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Any Current Healthcare Solutions for Pre 65 healthcare?

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Hi,

 

I need to select either SD or TX as domicile, and I will be roaming out of state primarily.

 

Reading what has been posted I see the healthcare insurance problem for pre-medicare age retirees. I noticed some discussion that Hillary may have a solution for us, and other concerns mentioned during 2015.

 

Has anyone found "any" solution now for pre-medicare age insurance plans that covers outside the domicile state?

 

For just using the healthcare inside the domicile state are people being rejected simply because they are RVers?

 

I see the tele-medicine support, but is there actually an insurance plan to protect from catastrophic costs? If not, I suppose there isn't much difference between the SD or TX locations.

 

Any input?

 

Thanks,

Bill

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Welcome to the Escapee forums. We are here to help so feel free to take part in any forum and ask questions or offer comments.

 

Since we don't really know where you are moving your domicile from or any of your plans, let me suggest that you share a bit more information with us about yourself. To learn about domicile and selecting one, let me invite you to read this article from Escapees magazine. For help with your insurance questions I suggest you contact Kyle Henson who is our resident insurance expert. The health industry is in a time of great change an finding the right policy can be difficult. You will find many opinions on our forums and some advice may be helpful, but be sure to get advice for a good source and from a reliable source. As one who is on Medicare and has been since before the current laws took effect, I'll yield to those who are more current in the insurance market.

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I need to select either SD or TX as domicile, and I will be roaming out of state primarily.

 

For those under 65 who have to purchase their own health care, SD and TX are about the two worst states to domicile in. Neither state offers PPO health plans that have nationwide health provider networks.

 

What about FL? It is a state with no state income tax, offers the Escapee mail service, and has BCBS EPO health plans that have nationwide networks.

 

Also, there are other states that offer BCBS PPO plans -- see Selecting a Domicile (Part 2.5).

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Note that Zulu specifically mentioned BCBS plans on the guide he linked to. Don't be fooled by seeing PPOs listed for states like South Dakota and Texas--those are PPOs but they are local networks only, not nationwide. I'm not even sure all BCBS offerings are nationwide, but I know for sure the others aren't. That list is deceptive for fulltimers seeking a nationwide network of providers.

 

Are you limited to finding a plan on the exchange because you qualify for a subsidy? You might have more choices if you don't limit yourself to on-exchange plans.

 

At one point, people in South Dakota were being rejected because they were RVers, but I'm not sure if that's still going on. Texas has not had that problem that I am aware of.

 

As Zulu pointed out, you should consider Florida. Escapees has an add-on mail service (you do this in addition to your traditional Livingston, Texas, address), or there are other mail forwarding services in Florida that fulltimers use.

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I also am interested why you are limiting your domicile to South Dakota or Texas. For those of us under 65 the traditional analysis for fulltimer domiciles is usually inapplicable due to the high cost of health care. Health care considerations overhwhelm the typical reasons for choosing a domicile.

 

To answer your question, I am aware of no new developments since the previous discussions of this issue. The options are to (1) get an exchange plan with out of state coverage (you need a domicile in a state that offers this) (2) use one of the ministry share plans (not really insurance but you avoid ACA penalty and get some coverage or (3) pay the ACA penalty and look for a non ACA compliant plan that will provide you some level of protection.

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For myself there is nothing that draws me east, especially as far east and south as Florida. I just don't see myself ever being in Florida. With both South Dakota and Texas it would be do-able to go back once each year, or so, because all one can get is local coverage. Could one use Florida, just to get the insurance, and 'never' have to go back?

 

I was looking at BCBS's website the other day and when they speak of nation wide coverage they refer to a specific program. I'd need to call them, but I wonder if that is an additional premium.

 

I wonder: looking at ZULU's link to other states with PPOs - What does it take to establish domicile in those states and .... What does one do for a mail service then? I looked at one mail forwarding company in Oregon and they were out of business.

 

Blues: What are the other options you are referring to if one is not looking for subsidy.

 

Thanks - this is really complicated. What a sad statement for healthcare. Really, "health" and "care" - like those words go together anymore. Health money: that what it should be called.

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Following up with Zulu's comment about PPOs in other states: I think that would require I meet domicile requirements in that state. For example I would need some sort of legitimate address in Oregon I believe. So I would be back to the cost of that. I suppose one could just rent a room from someone, but I bet that would be hard to do for less than $400 per month.

