State Residency and ACA (Obamacare) Health Plans

[Zulu]

It sounds like you must have one of the HMO plans. What you will want is the PPO type with coverage and network providers in all states. You should be able to locate one in FL.

 

There are no ACA PPO plans in FL. However, there are ACA BCBS EPO plans that I think offer out-of-state coverage.

[Daveh]

Anyone have the link for that insurance option that was just offered by the group that is (was) associated with Escapees? That had another option. I was sure I kept the link but cannot find it.

[jbh]

Switch to a BCBS EPO plan that has nationwide coverage. Not all do.

[Daveh]

Here is the one I was thinking of. http://www.rverinsurance.com/2017-health-insurance/

[Blues]

Nobody has mentioned this provision:

 

Q13. Can an individual who meets the residency requirement in more than one location qualify for the Permanent Move S E P?

As described in Question 10, in limited circumstances an individual may meet the residency requirement in more than one location. Such individuals may qualify for the Permanent Move S E P to enroll in or change plans when they move between Marketplace residences, but they should consider whether they would benefit more from enrolling in a QHP that offers a national provider network or out-of-network coverage instead.

 

 

This provision anticipates that a person can choose to enroll in a QHP that will provide coverage in whichever location he is residing rather than enroll in a new plan each time he goes to a different residence.

 

While Q13 appears to anticipate only a couple of residences, the provisions don't appear to be limited to that. So would a fulltime RVer fall into the type of people addressed by Q13, differing only in the number of residences? And in the case of an RVer, it would stand to reason that since it's impossible for him to get a new health plan every time he changes residence, his only option is to pick one somewhere, and following the advice in Q13, one that will cover him no matter where his current residence is.

[Ronbo]

Just because you are in a state the says you have to become a resident after a certain amount of time doesn't mean they can force you. What happens if you are on the road and diagnosed with cancer and have to undergo chemo? I just spent 8 months in Arizona. It comes down to intent. My intent is not for Arizona to become my residence. I intend to return to Texas some day so that is my state of residence.

[Blues]

 

If you have an ACA health plan based on your domicile residence and you believe that you can keep that ACA health plan while you're away from your domicile for 3 years, then I have a bridge to sell you.

 

What is the alternative? What if I stay gone from my domicile for three years, and don't set foot in that state at all during that time, but I also don't spend more than a couple of weeks in any other state? Where should my health insurance be based?

[Zulu]

 

What is the alternative? What if I stay gone from my domicile for three years, and don't set foot in that state at all during that time, but I also don't spend more than a couple of weeks in any other state? Where should my health insurance be based?

 

Contact https://www.healthcare.gov/

[Kirk W]

What if I stay gone from my domicile for three years, and don't set foot in that state at all during that time, but I also don't spend more than a couple of weeks in any other state? Where should my health insurance be based?

Do you have a primary care physician? Many, if not most of us have some sort of continuing medical issue that requires maintenance prescriptions. In such cases, we typically need to visit that primary care physician annually in order to keep renewing prescriptions. Of course if you are healthy enough to have no continuing medications, you could stay away for longer periods but a brief passage through your chosen domicile state for an annual physical with your declared primary care physician would avoid this type of difficulty.

[Daveh]

 

If you have an ACA health plan based on your domicile residence and you believe that you can keep that ACA health plan while you're away from your domicile for 3 years, then I have a bridge to sell you.

Zulu, I guess I did not notice this earlier. Do you know of an ACA requirement that you must be physically in the state? I get to Mich every year but I would not be troubled by traveling 3 years as I keep a residence address there. As I think you and others have said, the intent for permanent residence is what matters. I have lived in Mich most of my life though. It would be another matter if I just selected a random state and never went there.

[sushidog]

An interseting discussion, but this will all change shortly, as it seems that the ACA won't be around much longer - at least not in its current form.

 

http://www.msn.com/en-us/news/politics/gop-plans-immediate-repeal-of-health-law-then-a-delay/ar-AAl4lAx?li=AA5a8k

 

I'm 60 now and plan on retiring to a FT lifestyle in a couple years, so I will be in the "gap" for 3 years until Medicare kicks in at 65.

 

I sure hope they (the government) will allow healthcare savings accounts in lieu of mandatory insurance (remove the ACA penalty) through these gap years, as I won't be able to afford insurance without an ACA subsidy - unless the prices drop drastically (something I don't expect to happen). I'm currently paying $5,200/yr for my DW and myself under my employer's health insurance plan where he pays 2/3rds. That means that If I had to buy this same plan on my own it would cost $15,600/yr which would take my entire SS check and part of me DW's check too, so that option of off the table.

 

Like many others I may be forced to go without insurance for a few years, paying out of pocket (possibly in Mexico?) for my health care needs, rolling the dice out of financial necessity. Fortunately my DW and I are in good health, and I hope this holds up for a few more years. If I were forced to pay cash for our routine doctor's visits and drugs today, I'd spend a tiny fraction of the $5,200/yr my insurance currently costs, but of course, if either of us had a catastrophic health care expense we'd be SOL.

