then if they won't cover it fly home and have it attended to in-network.

Many years ago, I broke my nose while in Orlando on a business trip... I went to the local urgent care and had it diagnosed and they gave me some pain meds... then I terminated my trip and flew home and had the nose set. With my insurance I could have had it set in Florida but I was more comfortable having it done at home.

 

[agh1]

I think people are missing my point. We individuals would like to be able to purchase the sort of comprehensive health insurance that is only available through an employer. Most people do not understand that it is not available at any price until they lose their job. We want insurance that will provide care and protect our savings which is what insurance should do.

 

[cathy63]

I think people are missing my point. We individuals would like to be able to purchase the sort of comprehensive health insurance that is only available through an employer. Most people do not understand that it is not available at any price until they lose their job. We want insurance that will provide care and protect our savings which is what insurance should do.

I disagree that we're missing your point. I totally understand what you want, and I think most others do too. This issue has been discussed here many times and if you search for other threads you'll find that there's no new ground being broken in this particular conversation.

The reality is that none of the people you're talking to here can give you what you want. We are not insurance co execs or state insurance commissioners. However, a lot of us like to solve problems and want to be helpful, so we'll try to describe how you might be able to fill in some gaps with travel insurance. That's about the best we can do in a frustrating situation. Maybe you just wanted to vent and were only interested in sympathy rather than answers. That's o.k. too, but it's hard for people to get that from your posts, and also hard for the problem solvers to refrain from giving advice.

 

[wompo]

I think people are missing my point. We individuals would like to be able to purchase the sort of comprehensive health insurance that is only available through an employer. Most people do not understand that it is not available at any price until they lose their job. We want insurance that will provide care and protect our savings which is what insurance should do.

Exactly what I would love to be able to purchase. But what I get is a more expensive plan than the COBRA rate with a restrictive HMO and a 16,300 deductible and OOP. which means I pay close to 12,000.00 premium annually and if I need care I pay another 16,300 before insurance pays anything. Better than not having insurance but it just seems crazy

 

[GreenEggs]

Isn't there some type of church-based insurance plan? Does anyone (here) know if it's a worthwhile option?

 

[agh1]

Exactly what I would love to be able to purchase. But what I get is a more expensive plan than the COBRA rate with a restrictive HMO and a 16,300 deductible and OOP. which means I pay close to 12,000.00 premium annually and if I need care I pay another 16,300 before insurance pays anything. Better than not having insurance but it just seems crazy

Since I am 61 years old I pay similar premiums for about the same amount of coverage.

I do not agree with the poster above who says travel insurance is the answer. I happen to live on the border of my state. Many of my friends live on the other side of that border by 20 or 30 miles. If I were to get in a serious car accident over there I would not have medical coverage & could incur large bills before I could get back over to an in network hospital on my side of the state/county line. Obviously I would not buy travel insurance just to visit friends for lunch or dinner.

Cousin was taken to an out of network hospital following her heart attack and was not able to move to the in network hospital. Fortunately she had employer health insurance so she had good coverage anyway.

 

[RetireAge50]

I’m sure you have already researched it but I think their is a Kaiser in Spokane WA and they have locations in other parts of the country. From Florida you might need to drive up to Georgia for example.

This is my plan.

 

[agh1]

I’m sure you have already researched it but I think their is a Kaiser in Spokane WA and they have locations in other parts of the country. From Florida you might need to drive up to Georgia for example.

This is my plan.

According to Google: "Kaiser Permanente operates in eight states (Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia) and the District of Columbia."

That means nothing remotely close to me.

 

[RetireAge50]

Sorry was replying about the OP Fermion.

 

[Cessna152]

I’m probably misunderstanding the problem statement or requirement, since others say there really is no insurance to be had that is national in scope, but I thought there was both catastrophic and supplemental plans offered by several companies, such as mentioned in this article:
https://help.ihealthagents.com/hc/en-us/articles/224360547-Can-I-Use-My-Health-Insurance-Plan-Outside-of-My-State-

 

[imoldernu]

It was before the ACA, and our Plan was for the local Illiois Hospital. We were snowbirding in FL, when jeanie had a very difficult stroke, that ended up with a cost of $175K. While she was in the FL hospital, they called our plan, and asked for the assigned doctor to approve her operation to be paid from the plan.
He simply said no. Her Florida doctor was the #1 heart/stroke physician in Florida, and the operation was nearly 5 hours. He told us it was the most dangerous case he had ever dealt with.

It finally ended up with a settlement, and we didn't have to pay, but it was a long scary three months before it was settled.

We finally changed our provider to Florida Blue, and have simply kept it there, aeven though we haven't been back for 7 years. It's ok to do that now, where it wasn't back in 1993.

 

[pb4uski]

This whole thread is why even as a life long conservative, I am open to considering some sort of Medicare for All approach... the current system is totally broke and large, disruptive changes are needed.

 

[ncbill]

For US travelers traveling within the US there are inexpensive annual medical evacuation plans.

