Nationwide Health Insurance

[Bill Howard]

Hi Folks,
My wife and I are going full time in out RV when our home sells in Texas. We plan to keep our domicile in Texas and we are getting quotes from various carriers. We have found that when the insurance carriers find that you are full time we have learned that they expect you to return to that state, Blue Cross Blue Shield for example, to use Doctors, and Hospitals located there under the plan there. I have Medicare and Part G, My wife age 60 and retired has cobra that is about to expire so if anyone can provide any company that will provide coverage Nationwide that would be helpful. Hope we are not asking for the impossible. Your response is gratefully appreciated 

Thanks
Bill

__________________
2011 Tiffin Allegro Bus 43 QRP
Cummins 8.9, Mileage 24,850.

[Big Greg]

We have Blue Cross Blue Shield of Michigan PPO plan and it has and continues to cover us across the US for the 11+ years we have been on the road.  We have used it for minor and major medical issues.  I believe they call it an Advantage plan that also manages Medicare.  All our insurance activity is through BCBS.  We are currently SD residents.      Greg

[Barbaraok]

Greg,

Is your BSBC through your former employer?  And are your primary care physicians still in Michigan?

[Kirk W]

Bill, you may find it helpful to contact the RVer's Insurance Exchange, an endorsed vendor and one who often supplies healthcare advice to the forums. 

[SWharton]

I just received an ad from FMCA for insurance. I dont't know what type.

[Zulu]

7 hours ago, Bill Howard said:

My wife age 60 and retired has cobra that is about to expire so if anyone can provide any company that will provide coverage Nationwide that would be helpful.

You'll have to domicile in FL for nationwide coverage . . . at least for 2018.

[rynosback]

We have Blue Cross Blue Shield PPO.  We never see the same doctor or dentist as we are fulltime.

[Barbaraok]

13 hours ago, rynosback said:

We have Blue Cross Blue Shield PPO.  We never see the same doctor or dentist as we are fulltime.

Which means that you are rolling the dice since you do not have an ongoing relationship to help identify slight changes.  While you can get by with this when younger, as you age you really need to see health care professional on a reoccurring basis.

[SWharton]

That is why we are establishing a relationship with doctors at our winter stop. This stip will never change as the Grandkids are in Phoenix. Plus, being Phoenix, there is understanding about snowbirds.

[Barbaraok]

Yes, we’ve been getting calls confirming when we will arrive and our fall appointment times.  Then we see them in March before leaving for the summer.

[richfaa]

We get our full check up by our Long time local Dr before we leave for the winter. We do have a back up at our Winter  residence.

 

[rynosback]

9 hours ago, Barbaraok said:

Which means that you are rolling the dice since you do not have an ongoing relationship to help identify slight changes.  While you can get by with this when younger, as you age you really need to see health care professional on a reoccurring basis.

We carry our records with us.  And bring them in when needed.  Do you really think that they remember you?  As they see how many people a day, 5 days a week, 52 weeks a year.  They can look at your records of previous visits.

[sandsys]

I'm sure my doctor reviews my records before she sees me but I'm also sure she remembers me. She remembers what things I won't do.

Linda Sand

[Kirk W]

8 hours ago, rynosback said:

We carry our records with us.  And bring them in when needed.  Do you really think that they remember you?

We carried a complete copy of our medical records along for nearly 12 years even though we did return annually to our doctors back in our domicile state to update things and renew prescriptions. If you do not have any maintenance medications, you may not need the annual checkup but as we get older that can become more important. 

In those 12 years we had occasion to visit a doctor from time to time and while pretty much all of them wanted to see a list of current medications, not one time did any doctor even show interest in the medical histories we carried. On the other hand, when you return to the same doctor year after year that doctor will have his/her own records at hand to review and most of them do recognize you as their patient and memory is refreshed by reviewing them. It probably depends on how many years you have been a patient of the same doctor and how frequently you had contact with them. If you have a continuing medical condition I believe that there is great value in returning to the same doctor.

[Barbaraok]

12 hours ago, rynosback said:

We carry our records with us.  And bring them in when needed.  Do you really think that they remember you?  As they see how many people a day, 5 days a week, 52 weeks a year.  They can look at your records of previous visits.

