Health Insurance and the Affordable Health Care Act

[Jack Mayer]

I also strongly recommend you talk to RVerinsurance. While you CAN educate yourself on this stuff, it is VERY difficult. And easy to make a mistake or assume something that is not true. And it is virtually impossible to find out all the info on each plan that is available - at least it was for me. Summary info is available, but plan details are hard to dig out. The agents do know this stuff pretty well and Kyle's company specializes in RVers insurance. Use their expertise. It won't cost you any more.

[Zulu]

I also strongly recommend you talk to RVerinsurance. While you CAN educate yourself on this stuff, it is VERY difficult. And easy to make a mistake or assume something that is not true. And it is virtually impossible to find out all the info on each plan that is available - at least it was for me. Summary info is available, but plan details are hard to dig out. The agents do know this stuff pretty well and Kyle's company specializes in RVers insurance. Use their expertise. It won't cost you any more.

 

True enough, but don't neglect doing your own research.

 

Then you can ask better questions.

[Jim & Wilma]

Thanks Zulu for your research and posting. We'll be enrolled in ACA by this time next year and your research is of great value to us.

 

Jack,

I got an automated email response back from RV Insurance Exchange that said they " . . . won’t be able to provide one-on-one consultations for non-Medicare health insurance until further notice."

 

Here's the entire email:

 

Thank you so much for contacting us here at RVer Insurance Exchange. This is a confirmation email that we have received your inquiry. We will reply as soon as we can!

Important: Please read the following if you are under 65 and requesting a health insurance quote from us:

 

Dear fellow RVer,

 

Thank you for contacting us here at RVer Insurance Exchange. It is with great disappointment that we have to announce that due to recent announcements from most insurance companies to discontinue compensating agents we will not be able to provide custom insurance quotes to non-Medicare customers until further notice effective February 1, 2016 and instead will move to a self-service website for non-Medicare health insurance quoting and enrolling for the rest of 2016.

 

As you may know, as insurance brokers we are paid a commission for enrolling a client and servicing your policy. In order to cut costs and reduce enrollments, many insurance companies have now gone to a 0% commission to agents and brokers and have flat out told us to stop enrolling people outside of Open Enrollment. Of course, this means we are not compensated for our work unless we charge a fee to the customer (you)—something we here at RVer Insurance Exchange are not ever willing to do!

 

We will leave the website up as a free resource and self-service enrollment platform (a few companies may compensate us for your enrollment). We will continue to update the website and add information relevant to health insurance for RVers—we just won’t be able to provide one-on-one consultations for non-Medicare health insurance until further notice.

 

Please note that this does not apply to our other products! We will continue to offer quotes for Auto/RV, Short Term Medical, Medicare, Telemedicine, and more at RVer Insurance Exchange.

 

What can you do? First, we suggest you read our RVer Guide to ACA Enrollment. The end of the guide gives you some insight into what specific insurance companies we recommend you consider in FL, SD, or TX.

 

[trostberg]

I am finding the best information outside of the 3 states that are always talked about is those of us on these forums that live in other states.

 

Talking directly to the insurance company in a particular state has been helpful as well.....especially since so many brokers are out of the business.

[Jack Mayer]

Very interesting Jim. At the risk of pushing the "political edge" - something has to be done about the health care mess in this country that was amplified by the current program as it was implemented. It is starting to affect everyone's way of life (eg. can I fulltime?), where they live , how and where they work, etc. It is becoming a very serious problem that many people still do not recognize.

[Daveh]

I came across this website address the other day which I have not checked out but which is supposed to give you the non ACA compliant insurance options in a zip code. Presumably between this and and the regular healthcare.gov site you get to see all options for a given area. finder.healthcare.gov

[Zulu]

Very interesting Jim. At the risk of pushing the "political edge" - something has to be done about the health care mess in this country that was amplified by the current program as it was implemented. It is starting to affect everyone's way of life (eg. can I fulltime?), where they live , how and where they work, etc. It is becoming a very serious problem that many people still do not recognize.