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Following up with Zulu's comment about PPOs in other states: I think that would require I meet domicile requirements in that state. For example I would need some sort of legitimate address in Oregon I believe. So I would be back to the cost of that. I suppose one could just rent a room from someone, but I bet that would be hard to do for less than $400 per month.

 

Why are you looking at Oregon? Is it because you looked at that chart and saw there are five PPOs listed for Oregon and you liked the odds of getting suitable coverage from one of the five PPOs listed?

 

 

For myself there is nothing that draws me east, especially as far east and south as Florida. I just don't see myself ever being in Florida. With both South Dakota and Texas it would be do-able to go back once each year, or so, because all one can get is local coverage. Could one use Florida, just to get the insurance, and 'never' have to go back?

 

I was looking at BCBS's website the other day and when they speak of nation wide coverage they refer to a specific program. I'd need to call them, but I wonder if that is an additional premium.

 

I wonder: looking at ZULU's link to other states with PPOs - What does it take to establish domicile in those states and .... What does one do for a mail service then? I looked at one mail forwarding company in Oregon and they were out of business.

 

Blues: What are the other options you are referring to if one is not looking for subsidy.

 

 

 

Insurance plans are either on the exchange or off the exchange. If you want a subsidy, you're limited to plans that are on the exchange (and a silver plant, at that). If you don't qualify for a subsidy, you can look for plans off the exchange, and you can get them through an agent or directly from the health insurer. All of them are ACA compliant (provide a base level of coverage). Or, as Daveh said, you can get a non-ACA compliant plan and pay the penalty.

 

I'm not sure from your comment whether you're talking about going to your state of domicile every year or so for health care, or if you think you need to do that to maintain your domicile. If it's about maintaining your domicile, then you need to do a lot more reading of the hundreds of discussions about that, to become more informed. South Dakota, Texas, and Florida all have long-established mail forwarding services that cater to RVers and know what they're doing.

 

If going back every year or so is about getting health care, people have done that voluntarily because they want to keep seeing their doctors, but I'll warn you that many insurance plans provide no out-of-network coverage at all, period. So if you have to see a doctor out of your network, you'd better hope the insurance company considers it an emergency (as well as any required after-care out of the network), or you're on the hook for all of it. And even if you have out-of-network coverage, it's a separate deductible AND you're on the hook for the difference between what your insurer pays the provider and what the provider thinks it should be paid (it's called balance billing and is terrifying). This is why getting a nationwide network is so important to people who travel all the time.

 

Also, be aware that the health insurance landscape could change dramatically come October, when the new plans for 2017 appear. Up until October 2015, people using Escapees mail service to be Texas residents had access to Blue Cross PPO with a nationwide network, and then BCBS announced they wouldn't provide that plan in Texas for 2016, so everyone went scrambling. So unless you need health insurance right now, you should consider what you're learning now as background (very useful background) and wait to see the changes that appear in October.

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Why are you looking at Oregon? Is it because you looked at that chart and saw there are five PPOs listed for Oregon and you liked the odds of getting suitable coverage from one of the five PPOs listed

As I said , "For example..." and maybe its a place I'd choose to live rather than Florida. ... following up with my question to Zulu.

 

 

 

 

I'm not sure from your comment whether you're talking about going to your state of domicile every year or so for health care, or if you think you need to do that to maintain your domicile. If it's about maintaining your domicile, then you need to do a lot more reading of the hundreds of discussions about that, to become more informed. South Dakota, Texas, and Florida all have long-established mail forwarding services that cater to RVers and know what they're doing.

 

I made the comment because if I pay for a PPO service that provides only local network, that I might as well go back there for at least basic annual medical needs to benefit partially from a policy that I would be paying for.

 

 

 

 

 

 

 

If going back every year or so is about getting health care, people have done that voluntarily because they want to keep seeing their doctors, but I'll warn you that many insurance plans provide no out-of-network coverage at all, period. So if you have to see a doctor out of your network, you'd better hope the insurance company considers it an emergency (as well as any required after-care out of the network), or you're on the hook for all of it. And even if you have out-of-network coverage, it's a separate deductible AND you're on the hook for the difference between what your insurer pays the provider and what the provider thinks it should be paid (it's called balance billing and is terrifying). This is why getting a nationwide network is so important to people who travel all the time.