 

I guess we'll just have to wait and see what tomorrow may bring. Good luck with everyone's plans.

 

Chip

[Zulu]

Zulu, I guess I did not notice this earlier. Do you know of an ACA requirement that you must be physically in the state? I get to Mich every year but I would not be troubled by traveling 3 years as I keep a residence address there. As I think you and others have said, the intent for permanent residence is what matters. I have lived in Mich most of my life though. It would be another matter if I just selected a random state and never went there.

 

No!

 

Don't get state residency requirements confused with ACA residency requirements. They are NOT the same.

 

While states care about "intent", the ACA is concerned about where you actually stay. For example, if your state domicile is MI, but you actually spend most of your time in FL, then you can sign up for a FL ACA plan.

[Blues]

Do you have a primary care physician? Many, if not most of us have some sort of continuing medical issue that requires maintenance prescriptions. In such cases, we typically need to visit that primary care physician annually in order to keep renewing prescriptions. Of course if you are healthy enough to have no continuing medications, you could stay away for longer periods but a brief passage through your chosen domicile state for an annual physical with your declared primary care physician would avoid this type of difficulty.

 

No, I don't have a primary care physician. When you say "many, if not most of us," I think you're considering the population of fulltimer RVers and/or the population of people on this forum, and it's easy to forget that the people who are dealing with this particular issue are younger and generally healthier, and have different health insurance needs. We're looking for something to keep us from going bankrupt if a medical catastrophe occurs, and are in the unique position that, unlike the vast majority of people, our medical catastrophe is likely to occur when we're not in the small geographic area that most insurance plans cover these days.

 

Also, a "brief passage" through somewhere to see a specified doctor every year wouldn't necessarily be all that easy, especially if you consider that you have to schedule appointments for things like physicals in advance, sometimes well in advance.

 

 

 

While states care about "intent", the ACA is concerned about where you actually stay. For example, if your state domicile is MI, but you actually spend most of your time in FL, then you can sign up for a FL ACA plan.

 

But what if you don't spend most of your time anywhere? And even if you did know that next year you'll spend 21 days in Kansas in July 2017, and that those 21 days will be more time in that state than any other state during 2017 (and assuming nothing changes those plans), is Kansas where you should sign up for health insurance now? What address would you use on your application?

 

And if it's that arbitrary, then what's the difference between that and picking a state for other reasons, like the availability of a plan with a nationwide network?

 

Please remember that I'm talking about people who really don't have an "obvious" choice, or who have only a couple of obvious choices (like a winter home and a summer home, or their home and their seasonal job somewhere else).

 

With all due respect, do you really think it's helpful to point someone to healthcare.gov for an answer to the unique situation presented by traveling fulltimers? I'm pretty confident that if you do ask the question, and assuming you can get them to understand it (good luck with that), they'll eventually say you should get insurance where your driver's license is.

[Zulu]

With all due respect, do you really think it's helpful to point someone to healthcare.gov for an answer to the unique situation presented by traveling fulltimers? I'm pretty confident that if you do ask the question, and assuming you can get them to understand it (good luck with that), they'll eventually say you should get insurance where your driver's license is.

I'm pretty sure the folks at healthcare.gov have heard it all.

 

 

But what if you don't spend most of your time anywhere?

Then I'd say you may have a lot of choices.

 

 

And even if you did know that next year you'll spend 21 days in Kansas in July 2017, and that those 21 days will be more time in that state than any other state during 2017 (and assuming nothing changes those plans), is Kansas where you should sign up for health insurance now?

I'm not sure a future residence would work . . . However, see my final "work the system" comment.

 

 

What address would you use on your application?

You don't need one -- see page 2, "Home Address" of the ACA Online Application.

 

 

And if it's that arbitrary, then what's the difference between that and picking a state for other reasons, like the availability of a plan with a nationwide network?

 

Traveling full timers can be unique if you're a true nomad. If that's the case, you may have to go with the state on your driver's license because . . .

• You essentially told your domicile state that it is where you intend to reside (even if you spend little or no time there). So the ACA may also consider this "intent" for their purposes.

• "Individuals visiting an Exchange service area for a transitory purpose, for example, to attend to a business matter, obtain medical care, or for personal pleasure, do not have a present intent to reside, and do not meet the residency requirement for Marketplace coverage for the Marketplace service area they are visiting" (from ACA FAQ)

 

On the other hand, this is probably the ACA's last year -- work the system. If I was constantly moving with not a lot of time spent in any location, I'd pick the location with the best ACA plans.

 

Finally, you really should talk with someone at Healthcare.gov.

 

Good luck.

[Kirk W]

No, I don't have a primary care physician. When you say "many, if not most of us," I think you're considering the population of fulltimer RVers and/or the population of people on this forum, and it's easy to forget that the people who are dealing with this particular issue are younger and generally healthier, and have different health insurance needs. We're looking for something to keep us from going bankrupt if a medical catastrophe occurs, and are in the unique position that, unlike the vast majority of people, our medical catastrophe is likely to occur when we're not in the small geographic area that most insurance plans cover these days.

..........................

