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You can get insurance, you just can't get any care other than emergency outside of SD.

I have BCBS- WellMark- in South Dakota and have had no issue having my regular annual exams in North Carolina, blood testing in Texas, eye exam in Mississippi, dental work in Texas, and prescriptions covered in 6-7 states.

Alie & Jim + 8 paws

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I have BCBS- WellMark- in South Dakota and have had no issue having my regular annual exams in North Carolina, blood testing in Texas, eye exam in Mississippi, dental work in Texas, and prescriptions covered in 6-7 states.

 

Is this part of a retirement program through a previous employer?

 

Barb

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Is this part of a retirement program through a previous employer?

 

Barb

No, this is self purchase thru the state run website. I didn't qualify for any subsidies so the whole cost is on me. Silver plan is in the $300 range a month. I went thru Kyle Henson.

Alie & Jim + 8 paws

2017 DRV Memphis 

BART- 1998 Volvo 610

Lil'ole 6cyl Cummins

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I guess the next question is when did you sign up for this Wellmark policy? Kyle has been reporting that Wellmark refused to participate in SD ":on exchange" for all of 2014 and continued their decision not to participate in the exchange for 2015. Prior to ACA, Wellmark had a reputation for denying policies to anyone with a mail forwarding address, and some of those who slipped through got cancellation notices after the fact. just curious when this all changed, I don't see any recent update on Kyle's site

 

No, this is self purchase thru the state run website. I didn't qualify for any subsidies so the whole cost is on me. Silver plan is in the $300 range a month. I went thru Kyle Henson.

Jim

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Hello all,

I just got off of the phone with the folks at RVerHealth. What I was told is that Avera cannot deny anyone coverage if you purchase insurance "on exchange". "They cannot deny you coverage for being a full time RVer". Avera will cover Urgent and ER care. They will not cover routine care out of state.

That being said, if you are like I am and buy a Bronze plan then they would not "pay" for "a lot" of routine care until the deductible is hit anyway. I've been paying for my yearly routine care for years so this isn't a big deal to me.

What I need is coverage when we're on the road and something happens, turn an ankle, come down with strep throat or the like. My understanding is that Avera would cover this sort of thing.

So, I don't think SD is necessarily out of play if you plan to domicile there and don't mind paying for most of the routine stuff out of pocket when you're on the road..

Phil

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I have BCBS- WellMark- in South Dakota and have had no issue having my regular annual exams in North Carolina, blood testing in Texas, eye exam in Mississippi, dental work in Texas, and prescriptions covered in 6-7 states.

 

Wellmark SD just turned us down for a Medicare Medigap Plan F because we couldn't provide adequate "proof of residence". Even though we had SD drivers licenses they wanted utility bills, rental agreement, property taxes, etc. According to the broker we are working with this has happened to other RVers but we have been told that the other Medigap carriers don't care. We've now reapplied with another carrier; we'll see what happens next.

Sandie & Joel

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  • 4 weeks later...

A few quick points...

 

  1. Each person's situation is unique (subsidies, health, Medicare/non-Medicare, time in the state, addresses etc.) and you definitely do not want to make a decision about your own health insurance based solely on someone's forum post which does not spell out all of these factors.
  2. Avera Health has plans both on and off the exchange. Their policy in 2015 is to accept those that enroll on the exchange (whether via Healthcare.gov or a broker's site [my site]). They have to in order to be in compliance with ACA regulations. ACA requires insurance companies to accept an application that has been approved by the Marketplace. OFF the exchange, however, they have stated that they will not accept your application if you only have PMB address in SD with no physical permanent home. And they CAN do that. (Hopefully in the future we can advocate for a change to this statewide policy in SD).
  3. Wellmark does not openly accept applications from RVers with PMB addresses in SD. However, many people NOT ON MEDICARE have been successful applying through a broker (via the online QUE system [my site]) because Wellmark does not currently "flag" these addresses like they used to. They reserve the right to do so, however. Wellmark is not on the exchange in 2015.
  4. For individuals whom ARE on Medicare it does appear that Wellmark is still flagging PMB addresses and denying coverage for Medicare Supplement plans. I have not tried to enroll anyone in their supplements though because there are better options for these plans in SD from carriers that do not have a problem with PMB addresses.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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So, Kyle, with regard to the "trick" above of applying through the exchange....if you subsequently had a large claim would they then be in a position to deny paying it because you are not "qualified" to have a plan in SD? This would be a concern to me....