Hence, my original posted question.

 

 

 

Also, be aware that the health insurance landscape could change dramatically come October, when the new plans for 2017 appear. Up until October 2015, people using Escapees mail service to be Texas residents had access to Blue Cross PPO with a nationwide network, and then BCBS announced they wouldn't provide that plan in Texas for 2016, so everyone went scrambling. So unless you need health insurance right now, you should consider what you're learning now as background (very useful background) and wait to see the changes that appear in October.

Another reason I would not seek domicile in Florida. As WheelingIt.Us says, it looks like the trend is to eliminate such coverages - in their opinion.

 

 

I am familiar with the background issues. My original questions were:

 

"Has anyone found "any" solution now for pre-medicare age insurance plans that covers outside the domicile state?"

"For just using the healthcare inside the domicile state are people being rejected simply because they are RVers?"

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"Has anyone found "any" solution now for pre-medicare age insurance plans that covers outside the domicile state?"

 

The locations of the major mail forwarding companies in South Dakota and Texas don't offer that, and that's why people are having trouble. But if you don't need to be tied to those services, and especially if you don't need a plan that offers a subsidy, it's possible to find coverage with a nationwide network.

 

For example, I just did a quick check and found, for a zip code in the Denver area, Humana has three plans that are in the National POS - Open Access network. I did a search for a general practitioner within 100 miles of Dallas and got 3,645 hits.

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If I were you I would look at those states which expanded Medcaid early in the Obamacare process and which have voted Democratic in the last two presidential elections.

 

Then I would focus on the states geographically that I would most desire as a home base.

 

Once I had that list I would look at which of those states have plans with out-of- state coverage. I would also try to search local newspapers for any discussion of insurance issues or plan changes in those states.

 

Once you have that list then drill down further and look at domicile issues for those states.

 

Unfortunately it is a lot of work and even if you get it all in place you still are in no better position than the rest of us under-65s. We just have to plan as best we can and take it year by year. I am in Michigan, which I chose because I lived there 35 years and have the connections. However, the state has a Republican legislature and governor (engaged in such behavior as switching Flint to a leaded water supply), so this would not be my choice had it not previously been my domicile.

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Yeah, I have a pretty good idea of where I choose as a home state; not 100% sure. The big problem is residency (and mail forwarding). The cheapest way to do that is to just rent a room somewhere so one has an address to start, but that would likely cost $400+ per month just to have an address..

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I wonder: looking at ZULU's link to other states with PPOs - What does it take to establish domicile in those states and .... What does one do for a mail service then?

 

I've used mom & pop mail forwarding services with success.

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. . . if you don't need a plan that offers a subsidy, it's possible to find coverage with a nationwide network.

 

For example, I just did a quick check and found, for a zip code in the Denver area, Humana has three plans that are in the National POS - Open Access network. I did a search for a general practitioner within 100 miles of Dallas and got 3,645 hits.

 

I did a thorough check, and every CO county offers an on-exchange ACA Anthem BCBS health plan (Bronze & Gold). You'll have to check if these BCBS plans offer national networks.

 

However, CO vehicle registration & license fees look high.

 

BTW, if you want to search for off-exchange health plans, try this -- https://finder.healthcare.gov/

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I did a thorough check, and every CO county offers an on-exchange ACA Anthem BCBS health plan (Bronze & Gold). You'll have to check if these BCBS plans offer national networks.

 

However, CO vehicle registration & license fees look high.

 

BTW, if you want to search for off-exchange health plans, try this -- https://finder.healthcare.gov/

 

 

 

Thanks, but that still leaves the problem of domicile in Colorado and mail forwarding. To me these are the most problematic aspects.

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Thanks, but that still leaves the problem of domicile in Colorado and mail forwarding. To me these are the most problematic aspects.

 

While domicile can be problematic, mail forwarding should not be an issue . . . unless you must have one of the "big name" services.

 

You really need to do more domicile homework. For example, some counties in some states require yearly emissions testing -- something you probably want to avoid.

Edited by Zulu

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Thanks Zulu. I looked at mail forwarding once in Oregon and the company was going shutting down. I didn't explore the issue further since I would likely be considering Oregon/Idaho/Montana/Colorado region... in the long run.

 

I guess the big question is who offers mail forwarding, "and" also meets the need for domicile.