 

While we wait, I suggest something closer to home. I emailed this to the RVer Insurance Exchange today:

 

To RVer Insurance Exchange,

 

Since RVer Insurance Exchange is in partnership with the Escapees RV Club, I request that you provide more strategies for dealing with the Affordable Care Act (ACA) for those Escapees under 65.

 

Though your "RVer Guide to ACA Enrollment" is an excellent resource, it admittedly only addresses itself to Texas, South Dakota, and Florida. In addition, the fact that the RVer Insurance Exchange has now become a "self service" site for those under 65 makes finding good information that much harder.

 

While a comprehensive 50-state guide may be beyond your resources, I'm fairly confident that there are general ACA exchange strategies (such as moving to a different county) that may apply to all the states.

 

I know the Escapees RV Club is heavily invested in Texas, South Dakota, and Florida, but not all Escapees -- particularly those under 65 -- domicile in those three states.

 

Tom Hughes

http://rvseniormoments.com/

[trostberg]

Well said.

 

Is there a way to cross post this to the Xscapers Facebook page

[KHenson]

Zulu,

 

Here are a few strategies we have implemented or recommended for accessing healthcare on the road:

 

1. Telemedicine: This is in my opinion a must-have for RVers. We have used it for our family 4 times in the past 6 months and it has been very convenient for us. We were able to get a phone consultation, diagnosis and Rx prescribed quickly, accurately, and easily from each of the locations we used it. **Disclaimer: I may earn a commission if someone enrolls in this.

 

2. Short Term Medical: Although the ACA penalty is making this option more difficult (it increased in 2016) it is still worth looking into as an alternative to ACA coverage because many of them have broader nationwide networks and lower (unsubsidized) premiums. **Disclaimer: I may earn a commission if someone enrolls in this.

 

3. MDVIP: This is something fairly new that many folks are not aware of. It is a membership-based Direct Primary Care program whereby you have access to affiliated doctors (over 800 nationwide) 24/7 and same or next day appointment priority. I DO NOT earn a commission for these enrollments.

 

A comprehensive 50 state guide is something I would like to work towards but that will be extremely time-consuming, complicated, and constantly evolving. As soon as we published such a guide we would have to rewrite it since insurance companies are rapidly changing their rules and offerings. It would be near impossible to stay on top of every company in all 50 states. I do plan on putting together a more comprehensive guide for 2017 Open Enrollment but it is not likely to address specific plan options in all 50 states.

 

I am extremely reluctant to recommend any "moving strategies" as a health insurance fix because, 1) Although health insurance is a big issue for RVers there are other domicile factors (legal, taxes, etc,) that must go into such a decision that I am not qualified to address, and 2) As we have seen happen in Texas, changing your domicile for better health insurance may be a temporary band-aid at best since any insurance company can change their rules/offerings in any given year. Additionally, there is a lot of uncertainty around what will happen with the ACA as a result of the presidential election.

 

Now that most insurance companies have discontinued paying agent commissions it is becoming even more difficult for us all. The high quality service business model I operated on for 15 years has now become near impossible in the health insurance market with short enrollment windows, limited offerings, time-consuming consultations and now zero commissions. The roll of the agent/broker service in under-65 health insurance is more important than ever, yet harder to provide than ever.

 

Not a day goes by that I don't struggle with coming up with health insurance solutions for RVers; but this is a highly regulated and highly monitored industry which allows for very little creative alternative strategies. Nevertheless, I am still exploring

[VallAndMo]

Hello everyone,

 

Interesting article mentioning the issues insurance companies are going thru, specially BSBC's parent company:

 

http://www.chicagotribune.com/business/ct-blue-cross-obamacare-insurance-0313-biz-20160311-story.html

 

Cheers,

--

Vall.