Yes, they do remember if they have good notes - especially if you have established a relationship with them.  And there may be things written in the notes the physician has like "fulltime RVer, only see once a year", or "Check abc level next year" or "schedule for colonoscopy next year", etc.   We now can ask questions of our physician via their patient portal, so when Dave had a question about dosage on a med he sent a note asking about possible change, she asked him to cut dose in half of that med and up dose on another.  That worked and it is on the list of things to discuss this fall when we see her again.  

[rynosback]

11 hours ago, Kirk Wood said:

We carried a complete copy of our medical records along for nearly 12 years even though we did return annually to our doctors back in our domicile state to update things and renew prescriptions. If you do not have any maintenance medications, you may not need the annual checkup but as we get older that can become more important. 

In those 12 years we had occasion to visit a doctor from time to time and while pretty much all of them wanted to see a list of current medications, not one time did any doctor even show interest in the medical histories we carried. On the other hand, when you return to the same doctor year after year that doctor will have his/her own records at hand to review and most of them do recognize you as their patient and memory is refreshed by reviewing them. It probably depends on how many years you have been a patient of the same doctor and how frequently you had contact with them. If you have a continuing medical condition I believe that there is great value in returning to the same doctor.

I do get an annual check up.  We we get our yearly scrips when we do them.  

[Kirk W]

12 hours ago, rynosback said:

I do get an annual check up.

If you mean that you return to the same doctor for it, that is pretty much what we did also. What we understood you to say was that you have no doctor that you return to each year?

[kb0zke]

We're domiciled in SD and on Medicare. We have supplemental insurance and Part D. We've never seen a doctor in SD, but Jo Ann had emergency surgery in WI a couple of years ago and I had cataract surgery in MO this year. NO problems with bills. Our supplement policy doesn't cover the annual deductible, but does cover everything else. Once all the bills are run past Medicare and the insurance company, we get a bill for the deductible. We pay it, and all is done. Usually, by the time we get that final bill we're long gone from wherever the service was provided.

When we set up all of the medicare stuff we told the agent we were full-timers and likely wouldn't be in SD much. He envied us and said he had thought about joining us when he got to that point in life.

[Blues]

On 9/7/2018 at 4:15 PM, Zulu said:

You'll have to domicile in FL for nationwide coverage . . . at least for 2018.

Florida isn't the only state that offers health insurance plans with nationwide coverage.  As mentioned upthread, Blue Cross in Michigan has a PPO plan.  And I know that Blue Cross offers a PPO plan in Maryland that has a nationwide network.

 

On 9/7/2018 at 11:10 AM, SWharton said:

I just received an ad from FMCA for insurance. I dont't know what type.

That is not health insurance.  It's an indemnity plan.  They are not the same thing, and don't even consider an indemnity plan as a substitute for health insurance unless you really understand what it is.

[Zulu]

44 minutes ago, Blues said:

Florida isn't the only state that offers health insurance plans with nationwide coverage.  As mentioned upthread, Blue Cross in Michigan has a PPO plan.  And I know that Blue Cross offers a PPO plan in Maryland that has a nationwide network.

Yes, but all these states have state taxes unlike TX and FL.

[mkc]

On 9/7/2018 at 9:46 AM, Bill Howard said:

My wife and I are going full time in out RV when our home sells in Texas. We plan to keep our domicile in Texas and we are getting quotes from various carriers. We have found that when the insurance carriers find that you are full time we have learned that they expect you to return to that state, Blue Cross Blue Shield for example, to use Doctors, and Hospitals located there under the plan there. I have Medicare and Part G, My wife age 60 and retired has cobra that is about to expire so if anyone can provide any company that will provide coverage Nationwide that would be helpful.

I've seen your identical topics on this subject on other RV sites as well, and you've received some good info on those sites.

For pre-Medicare-age health insurance, if you are purchasing yourself and not through an employer you are going to be limited to the Marketplace if you want true major medical insurance (as was noted by Blues, what FMCA offers is not major medical insurance, it is a hospital indemnity plan).