 

Also, a "brief passage" through somewhere to see a specified doctor every year wouldn't necessarily be all that easy, especially if you consider that you have to schedule appointments for things like physicals in advance, sometimes well in advance.

Primary care physicians are not exclusive to "elderly" people but are actually pretty common for families as well and are generally a must for anyone who has a continuing medical issue such as diabetes or numerous other medical issues and women are advised to get an annual pap smear test and some other medical checks. I'd have to concede that I didn't do so until my mid to late 40's but men too are generally advised to get an annual physical which I eventually did since our health plan covered 100% of that to encourage it as a preventive measure. In your position, I really can't say what I'd do since my wife developed ongoing medical issues pretty early in life and so we really never had the option to go long term between her visits. Unfortunately we seem to be living in a world where health care insurance is in constant change. Zulu has spent a lot of time and study on the subject, which I have not and won't be doing since we are both past the age of Medicare and we were fortunate to have had coverage by my previous employer between my retirement and age 65.

 

When you have a relationship with a primary care physician, in most cases it is actually quite easy to schedule an appointment pretty much when you want as long as you plan ahead at least a month or two and you can call or email to make the appointment. If you choose not to develop such a relationship, then you should be able to use one of the emergency physician services for occasional needs as you travel and go with some form of catastrophic health care plan. I wish you the best success with this issue. I have come to feel very fortunate to have had the plan we did.

Also, a "brief passage" through somewhere to see a specified doctor every year wouldn't necessarily be all that easy, especially if you consider that you have to schedule appointments for things like physicals in advance, sometimes well in advance.

[Blues]

I'm pretty sure the folks at healthcare.gov have heard it all.

...

Finally, you really should talk with someone at Healthcare.gov. sss

 

I'm sure the people at healthcare.gov have heard it all, but I'm not confident they've had all the answers.

 

And I have talked to them, a lot. For some reason, my identity can never be verified on the website, so to get anything accomplished I have to do it over the phone. It's been that way every single year.

 

The people there are the same as at any call center--they have a script and that's what they use. I can't fault them for that, and I can't really fault the system for not having an answer for true nomads, since we're such a minuscule portion of the population. I don't think there is an answer, other than the fallback of getting insurance where your driver's license is.

 

And, even though you say true nomads may have a lot of choices, you also said, upthread, "If you have an ACA health plan based on your domicile residence and you believe that you can keep that ACA health plan while you're away from your domicile for 3 years, then I have a bridge to sell you." True nomads are in the position of trying to keep that ACA plan while away from their domicile for 3 years.

 

 

 

When you have a relationship with a primary care physician, in most cases it is actually quite easy to schedule an appointment pretty much when you want as long as you plan ahead at least a month or two and you can call or email to make the appointment. If you choose not to develop such a relationship, then you should be able to use one of the emergency physician services for occasional needs as you travel and go with some form of catastrophic health care plan. I wish you the best success with this issue. I have come to feel very fortunate to have had the plan we did.

 

You are very fortunate.

 

For the way we travel, scheduling an appointment months (or even a month) in advance really is a problem. I know a lot of people have more set schedules than that, but we don't. And the thing is, we sometimes end up staying somewhere for six months, but it's never planned. So we're a subset of a subset of a set of people health insurers don't even think about.

 

I'm not sure what you mean by "emergency physician services." The problem with any of that is the network--very few plans (and none in Texas, where I have a driver's license) have nationwide networks any more, so if I'm traveling, I have no health insurance coverage. I can self-pay for a doc-in-a-box, but that's a possibly knowable cost, so the prospect isn't terrifying (ignoring the fact that I'm already paying a lot for health insurance that I can't use in that situation).

 

My current plan has only a local network, but it does have out-of-network coverage. The out-of-network deductible is something like $12,000 (and separate from the in-network deductible), plus I'm liable for the dreaded balance billing for any out-of-network services, which has no limit, but at least it's something between me and total bankruptcy.

 

But that plan isn't available for 2017, and the plans that are available do not have any out-of-network coverage whatsoever, so if I get any medical care outside the insurer's local network, it's as if I don't have insurance at all.

 

And while emergency room visits are covered under all plans, whether in-network or out-of-network, there's still the possibility that the insurance company could refuse to cover it because they don't consider it to have been an emergency. And there's the question of exactly what is covered: if I have a heart attack and go to the emergency room, what happens in the ER would (presumably) be covered, but once I'm stabilized and put in the hospital for observation/recovery, how is that classified? At what point does the "emergency" stop and I become on the hook for medical bills? I'm pretty sure how the insurance company would like to do it.

 

I'm not sure what you meant by "catastrophic" insurance--if it's that exact product, then I don't qualify because those plans are available only to people under 30 or who have a hardship exemption from the requirement to have health insurance. And even if I could get it, I seriously doubt those plans have the nationwide networks that all the other plans have stopped offering.

 

In fact, what I actually want is catastrophic coverage: I'll take care of the day-to-day stuff myself, but I want coverage for a catastrophe if I'm not in the local network. What all the plans offer is actually the opposite of that.