But a big caveat is that to be covered on a trip it has to be at least 100 miles from home:

https://travel.nationwide.com/plans/annual

 

[Fermion]

For US travelers traveling within the US there are inexpensive annual medical evacuation plans.

But a big caveat is that to be covered on a trip it has to be at least 100 miles from home:

https://travel.nationwide.com/plans/annual

Only covers for 30 day max trip...we have already been in Florida 40 days now.

Only covers $10,000 of emergency medical...can just self insure for that amount

$50,000 for medical evacuation...unsure about this...what if you can't fly because of condition (stroke, heart attack). Where do they evacuate you to? Do they pay $50,000 for Uber?


I see our options right now are:

Self insure, hope for a little luck that our condition allows flying back home

Move our home base to a county in our state that has a blue cross blue shield ACA plan (there are 5 counties in WA that seem to have a Premera Blue Cross)

Don't travel too far from home

Wait for Medicare for all or something similar

 

[Rianne]

This is my understanding as well. They stabilize you but I am not even sure if the emergency room has to get you to the point where you can safely take a flight home. You might need hospital stay that is not covered and that would be thousands per day.

If the overnight stay is directly related to the emergency, it should be covered, provided it's coded correctly. How it's coded is important. If you bump your head, you're unconscious go to ER, they keep you overnight...should be covered. If they find something else unrelated and treat it, that's out of network.

 

[Aerides]

...
I see our options right now are:

Self insure, hope for a little luck that our condition allows flying back home

Move our home base to a county in our state that has a blue cross blue shield ACA plan (there are 5 counties in WA that seem to have a Premera Blue Cross)

Don't travel too far from home

Wait for Medicare for all or something similar

For "normal healthy" folks the odds of something catastrophic, travel-prohibitive, occuring are very slim.

Heart Attack - ok, you'd get emergency care and stabilized, but probably have to just be driven home or get amtrak across country - but that's an outlier for someone with no heart disease who is getting regular check ups.

Wife found a lump? go home, but not in a rush (work out a change on your return flight for a fee). Even after testing it's a few days at best to get a result, and doesn't always even mean immediate surgery. First step would be call and talk to your primary/gyno.

Accident/break a leg: Emergency care, then go home if you can't do the rest of your trip in a cast, etc.

Beyond that sort of thing, no you can't insure for every scenario. You could stay home in a bubble but then what was the point of retiring. But yes if someone travels extensively and frequently, and has the option to get a provider with some sort of national coverage (like Blue) then it's worth the effort.

 

[ncbill]

Only covers for 30 day max trip...we have already been in Florida 40 days now.

Only covers $10,000 of emergency medical...can just self insure for that amount

$50,000 for medical evacuation...unsure about this...what if you can't fly because of condition (stroke, heart attack). Where do they evacuate you to? Do they pay $50,000 for Uber?

I see our options right now are:

Self insure, hope for a little luck that our condition allows flying back home

Move our home base to a county in our state that has a blue cross blue shield ACA plan (there are 5 counties in WA that seem to have a Premera Blue Cross)

Don't travel too far from home

Wait for Medicare for all or something similar

You've never had a private ambulance pass you on the road?

Those are used for medical ground transport.

Note Nationwide is only one of the companies offering such coverage...I'm sure there are others without the 30-day trip maximum.

Still, for $59/year it's a bargain for those making multiple trips annually inside the U.S.

 

[agh1]

For "normal healthy" folks the odds of something catastrophic, travel-prohibitive, occuring are very slim.

Heart Attack - ok, you'd get emergency care and stabilized, but probably have to just be driven home or get amtrak across country - but that's an outlier for someone with no heart disease who is getting regular check ups.

Wife found a lump? go home, but not in a rush (work out a change on your return flight for a fee). Even after testing it's a few days at best to get a result, and doesn't always even mean immediate surgery. First step would be call and talk to your primary/gyno.

Accident/break a leg: Emergency care, then go home if you can't do the rest of your trip in a cast, etc.

Beyond that sort of thing, no you can't insure for every scenario. You could stay home in a bubble but then what was the point of retiring. But yes if someone travels extensively and frequently, and has the option to get a provider with some sort of national coverage (like Blue) then it's worth the effort.

Father was a normal healthy adult in his early 50's until he woke up at 3 AM with "the worst headache of his life". It was a massive stroke that left him unable to breathe on his own, paralyzed on one side, unable to talk and eventually in a coma. Mother also had strokes out of nowhere but she was older and qualified for Medicare plus supplemental by that time. Difference in care options and costs was totally night & day.

The event that seems unlikely to you seems very, very real to me.

 

[Fermion]

Well, I don't want to live in fear either because that is no fun.

There is a protective limit on our risk exposure because we have quite a bit of assets in our 401k and IRAs. Essentially they can't take every penny because these accounts are very well protected.

If you think about it, someone with say, a 3% withdrawal rate on a $2 million dollar portfolio who happens to encounter $100,000 of out of pocket medical costs could either increase their withdrawal rate to 3.15% or reduce their annual spending by $3,000 and keep their 3% withdrawal rate.