[Mariner]

Very interesting Jim. At the risk of pushing the "political edge" - something has to be done about the health care mess in this country that was amplified by the current program as it was implemented. It is starting to affect everyone's way of life (eg. can I fulltime?), where they live , how and where they work, etc. It is becoming a very serious problem that many people still do not recognize.

 

Jack you are so right. I've been saying for quite some time that the effect on everyday life would be disruptive. The last enrollment figures being touted was 8.8 million for the ACA. The entire Healthcare system blown up for 8.8mil. out of 300 million?? Where's the logic in that?

[Barbaraok]

I think you are forgetting that all 300+ million no longer have pre-exisiting conditions; no longer have lifetime caps, all of us now have a list of procedures that must be covered, doesn't matter what the source of the policy, all children can stay on parent's ins until 26; shrinkage of donut hole in Medicare, etc.

[Daveh]

Yes, Barb there are those significant omissions and the fact that Mariner's numbers are just wrong. His 8.8 million number is off by over 40%. The most recent number is 12.7 million enrolled through ACA. http://www.modernhealthcare.com/article/20160311/NEWS/160319974. When you add Medicaid expansion and young adults under 26 that stay on their parents policy the number is over 20 million which means Mariner's number is off by approximately 130%. The uninsured rate in the US is now around 11% down from the pre ACA level of 18%.

[sailwing2003]

With all the "good" that can be found or said about the ACA, I am still stunned that here in TX we can't get but one plan, at almost $900 each, that would allow or provide health care needs beyond a select few counties. The worry and concern about being out of network, when you travel 50-100 miles from home is really unsettling.

 

As we hope to be out of state for the summer, we will have to drive 800 miles home for Drs. and coverage, and lab tests. Would seem that a blood lab test done in NM, might be about the same cost as one done in the DFW area. Being 400 miles from home these last 3 months has had us out of network. When I first tried to refill a RX at CVS here, I was first told that I had to use the CVS, 400 miles north, just a mile from my house. A couple of phone calls got that straighten out. We have a plan with Baylor in the name, but we can not use the Baylor teaching hospital near by, only the ones in the DFW area.

 

We are in the highest costing zip codes by the chart, yet can not get in network service in less expensive zip codes in the state.

Frustration is a slightly under rated word. Already reported members can not get lab work done where they are parked.

[Barbaraok]

I would suggest that you see if your physicians can't write Rx for 3 months at a time and that you use a mail order pharmacy.
But you must remember, that MOST people have their physicians in the town/county where they live. And all insurance is based upon what MOST people in the pool need. And the problems in TX are there because of the way insurance is managed at the state level. And we probably are at that discussion line that shouldn't be crossed on an RV forum.

 

Barb

[sailwing2003]

Barb, thank you for the suggestion on mail order. That has been my solution for the last 6 years, for the huge 90% cost savings on the one RX that I take. I have RX for 3 months. And note that means 84 days, and 4 times that is not a year! This time I got jammed up with the mail order company and their system. They took the info, 3x and called to confirm 2x, and then showed us pending when the order was to have arrived. A last call got them to accept the CC they said they would not take, instead of the check info given. They got it finally on it's way. In the mean time I stopped to get just a month's supply to hold me over. That when I got to pay 10x as much per pill, at CVS.

 

We learned that our new insurance company only wants to do only 30 day refills, on 3 month RXs. Calls have gotten us the info, to ask for vacation over rides, (90 days). Learning the new system is frustrating, when they keep changing the old rules.

 

Dolly takes about 12 RXs, and this year is going to be very differently done than last year.

[Jack Mayer]

There is no question that some good things came from the ACA. As Barb likes to point out - diagnostic testing, preconditions, etc are all good things. I've benefited some from them. Especially in getting a $2K or more colonoscopy done for literally nothing. So I do think some good has come from it. But at a VERY, VERY high price. There is nothing affordable about the health insurance available under the current set of conditions in this country. EVEN IF I was covered under the exchange and got a high subsidy it would still be very restrictive (location wise) and costly.