 

I don't mind coming back to the domicile state annually. I just don't want to drive to Florida. I suppose that puts me in the category of staying in the West coast/Rocky Mountain states.

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Health share programs eliminate this issue. We use Liberty Health Share. I am 59, wife 62. We full time and have Texas resident. Go to any state any doctor any network

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Have you made contact with Kyle Henson yet? I repeat my caution about choosing what to act on. If you are really willing to move to most any state, there are alternative states that will accept a mail service address for driver's license, vehicle registrations and insurance and other things that you will need. Nevada has been used in the past. Oregon does also but you must live physically in that state for at least 6 months to qualify there. The reason that SD, FL and TX are so popular is the combination of features such as a lack of income tax an acceptance of mail service addresses. But there are several other states that may be acceptable. Since the passage of the "Affordable Healthcare Act" there has been an almost constant change in policies offered in the various states and it seems to be more complicated every year. I think that you would be wise to discuss your issues with Kyle because not only is he in the business, but he also is an expert on the subject and has a proven track record of advising members to buy where it suits their needs best, even if it means that he can't be your agent.

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Yes I spoke with him a few months ago when I was planning the timetable for my exit strategy. We agreed we'd talk again when I was closer to that time

 

What two other Western states would allow me to establish domicile (providing legitimate address without residency) that would also have mail forwarding service?

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In the 77399 zip (TX, Escapees) last year I had an EPO that was rational. That is the best you can do in that zip. It was off-exchange. There are NO on-exchange plans in 77399 that allow coverage in a rational way while travelling.

 

The advice to look carefully in October when new plans come out is good advice. The currently existing meager selection of plans that meet constant travelers needs are likely going to be (again) DRASTICALLY reduced in every state. I find it likely that those that need medical coverage (and want to travel extensively) in five years will have virtually no plans to choose from if the current system stays in place. That is just my opinion though.

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This remains one of the toughest nuts to crack for the Pre 65 group without retirement covered health insurance. No magic answer, and best I could find, for sure no inexpensive plans. (My wife, age 57, myself age 62 - pay $19.8K for PPO insurance (BCBS from North Carolina, a Retirement Group Health Plan.). We then have deductibles on top of that, so about $23-24K our of pocket to have coverage.)

 

I've looked into the faith based plans, would support us, and save us about $10-12K per year on just insurance costs. However, my daughter and her wife are for sure living a happy alternative lifestyle:)! And I can not in good conscious state that I do not believe that they should have a right to live their lives as they see fit. So, faith based is out for us.

 

We are SD Domicile. I've looked into getting a piece or property with a regular bill, to establish instate address. But as mentioned, even this does not provide a national based PPO coverage. We considered still getting one, off exchange, and then this coupled with FMCA insurance that will help us relocate back to our 'primary care' doctors in case of an emergency on the road. (Read the small words on these plans, as they state that Administrator Approval is required to approve the coverage of transfer to the primary care doctor....).

 

Another option, was to not have insurance at all. Pay as we go, which for the last few years we've been doing anyways for actual care - then with the pleasure of paying the Health Insurance cost on top of that. And then if something catastrophic comes up, we could change our Domicile to another state, which then triggers the 'life event', and then sign up for a health insurance plan for that state. No pre-existing, so we should then be covered for ongoing costs for this events recovery. (Note: I've had this both confirmed by some as a realistic strategy. And also had a few 'experts' say they did not know if this would work or not. So, do your own homework on this:)!) And yes, we'd then pay the no coverage penalty each year, which is going up too. But, if we remained healthy, it looked like about $13-14K per year savings.

 

OK - So what? And do I have any conclusion. Yes, I've concluded that the clowns in DC have really screwed up the coverage for the Pre 65 retired group. Ironic, as this group is usually the ones that 'Had done the right things.' along their lives, to be financially capable to retire at Pre 65. Now they seem to be penalized.

 

I'll also second Jack's caution, to wait until we see what 2017 will bring... Less plans, and higher costs. United Health pulling out of many states, including now California, makes the choices even less....

 

I personally have no confidence that regardless of 'what party' wins in this years elections - that anything will be done. Or if it is, it will be too late before it becomes rolled out, to do much good for us. Well more me as I'm now 63 (62 when signing up of 2016 insurance), and the wife will have 7 more years until 65. So it might help her some, and thus us. But the damage to our retirement budget has been done, and I suspect no one will retroactively say 'Oh, that was unfair to this group. Let's compensate them for this damage.'. Actually, regardless of what group takes of DC, I suspect this Pre 65 group, will be tapped on to help pay for those that have, or can not, take care of their own expenses for health care. And yes, even for those that are not citizens of the US.

