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Health Insurance and the Affordable Health Care Act


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You have to have paid into the system to be eligible for Medicare, I believe. Many municipal, county, and State employees did not participate in Social Security. I believe that starting in the 1980's newer employees had to pay into Medicare, but older employees did not.

As a Federal employee under the Civil Service Retirement Plan, I didnt pay into Social Security, but I did have to pay Medicare payroll taxes, so I would be eligible for Medicare. I wasnt aware that those groups that didnt pay into Social Security we able to opt out of paying Medicare payroll taxes as well.

 

Thanks for your answer

2005 Winnebago Voyage 38J

 

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As a Federal employee under the Civil Service Retirement Plan, I didnt pay into Social Security, but I did have to pay Medicare payroll taxes, so I would be eligible for Medicare. I wasnt aware that those groups that didnt pay into Social Security we able to opt out of paying Medicare payroll taxes as well.

 

Thanks for your answer

 

Paul, don't take my word for this. I worked for a municipality for almost 40 years and did not pay into Social Security or Medicare. I do know that younger employees did pay into Medicare, I'm not sure when that started but believe in the mid 80's. I qualify for Medicare because I paid into SS for more than 40 quarters prior to and during my municipal employment on second jobs.

Everybody wanna hear the truth, but everybody tell a lie.  Everybody wanna go to Heaven, but nobody want to die.  Albert King

 

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A word of caution to all. When you go on an exchange and see the term Multi-State plan, do not assume that this means the plan will work in states other than the one where purchased. The job is not so simple. Multi State plan just refers to that fact that a similar policy is offered by the company in other states. To know for sure you need to look at the specific terms of the plan you are purchasing and the availability of a nationwide network of providers. If in doubt call and/or use an agent.

I am under 65 and purchased insurance on the Exchange. I tried to use an agent (two agents, actually) and also called BCBS directly but no one could provide me with a list of network providers or even tell me if there were providers in all 50 states. After two weeks I gave up and bought a plan with Assurant. Unfortunately it's being cancelled.

 

I don't understand how a provider would even know where you purchased your policy. My insurance card has nothing that indicates it was purchased on the Exchange. And the version available off the Exchange is identical - even down to the policy number.


There's more to see than can ever be seen

More to do than can ever be done

 

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This is not exclusive to the ACA.

My wife and I both have Medicare and an AARP supplement. Quite often, we run into situations where doctors simply will not accept Medicare because the rate of reimbursment is too low. Doctors do not have to accept Medicare or ACA policies if they don't want to do so.

 

However. If a facility, like a hospital, accepts any Federal dollars, and almost all do, then they must accept Medicare/Medicade.

If you're really sick, go to the ER.

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  • 3 months later...

Any new news on health insurance for the pre-medicare consumers, especially for Texas?

 

We should know something about what the insurance landscape will look like in TX in a week or two. As of today, insurance companies are still "lips sealed" on their 2016 offerings.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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  • 2 weeks later...

Any new news on health insurance for the pre-medicare consumers, especially for Texas?

Both TX BCBS and FL BCBS have their 2016 plans with rates on their respective websites. All the TX plans are Blue Advantage. At least Florida still offers their EPO(in state)/PPO(out of state) plans,

although the rates have increased and the Bronze 1419 EPO/PPO plan is no longer HSA compliant, since the deductible increased to $6850.

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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I've been pondering this Pre 65 dilemma too. Currently have a BCBS North Carolina PPO via Untied Technologies/Goodrich Group Retirement Plan. Know they've requested a pretty solid increase (30+%) for normal BCBS participants, no idea yet if this will be the same for negotiated Group Retirement Plans. And also no idea if large companies will still even try to negotiate Group Retirement Plans for under the post ACA world:)! So, looking for contingency plans, if they don't, or if the costs are just too high for what they offer.

 

I've been considering HMO plans, but supplemented with a Travel Health Insurance plan, that if something catastrophic happens, will get whomever needs it transported back to the state of the HMO. (Not sure what State that will be, currently our Domicile is in South Dakota. But will consider changes to Florida, Texas, or possibly another state - if it pencils out.

 

FMCA has their FMCAssist program, which does Medical Emergency Evacuation and Travel Assistance, if ever needed. Up to $500K. It has language that makes it less then crystal clear, if they would transport you back to your home base. As I read it, and as I called and asked questions, it is at the combo of the the Attending Physician after coordination with Seven Corners Medical Director. So, if the attending Doc feels it is in your best interest and care to have you transported to your normal physician, and Seven Corners Medical Director concurs - it gets you back to your home base and within the HMO coverage area. (I talked with two different reps at FMCA when asking my questions, and to say the least it was not a clear answer on what the Seven Corners Medical Director uses to determine if 'concurrence' with the attending Doc will be granted.)

 

So, while I'm not sure this will work at this time. I am using this as a starting point trying to determine if Supplemental Travel Health Insurance is viable to cover catastrophic situations. With the key objective, once stable, getting back within the HMO coverage area for final care.

 

With the now high deductibles, at least on what is realistically available to my wife and I, we are in reality 'self insuring' for normal care and yearly health maintenance. And paying the $17.5K on top of that, for less then 100% coverage after deductible. We budgeted $25K in 2015 for only health related insurance, and another $2.5K for dental and eyes, with a $5K contingency on top of that. (Basically eating up the bulk of my after tax retirement pension for healthcare, and glad I have it.