 

As I said, there is a LOT MORE work to do no health care in this country. We have only complicated things with the current plans. And the amount of waste associated with it is astounding. Just the website is well over a Billion dollars in cost. Which is incredible to those of us that understand what is involved in it.

 

As far as getting 90 days of medications - my "wonderful" EPO will not allow that - 30 days at a time only. And I pay almost full price for them - no prescription plan until 6800 deductible is met. I do get the "plan" price. Which amounts to a 15% discount over retail.

[Zulu]

Zulu,

 

Here are a few strategies we have implemented or recommended for accessing healthcare on the road:

 

1. Telemedicine: This is in my opinion a must-have for RVers. We have used it for our family 4 times in the past 6 months and it has been very convenient for us. We were able to get a phone consultation, diagnosis and Rx prescribed quickly, accurately, and easily from each of the locations we used it. **Disclaimer: I may earn a commission if someone enrolls in this.

 

2. Short Term Medical: Although the ACA penalty is making this option more difficult (it increased in 2016) it is still worth looking into as an alternative to ACA coverage because many of them have broader nationwide networks and lower (unsubsidized) premiums. **Disclaimer: I may earn a commission if someone enrolls in this.

 

3. MDVIP: This is something fairly new that many folks are not aware of. It is a membership-based Direct Primary Care program whereby you have access to affiliated doctors (over 800 nationwide) 24/7 and same or next day appointment priority. I DO NOT earn a commission for these enrollments.

 

I suggest adding another 4th "strategy" -- Healthcare Sharing Ministries. Though they aren't for me (and I'll guess not you either), people are choosing to go this route. Don't you think listing the Pros and Cons for this method would be beneficial? Glenn West on this forum will tell you the Pros .

 

 

I am extremely reluctant to recommend any "moving strategies" as a health insurance fix because, 1) Although health insurance is a big issue for RVers there are other domicile factors (legal, taxes, etc,) that must go into such a decision that I am not qualified to address, and 2) As we have seen happen in Texas, changing your domicile for better health insurance may be a temporary band-aid at best since any insurance company can change their rules/offerings in any given year. Additionally, there is a lot of uncertainty around what will happen with the ACA as a result of the presidential election.

 

My 5th strategy (moving to a new domicile) . . .

 

As for your #1 reason against this strategy (not feeling qualified), if you feel unqualified, aren't there other qualified folks that Escapees could tap? For example, Miri Kim Wakuta, the lawyer who wrote the Address and Domicile article in this March/April Escapees magazine?

 

Also, I would hope that the onus investigating all this would not be on just you. Maybe Escapees could take the lead on this and ask help from its membership or use crowdsourcing. As far as investigating ACA health plan options, I used "brute force" techniques over several months to get health plan info on 15 states (about 900 counties). I am certain this could be done more efficiently.

 

As for your #2 (moving may be at best a temporary fix), true, but if it could save someone hundreds in premiums AND get an RVer a very good health plan, then shouldn't this choice at least be presented as an option?

 

Regardless, in order to help its under 65 membership, I think Escapees needs to think outside the "box" -- that is, Texas, South Dakota, and Florida. I say this in response to the following quote from the March/April Escapees magazine article Telemedicine first paragraph:

 

"And now that Blue Cross and other health insurance providers have eliminated PPO health insurance plans that enabled full-time RVers like us to get health care anywhere, staying healthy is even more critical."

 

This statement is totally false.

 

In 15 states I examined, 8 of the 15 had nationwide BSBC plans.

[Daveh]

I really know no one that wants to see the health care system remain exactly as it currently exists. Some of the major problems are surprise out of network costs, high deductibles, narrow provider networks and abusive pricing with prescription drugs. We still spend almost twice as much per capita as the next industrialized nation with much lower satisifaction and poorer outcomes in many specialties. However, this does not diminish the things that have been accomplished with the ACA. Specifically, adding the benefits Barb outlined (all great but especially preexisting conditions) and the extremely significant increase in the number of insured is a huge accomplishment.