Depending on your timeframe, you can look at what's currently offered in your domicile zip code on healthcare.gov, but realize that all that is going to change for 2019 and we won't know until November 1 what will be available for each market.

In most cases, with a domicile in Texas you will be limited to an HMO plan when buying individual insurance, primarly through BCBSTX.  That type of plan requires you to see a primary care physician first for everything or to obtain a referral from the PCP to an in-network specialist if the PCP cannot treat the condition directly.  You must chose a PCP and that will be listed on your insurance card.  If you don't go through your PCP, your claim can be denied.  You can change your PCP, but it generally won't be effective until the next billing cycle.  The other type of plan offered in some markets in Texas is an EPO, which is an exclusive provider network.  Many of those have regional provider networks so there is no coverage out of the region (or network).  This is presently (for 2018) the situation when domiciling in Texas.

If you are not going to be making the change until January 2019, see what options are available when open enrollment comes up at the beginning of November.  There could be completely different options for next year (there often are).  It may also show that you should consider domiciling in a zip code other than one in Texas.  Just keep in mind this is going to be an annual event during open enrollment.  There is no guarantee a plan available one year will be available the next year.

 

[Blues]

On 9/25/2018 at 6:01 PM, Zulu said:

Yes, but all these states have state taxes unlike TX and FL.

But the statement was, "You'll have to domicile in FL for nationwide coverage . . . at least for 2018."  No one reading that would have any way of knowing you were limiting your response to states that don't have an income tax. 

For a fulltimer needing health insurance, I can see a situation where they'd accept a state income tax hit if it means they have a domicile where they can get an appropriate plan. 

 

On 9/7/2018 at 10:35 AM, Big Greg said:

We have Blue Cross Blue Shield of Michigan PPO plan and it has and continues to cover us across the US for the 11+ years we have been on the road.  We have used it for minor and major medical issues.  I believe they call it an Advantage plan that also manages Medicare.  All our insurance activity is through BCBS.  We are currently SD residents.  

I assume you had your Blue Cross Michigan plan before you started fulltiming.  Is it some sort of employer-provided plan?  I'm wondering how you're able to keep it if you're South Dakota residents. 

 

[Big Greg]

I drove a school bus for 10+ years and that allowed me to get BCBS Advantage medical insurance only after I retired.  This benefit was not available while I was driving as the job was considered part time.  After driving the equivalent of 10 full time years and retiring, Michigan School Employees Retirement policy has been good across the USA. even as a SD resident.   Greg

[Barbaraok]

51 minutes ago, Big Greg said:

I drove a school bus for 10+ years and that allowed me to get BCBS Advantage medical insurance only after I retired.  This benefit was not available while I was driving as the job was considered part time.  After driving the equivalent of 10 full time years and retiring, Michigan School Employees Retirement policy has been good across the USA. even as a SD resident.   Greg

Again, this is a benefit that isn't available to people who didn't work for a specific employer/belong to a specific group.  I will tell you that the Michigan School Employees Retirement group is self-insured.  BCBS administers the program and it is different from any BCBS insurance program open to the public.   We retired from University of Texas system.  They self-insure and BCBS administers the program, but all actions they take are at the direction of UT System advisory panel.  Our prescription formulary is different than most because the advisory committee is made up of pharmacology faculty from the medical schools across the state.   Lots of big organizations/companies self-insure (usually with a back up catastrophic coverage from Lloyds of London) not only their health insurance, but also all of their other insurances - - they have the financial ability to do that.     

[Kirk W]

1 hour ago, Barbaraok said:

  Lots of big organizations/companies self-insure (usually with a back up catastrophic coverage from Lloyds of London) not only their health insurance, but also all of their other insurances - - they have the financial ability to do that.     

Very true, as I was part of the safety committee for our division of 3M company and they were self-insured (which really means no insurance but keeping a financial reserve) for everything from health care to automobile insurance. As Barb side, we did have what they called re-insurance that covered excess costs in the event of astronomical losses. They have their own health care plan for both employees and for retired employees. Since the advent of the ACA they have separated the retirees' supplement program for Medicare because of the effects of that law.