Jack & Danielle Mayer #60376 Lifetime Member
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For individuals whom ARE on Medicare it does appear that Wellmark is still flagging PMB addresses and denying coverage for Medicare Supplement plans. I have not tried to enroll anyone in their supplements though because there are better options for these plans in SD from carriers that do not have a problem with PMB addresses.

 

 

FWIW our Medigap Plan F with Humana, which didn't have a problem with our PMB address, was <$5/mo more (total) for the two of us than the premium that Wellmark would have charged before it refused us because of the PMB address.

Sandie & Joel

2000 40' Beaver Patriot Thunder Princeton--425 HP/1550 ft-lbs CAT C-12
2014 Honda CR-V AWD EX-L with ReadyBrute tow bar/brake system
WiFiRanger Ambassador
Follow our adventures on Facebook at Weiss Travels

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Jack,

 

If you are referring to Avera and enrolling on the Healthcare Exchange the answer is "No".

 

It's not a "trick" in the sense that you are "tricking" the insurance company into believing something false about you (which, of course, would be fraudulent and absolutely grounds for denial of claims). Insurance companies participating in the ACA exchange have to adhere to Marketplace eligibility rules, though, which do not allow denial of coverage once the Marketplace approves an application. That's why Avera has agreed to allow enrollments on the exchange from SD residents with PMB addresses.

 

If you are referring to Wellmark, the answer is also "No".

 

By enrolling through their online QUE system (which is off the exchange) and answering the application questions honestly you are not providing any false information nor are you trying to side-step eligibility. It's just that their new QUE system does not automatically flag PMB addresses like their older system did pre-ACA.

 

There is nothing in Wellmark's written eligibility requirements that states you can not be an RVer and have a PMB address. In fact, the only reason I know that applicants with PMB addresses can get approved through their QUE system is because Wellmark told me.

 

Of course, this all assumes that the hypothetical person applying for coverage is in fact a legal resident of South Dakota and does not/can not claim another state as his or her residency.

 

I know it's not an ideal situation for RVers in SD whom are not on Medicare (again, for SD residents on Medicare there are plenty of options). SD has always been (and still remains) a difficult state for fulltime RVers that choose it as their resident state. But the fact of the matter is that there are thousands of RVers domiciling in SD and not everyone can or wants to move to Texas. So, we have to figure out how to get coverage for these individuals. Right now the best options for coverage for these folks are:

  1. On Exchange: Avera Health
  2. Off Exchange: Wellmark or Assurant Health
  3. Ministry share programs
  4. Short Term Medical (This does not qualify as Minimum Essential Coverage so the "shared responsibility payment" can be assessed to holders of these policies. They can still be a good strategy though.)

So, you CAN legally get coverage in SD, it's just not as clean and simple as it is in Texas.

 

 

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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FWIW our Medigap Plan F with Humana, which didn't have a problem with our PMB address, was <$5/mo more (total) for the two of us than the premium that Wellmark would have charged before it refused us because of the PMB address.

 

Yes, there are several better options in SD for Medicare enrollees. Wellmark's rates are not the lowest. Here are the best rates in SD (along with TX and FL) right now.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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  • 2 weeks later...

For what it is worth: We are home based in Emery SD. My wife has Avera health plans through the exchange. This past summer 2014 she contracted legionnaires in Middlebury Ind. I havent added up all of the claims that Avera paid, but one hospital bill was over $500k. They have so far paid for everything after the $1,100 in network deductible using the PHC network. 2 months IU Indianapolis, 1 month extended care, 1 month rehab facility, and 1 month outpatient rehab. Many medical transports, 1 helicopter was $25k I figure well over $1M. Just saying medical cost in this country are out of sight, but Avera came through for us. Your experience many vary.

George

2011 F350 6.7PSD CC 4X4 DRW Lariate
2015 Mobile Suites 41 RSSB4 5th Wheel

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