I know you could burn through $100,000 pretty fast but I think between being able to negotiate some settlement with your insurance company over how much was really an emergency and should be covered and being able to get back to your insurance network is some safe fashion, $100,000 is the upper limit of risk while traveling the USA if you have a HMO type of silver plan with limited network.

Heck, I risk $100,000 weekly on biotech.

 

[2lhasas]

What if you are a woman on vacation (say it is a 3 month trip to the Florida Keys) where you have booked a rental.

It is two weeks into the first month and you feel a small bump in your left breast.

Go to ER?

Try to make an appointment with local doctor? How many tests are you going to do before you rack up so many expenses that you feel you should have flown home to get tested?


I may just be a worry wart but as we travel around the country I think about these things.

The answer might be just to self insure and fly home for major treatments. Figure that you probably won't be out of pocket more than $5,000 or so even if you have to have a few tests run.

If you travel a lot and don’t have pre-existing conditions, you might want to look at some of the Cost Sharing plans. They aren’t ACA compliant, but often have more coverage across markets.

 

[2lhasas]

Isn't there some type of church-based insurance plan? Does anyone (here) know if it's a worthwhile option?

Health Cost Sharing plans or Christian Ministry plans often cover throughout the US. They also cover much less than an A A compliant plan. If you have pre-existing conditions, they will often be existed. They don’t cover as many preventative care visits, and the prescription coverage can be poor.

However, they are also much less expensive than unsubsidized ACA plans. I actually know one couple who were traveling a lot and purchased both and A A and a cost share plan. They were getting a pretty good subsidy for ACA so the overall cost wasn’t too bad.

 

[Bamaman]

There have been a bunch of posters on here, but not a lot of answers to your problem.

I'd suggest you go to one of the big RV websites and search their postings about the healthcare subject.

There are thousands of RVers in your shoes that have found out the best way to provide healthcare until they reach age 65 and can go on Medicare. And there are a surprising number of vagabonds full timing in their RV.

 

[FinanceGeek]

A theme in this thread is that various parts of the US have vastly unequal accessibility to wide-coverage plans such as PPOs and the BCBS BlueCard. Here are some resources I've used to identify which policies are available in each state:

https://www.healthcare.gov/health-and-d ... d-issuers/ - only shows Federal marketplace states, but shows each county's data
https://hixcompare.org/individual-markets.html - all states doesn't show availability county by county county

A few things to keep in mind:

• availability of any specific ACA plan is on a county-by-county basis.
• several states offers PPO networks for the catastrophic plans, but all metal plans are HMO or very restrictive EPO
• it's possible that the 'better' plans are only sold off-network, which eliminates the possibility of premium or cost sharing subsidies.

 

[saydiver]

Fermion, Believe me when I say I understand your problem. I was a full-time RVer aka vagabond for almost 8 years with a DH who was uninsurable long before ACA became effective. In order to get health insurance before ACA became effective, we became Texans, because Texas offered a high risk health plan for uninsurable residents.

Bamaman is correct. Many of the RV forums have a ton of posts about establishing residency in states where it's easy to establish a domicile and where the insurance companies in the state provide ACA plans with nationwide networks. The three RV friendly states are FL, TX and SD, but of the three, nowadays only FL offers PPO plans with a nationwide network. For the reasons mentioned a lot of RVers who need health insurance before age 65 become FL residents. There are a few other states that have PPO nationwide networks, but establishing residency is not as simple for RVers.

Florida Blue is one of a few insurance companies in the country that offers PPO health insurance plans with a nationwide network, called the BlueCard program where 95%+ of the hospitals and drs in the US are considered in-network. FL Blue's Blue Select and Blue Option plans are such plans when traveling out of state. When in-state the plans are considered an EPO and have networks. The Blue Option plans have a larger network of providers than the Blue Select plans and the Blue Select plans do have some limitations on ancillary charges.

Warning...FL Blue plans are very expensive if you don't keep your income under the subsidy max. For example without a subsidy DH is 61 and pays over $1200 a month for a Blue Option Bronze plan with a $6,000 deductible. It will be a few hundred dollars cheaper in the counties where Escapees and St Brendan Isle are located, which are the two companies most RVers/cruisers use to help with setting up their FL domicile. Another option would be to buy a RV lot and become a resident.

Here are links about establishing residency in FL using St Brendan Isle:

https://www.sbimailservice.com/become-a-florida-resident/

https://theboatgalley.com/establishing-residency-at-st-brendans-isle/

And another link about establishing residency in FL using Escapees:

https://www.escapees.com/education/domicile/florida/

There have been a bunch of posters on here, but not a lot of answers to your problem.

I'd suggest you go to one of the big RV websites and search their postings about the healthcare subject.

There are thousands of RVers in your shoes that have found out the best way to provide healthcare until they reach age 65 and can go on Medicare. And there are a surprising number of vagabonds full timing in their RV.