 

Jack I disagree with you on two points. First, you say the changes came at a very very high price, however, on average, premiums have risen by about 5.8 percent a year since Obama took office, compared to 13.2 percent in the nine years before Obama. http://www.politifact.com/truth-o-meter/statements/2015/oct/25/donald-trump/trump-obamacare-health-care-premiums-going-35-45-5/. Also, it just is not fair to judge the ACA by your experiences in Texas. That state obstructed the law and experiences therein cannot be used to fairly critique the law. My experience with Michigan has been dramatically different than what you describe.

 

I do agree with Zulu that Escapees could be much more active. Back in Novemeber I wrote the Escapees advocacy group to let them know that the CMS had out proposed rules for the ACA (one of the areas to be addressed was narrow networks) and were requesting comments. I encouraged them to get involved with the purpose of requiring that at least one plan be offered in each state that would provide out of state coverage. We cannot get new legislation in this environment but the CMS still has rule making authority under the original legislation. I also offered to help with any effort. I never got a response. No one is going to correct a problem without advocacy.

[Jack Mayer]

I find it hard to believe that premiums have risen so little when mine went up over 50%. In the two years of the ACA. Not to say that they were not increasing rapidly before that. Now if you count the supplement then no - they would not have gone up. Mine actually was about the same - for a better policy - the first year of ACA> But I had a fairly large supplement. If you added that cost into it then it went up substantially.

 

I'll have to research the overall costs, COUNTING the supplements.

[Mariner]

I find that the defenders of the ACA are the ones who have benefited from it the most, without any thought to the millions who have had their lives turned upside down by it. I would also defend it, IF it provided low cost healthcare as was promised, to EVERYONE!! Which of course it doesn't.

[Mariner]

Yes, Barb there are those significant omissions and the fact that Mariner's numbers are just wrong. His 8.8 million number is off by over 40%. The most recent number is 12.7 million enrolled through ACA. http://www.modernhealthcare.com/article/20160311/NEWS/160319974. When you add Medicaid expansion and young adults under 26 that stay on their parents policy the number is over 20 million which means Mariner's number is off by approximately 130%. The uninsured rate in the US is now around 11% down from the pre ACA level of 18%.

 

I went back and looked at the CBO's estimate on ACA enrollment for 2016. And their estimate for the entire year has changed. Where they were originally projecting an enrollment figure of 21 million by the end of the year, they now are projecting it to be only 12 million by the end of 2016. However you slice it, an entire healthcare system has been blown up for a very small population, at the expense of a very large majority.

[Daveh]

Mariner, you start by saying enrollment is 8.8 million, then you say, "okay it is 12 million, but it is still terrbily low". (The nmuber right now is 12.7 million). You now refer to the CBO report. The Congressional Budget Office is independent of the administration. They can make and revise whatever projections they want but it is the CMS implementing making the administration's projections for the ACA. Additionally, the CBO number of 20 million was confusing a lot of people and they did provide clarification in their January supplement which I describe below. Also, they should have a final baseline report coming out their this months giving the 2016 numbers. But don't hold the CMS to the numbers created by the CBO and then call the CMS a failure. Here is more of an explanation of the numbers:

 

On January 25, 2016, the Congressional Budget Office (CBO) released The Budget and Economic Outlook, 2016 to 2026. The report does not update completely the Affordable Care Act (ACA) estimates found in the CBO’s March 2015 Baseline Report (a complete update will not occur until this March’s report), but it does provide some new information.

The CBO had estimated in its March 2015 baseline report that 21 million individuals would be covered through the marketplaces by 2016. Enrollment has been much lower than projected, a fact noted frequently by ACA critics. The January 25, 2016 report clarifies that the 21 million number had included 15 million who would be covered through the marketplaces with premium tax credits and an additional 6 million who would purchase unsubsidized coverage through the marketplaces.