 

So I suppose my conclusion is to not count on any party in DC, or DC in general, to do anything constructive on this mess in the near future. We'll just keep cutting our spending in other areas, impacting other parts of the economy from less spending, to cover these higher costs...

 

No simple answers on this. And for sure, many views on 'Oh this is great!' - to 'Oh this rally sucked!'.... And depending upon if you are a 'have' or a 'have not' in this current mix, views will vary:)!

 

Best advise, is to keep doing what you are doing. Research states that you feel will support what you want, including health care, and then make a decision and get out and going to have some fun... Do keep an 'exit strategy' in your decision process, not just an 'exit strategy from work' into retirement:)!

 

Best to all, have fun, be safe,

Smitty

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Thanks Smitty. In terms of political statements, I think ACA is simply government mandated corporate profits. Even tho Hillary says she'd like to offer Medicare as a buy-in for those such as us, why would the insurance industry let her do that? I am looking at health coops in the mountains states who at least are not greedy for profits.

 

Currently I work in healthcare and I see that people who have ACA plans, bronze or silver, can't even get in the door unless they can pay upfront cash - which many don't have, although they have to pay some monthly premium. I think the people in the middle are the ones burnt most.

 

I expect to be without insurance likely during the Fall of 2016 as I try to find a primary physician that would support a RVer lifestyle. I don't mind having to return to domicile state for planned healthcare needs, but I would like some catastrophic policy for when one is on the road.

 

Off hand it seems one needs to purchase at least a Silver plan to have some sort of out-of-network support (ER and many 50% copay). And I am looking at Off Exchange products.

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Kirk, On the advice to consult Kyle, I thought we had previously determined he did not want tobe consulted for the under-65 crowd. If you go to the link you posted, you will see that he specifically states he is not consulting on these issues.

 

For a bright spot in this rather gloomy it does appear that the insurer problems with the ACA are for now limited to United Health as other major insurers remain committed. http://www.commonwealthfund.org/publications/issue-briefs/2016/june/insurance-exchanges-promote-value?utm_source=McCue%20Promoting%20Value&utm_medium=Twitter&utm_campaign=Health%20Coverage

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Thanks Smitty. In terms of political statements, I think ACA is simply government mandated corporate profits. Even tho Hillary says she'd like to offer Medicare as a buy-in for those such as us, why would the insurance industry let her do that? I am looking at health coops in the mountains states who at least are not greedy for profits.

 

Currently I work in healthcare and I see that people who have ACA plans, bronze or silver, can't even get in the door unless they can pay upfront cash - which many don't have, although they have to pay some monthly premium. I think the people in the middle are the ones burnt most.

 

I expect to be without insurance likely during the Fall of 2016 as I try to find a primary physician that would support a RVer lifestyle. I don't mind having to return to domicile state for planned healthcare needs, but I would like some catastrophic policy for when one is on the road.

 

Off hand it seems one needs to purchase at least a Silver plan to have some sort of out-of-network support (ER and many 50% copay). And I am looking at Off Exchange products.

I work in healthcare as well and feel your pain. My WI plan required me to drop their plan when I left the state for a 3 month seasonal job in Yellowstone. So I have changed my domicile to WA where I grew up and plan to go back on a regular basis since I am trying to sell my WI home anyway. I have a physical RV park where I stay occasionally as an address for DMV and a PO Box for mailing and was there volunteering at a state park for the first 3 months of the year and now doing a seasonal job in ND. A mail forwarding service is not allowed per the DMV. I am having issues forwarding my mail from one PO Box to another in ND but plan to be back in WA since you can only forward mail for one year. There are some items that will not let me us a PO Box even as a mailing address and the street addressing option is not working if you forward your mail. I am curious to see what happens this year since the Blue Cross Plan in WA only had one option with out of state coverage.

 

Best of luck. I am looking at not traveling as much and trying to stay closer to WA perhaps (where I would like to spend more time anyway). I have no health issues so catastrophic with Emergency Evac through FMCA is what I am counting on.

Edited by Teri_WI

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