 

How about it, anyone else looked into Emergency Travel Medical Insurance, as away to hedge against catastrophic problems? Info sharing greatly appreciated:)!

 

Best to all,

Smitty

Be safe, have fun,

Smitty

04 CC Allure "RooII" - Our "E" ride for life!

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Kyle,

We are trying to decide between Texas and Florida for our domicile state. I see Texas will not have PPO plans, is there any chance that Florida may?

Yes, FL BCBS does have 2016 PPO plans off the exchange. I don't know what's available on the exchange. The letter I received from FL BCBS says the 2016 plans will now be different on exchange and off exchange. FL's PPO plan is actually a combined EPO(instate)/PPO(out of state) plan. The 2016 Bronze EPO/PPO plan now has a $6850 deductible, so it no longer qualifies as a HSA.

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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I am under 65 and purchased insurance on the Exchange. I tried to use an agent (two agents, actually) and also called BCBS directly but no one could provide me with a list of network providers or even tell me if there were providers in all 50 states. After two weeks I gave up and bought a plan with Assurant. Unfortunately it's being cancelled.

 

I don't understand how a provider would even know where you purchased your policy. My insurance card has nothing that indicates it was purchased on the Exchange. And the version available off the Exchange is identical - even down to the policy number.

About 90% of the drs and specialists in the US are in the BCBS network. If a provider participates with any of the 36 BCBS health insurance companies, they're in the nationwide BCBS network. See the link for the list of BCBSs:

 

http://www.bcbs.com/about-the-companies/

 

To check if an individual dr/hospital/provider is in the BCBS network:

 

http://provider.bcbs.com

 

 

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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Kyle,

We are trying to decide between Texas and Florida for our domicile state. I see Texas will not have PPO plans, is there any chance that Florida may?

 

There may be an option OFF Exchange for PPO in Texas and Florida. ON Exchange we are still waiting on final word from insurance carriers in FL. It's looking pretty clear there won't be any PPO options ON Exchange in Polk County, TX though.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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Is Texas generally a less expensive state for insurance than Florida?

 

I would not make that general characterization, no. There are many factors that determine rates for all types of insurance and for some FL maybe more expensive and for others not so much.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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I have been watching this thread carefully since my husband and I have the current ACA Texas BlueShield PPO and have not had a problem getting in-network care throughout the US. Now that the Texas plans have been officially released for 2016, I see several problems for those of us who have addresses in Polk County and want to get insurance through the exchange.

  1. The basic HMO plans DO NOT cover out-of-network expenses AT ALL.
  2. The Blue Advantage 'Plus' plans DO cover out-of-network expenses, but with the following caveats: Cost-sharing is 50% (versus 20% or 30%), your deductible doubles or triples (or more), and the biggest concern of all, your out-of-pocket expenses ARE UNLIMITED.
  3. The 'multi-state' plans DO NOT include in-network coverage in other states, despite what any Blue Shield rep might tell you. The term 'multi-state' simply refers to the fact that the plan is sold in more than one state. You still have to stay in the Blue Advantage network. One advantage to this plan over the regular HMO is that you do not need a referral to see a specialist.

This is devastating to us because we will now have to choose a primary care physician in Texas that we have never met (and probably never will) and stop seeing our doctors and other providers that we have seen for decades. I feel very strongly that all of us Escapees need to write to our respective legislators and demand that they investigate what is happening here.

 

Suzy & Terry Johnson

Terry & Suzy Johnson

2008 Ford F-450

2014 Dutchmen Voltage 3905 Toyhauler

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  • The Blue Advantage 'Plus' plans DO cover out-of-network expenses, but with the following caveats: Cost-sharing is 50% (versus 20% or 30%), your deductible doubles or triples (or more), and the biggest concern of all, your out-of-pocket expenses ARE UNLIMITED.

 

And, based on a conversation with BCBSTX a few days ago, "UNLIMITED" means not only is there no out-of-pocket cap, but also that the provider can balance bill you, if the amount charged by the provider is more than the amount allowed by BCBSTX. In other words, you can be on the hook for more than the 50% co-pay.

 

We too have been on a BCBSTX PPO plan since 2014, and are now looking for other options. For those in this situtation, what options are you considering?

 

It looks like EPO/PPO plans will still be available in Florida in 2016. So changing domicile to Florida may be one option. Does anyone have experience with BCBS Florida ("Florida Blue")? We're also looking at "health share plans" like Liberty Healthshare. Any experiences there?

 

David

 

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We too have been on a BCBSTX PPO plan since 2014, and are now looking for other options. For those in this situtation, what options are you considering?

 

We are going to look at off-exchange plans when they become available. At least in 2015, United Healthcare had some off-exchange options with better networks (Choice, not Compass which is their network for exchange plans). None of the 2016 on-exchange plans have any of our doctors on their networks.

 

Michelle

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It looks like EPO/PPO plans will still be available in Florida in 2016. So changing domicile to Florida may be one option. Does anyone have experience with BCBS Florida ("Florida Blue")? We're also looking at "health share plans" like Liberty Healthshare. Any experiences there?

 

David

 

We have the FL Blue EPO/PPO plan, but we're no longer full-timers and we haven't used it out of state yet, but I foresee no issues, since it's a PPO. These plans are excellent for snow birds/sun birds too.

 

I will say our rate is $160 a month more than we were paying in TX for similar coverage.

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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