Domicile question

[Barbaraok]

Are there a lot of people who fulltime and have no primary care physician - someone who you see on an ongoing basis at least once a year? As a cancer survivor, I can't imagine not making sure I had an ongoing relationship with a primary care physician.

 

Barb

[Raquel]

We are 66 and 67. We have never had a primary care physician. Just because you cannot imagine it does not mean there are not a lot of people who are living it.

[Mariner]

We also have not had a primary care physician while full timing for over 5yrs. now. Never had a problem finding a Dr. when needed.

[WILDEBILL308]

Thanks everyone, I think we'll go with our original plan and become Texans!

Welcome to Texas.

Bill

[LFDR3116]

We also do not have a primary care physician. DH has been uninsured all of his life - now has Medicare. I did have insurance thru my employer until 4 1/2 yrs ago and now am uninsured until I qualify for medicare. I do have a HSA with funds that I can use for myself. Luckily we are both in good health and do not even take any type of prescriptions. We cannot afford any premium from the current budget other than the medicare part B. That's just the way life is for some people.

[Barbaraok]

So do all of you forgo routine screenings such as mammograms, pap smears, PSA tests, colonoscopies, A1C, Cholesterol panel, CBC panel, liver, glacoma checks, cataract checks, BP, etc.? Just because you feel good doesn't mean there is no cause for concern. The body does begin to loose it's vim and vigor as we age - by picking up things early, you can often forgo problems later and live a long life.

[Zulu]

So do all of you forgo routine screenings such as mammograms, pap smears, PSA tests, colonoscopies, A1C, Cholesterol panel, CBC panel, liver, glacoma checks, cataract checks, BP, etc.?

 

Barb, as I remember, isn't your health insurance provided by a previous employer?

[Barbaraok]

No, we're on Medicare. I'm alive today because my ovarian cancer was caught early. I had no symptoms . If I had waited for symptoms I would be dead.

[airstream harry]

We do not travel any longer,but still live in our rig. We have a medicare Advantage plan. 1999 went on the roan age 60 wife 57. Had cobra for 18 months. After that no insurance. Wife had Texas High Risk(reynauds) very expensive. In a period of 3 years we had several financial disasters. So no insurance.

Barb, there are a lot of folks who do not have a primary care MD. We left to start our full time life with a complete set of medical records. Never had a problem getting them from providers when on the road. Example-wife broke her finger in Demning NM when to local hospital, paid cash ,bargained for a very reasonable rate. For blood work Quest Labs.

The point of this is more and more folks have to figure out how to manage their health care if it is not paid by former employer..It is not always poor planning.Lots of hard working people worked jobs that did not enable them to save a lot. So now they want to enjoy our life style and have to figure it out. God bless them.

c u on the road

[Zulu]

No, we're on Medicare. I'm alive today because my ovarian cancer was caught early. I had no symptoms . If I had waited for symptoms I would be dead.

 

Before Medicare, though, wasn't your health insurance provided by a previous employer?

[Barbaraok]

Yes, and?

[GlennWest]

We also get and keep all medical records. We use what doctor we can get since we move from job to job. By getting and keeping our records it has not been an issue. I am very blessed to be healthy. My wife is basically also. Some problems but nothing life threatening. And also with health share coverage we pick doctors we want. Texas has been great for us.

[sandsys]

So do all of you forgo routine screenings such as mammograms, pap smears, PSA tests, colonoscopies...

So many tests provide false positives that paying to have them then paying for treatment you didn't actually need irritates some of us. The recommendations for mammograms and colonoscopies have recently been reduced because of these false positives. Just because you were one of the lucky ones who actually got cancer that doesn't make the rest of us at high risk. We all get to choose how to live our lives.

 

If you are so determined we all have medical insurance, how much are you willing to contribute to our premiums? Not for Dave I since we, like you, were among the lucky ones who had employer provided insurance until we qualified for Medicare. But, for those who have to pay their own way, how much of your budget are you willing to sacrifice for them?

 

Linda Sand

[rynosback]

Since healthcare is a major factor now in deciding where to domicile, you really have to do some investigating. In some places just moving from one county to the next can save you hundreds. In our case, both over 65, we're saving over $1500 a yr. on our PPO supplemental plan by relocating to S.C. from Md.

Because MD is a VERY expensive state. I lived there all of my life.