The CBO now projects that 13 million will be covered through the marketplaces for 2016, including 11 million with subsidized coverage and 2 million without. Half of the 8 million enrollee discrepancy between the March 2015 and January 2016 enrollment numbers is due to a reduced estimate in the number of individuals projected to enroll in the marketplaces without subsidies.

The CBO expects that most of these individuals will now purchase coverage directly with an insurer. The CBO also dialed back its projections for marketplace enrollment for 2015 from 11 million to 9.5 million, with the difference entirely due to a reduction in the projected number of unsubsidized enrollees.

The CBO’s projection of 13 million marketplace enrollees is still higher than the 9.4 to 11.4 million that the Centers for Medicare and Medicaid Services (CMS) project will be covered by the end of 2016, but 2016 enrollment is so far coming in at the high end of the CMS projections, so final enrollment might be somewhere in between the CBO and CMS estimates. Reduced enrollment will, of course, reduce the cost of the program — the CBO projects a reduction of $7 billion over the next 10 years.

 

http://healthaffairs.org/blog/2016/01/26/cbo-lowers-marketplace-enrollment-projections-increases-medicaid-growth-projections/

[Ronbo]

Suzy, in your letter you stated that you and your husband are both prior military. You can both use the VA. I have been using the VA for my health care. I started Medicare this month (not yet 65 but on disability). My wife uses Christian Healthcare Ministry. We ask for and have always received a nice discount due to paying cash. We then submit for reimbursement. She pays $150 per month and $500 per event. Much cheaper than ACA.

[GlennWest]

 

I suggest adding another 4th "strategy" -- Healthcare Sharing Ministries. Though they aren't for me (and I'll guess not you either), people are choosing to go this route. Don't you think listing the Pros and Cons for this method would be beneficial? Glenn West on this forum will tell you the Pros .

 

 

 

My 5th strategy (moving to a new domicile) . . .

 

As for your #1 reason against this strategy (not feeling qualified), if you feel unqualified, aren't there other qualified folks that Escapees could tap? For example, Miri Kim Wakuta, the lawyer who wrote the Address and Domicile article in this March/April Escapees magazine?

 

Also, I would hope that the onus investigating all this would not be on just you. Maybe Escapees could take the lead on this and ask help from its membership or use crowdsourcing. As far as investigating ACA health plan options, I used "brute force" techniques over several months to get health plan info on 15 states (about 900 counties). I am certain this could be done more efficiently.

 

As for your #2 (moving may be at best a temporary fix), true, but if it could save someone hundreds in premiums AND get an RVer a very good health plan, then shouldn't this choice at least be presented as an option?

 

Regardless, in order to help its under 65 membership, I think Escapees needs to think outside the "box" -- that is, Texas, South Dakota, and Florida. I say this in response to the following quote from the March/April Escapees magazine article Telemedicine first paragraph:

 

"And now that Blue Cross and other health insurance providers have eliminated PPO health insurance plans that enabled full-time RVers like us to get health care anywhere, staying healthy is even more critical."

 

This statement is totally false.

 

In 15 states I examined, 8 of the 15 had nationwide BSBC plans.

I also have a big problem with paying for abortions. We don't with Liberty Health Share. We did with ACA. Not trying to make this political so please don't take this there. It is for us a Christian principle. Will state ours have a 1 million cap per event. Also doesn't have a drug prescription coverage. Now if connected to covered surgery, procedure, etc it is paid. Also it is much less monthly costs. This may be a problem for some. Also if you abuse your body you probably won't be accepted. Tobacco use is prohibited. Acceptance is not guaranteed. We do have the option to vote on what we want changed. If enough members want it and it is not against Christian principles it is passed. Ok Zulu, did list the cons also this time.