[GlennWest]

So many tests provide false positives that paying to have them then paying for treatment you didn't actually need irritates some of us. The recommendations for mammograms and colonoscopies have recently been reduced because of these false positives. Just because you were one of the lucky ones who actually got cancer that doesn't make the rest of us at high risk. We all get to choose how to live our lives.

 

If you are so determined we all have medical insurance, how much are you willing to contribute to our premiums? Not for Dave I since we, like you, were among the lucky ones who had employer provided insurance until we qualified for Medicare. But, for those who have to pay their own way, how much of your budget are you willing to sacrifice for them?

 

Linda Sand

It was costing us over 1K monthly for us for a PPO plan with 10k ded. We did not consider that reasonable or even tolerant. Most no one in our field of work have medical insurance unless wife has coverage thru her job. But this is true of any state. So I don't really see this a bearing on state domicile for us under 65. All my fellow workers are from Mississippi, Louisiana, Alabama, Texas, SC and NC and others. We all are in same problem with insurance. Many are very thankful I turned them on to health share plans. It is about the only alternative for us.

[Barbaraok]

Just because you were one of the lucky ones who actually got cancer that doesn't make the rest of us at high risk

 

Linda Sand

 

One of the lucky ones? Really? Sure didn't feel like I was lucky. I suppose Dave was also lucky to have his stroke, or have to have stents put in?

[Zulu]

It was costing us over 1K monthly for us for a PPO plan with 10k ded.

 

You earn too much to qualify for a subsidy?

 

You're 59, right? How hold is the Mrs?

[GlennWest]

Deleted

[Zulu]

That was both of us. And no, thankfully I dont live off of others. That is all a sudidy is. May not be popular statement but its others money

 

So you were eligible for a subsidy but didn't want to, right?

[GlennWest]

Deleted

[Zulu]

I stated no. Let's not turn this into a aca dispute. It was asked how much one would pay and I stopped at that cost. Texas is no different in this. It is terribly costly, period.

 

Glenn, in all the health discussions, you've posted how much you "had" to pay -- over $1K, right?

 

But in actuality if you had taken an ACA subsidy, the cost would have been less. Maybe significantly less.

 

[GlennWest]

Deleted

[Zulu]

It down not matter the state if you under 65. That is what I getting at.

 

For ACA on-exchange health plans (where you can qualify for subsidies), It makes ALL the difference -- even possibly more so is the county you domicile in.

 

States (and counties) not only vary in health insurance costs, but in the number of plans, types of plans (HMOs, PPOs, etc), and number of insurance carriers.

 

For example . . .

 

In all these examples, HealthSherpa was used and plan costs are based on a 63-year-old woman earning too much to qualify for a subsidy -- so paying full cost.

• In Mohave County, AZ (where I domicile -- bad choice), the lowest cost ACA on-exchange PPO plan is $862. In Pima County, AZ the same plan costs $439. That's over a $5,000 per year difference for the exact same health plan.

• In Mineral County, NV, the lowest cost ACA on-exchange PPO plan (from Anthem BCBS) is $894. In Clark County, NV the same plan costs $571. Over $3,800 per year difference for the same health plan.

• For the state of TX, SD, and FL, the average # of ACA on-exchange health plans in each county is 25, 18, and 34.

• For the state of WA, the average # of ACA on-exchange health plans in each county is 61.

• 58 of the 234 counties in TX offer ACA on-exchange PPO health plans, but not Polk County.

• BCBS ACA on-exchange PPO health plans are offered in AL, LA, NV, and WA.

 

My point is that if you're selecting a domicile and have to buy health insurance, look around.

 

 

[Alie&Jim's Carrilite]

My point is that if you're selecting a domicile and have to buy health insurance, look around.

But many of us had already established domicile before the ACA took effect. For instance in SD, I don't qualify for a subsidy- make too much $$..... so I'm paying thru the nose for a plan that I hope I don't get canceled/dropped from if they- the insurance company - realizes that I'm a fulltimer and don't actually live there. It is a PPO and has a rather high deductible but it covers all my prescription costs.... which is actually higher than the payment.

[Mariner]

As I've said before, because of the vast disparity in premiums from one county to the next it's going to force people to move to where the lower premiums are. But why should they have to move? If only the ACA was actually affordable and fair to everyone, everywhere, this problem wouldn't arise. But when did fairness ever become a pre-requisite when it come's to the ACA?