Domicile location vs Doctors/Dentist locations

[RV Hooligans]

Been to Rainbow's End twice & liked the area.  We're about to set up Escapees for our mail service.  We will be hitting the road next year & proceeding to register vehicles & get our DL in Livingston...basically become residents of Polk County! 

But the availability of doctors & some needed DME items seems pretty minimal there.  Question is: if ones address/domicile is Livingston (Polk County) will there be a problem if returning to another area for medical/dental/etc?   Right now it's looking like Tyler (Smith County) will better meet our needs.  If I remember Kirk & Pam fit in this scenario (I'm sure along with others!) & just curious if there are any issues we might expect.    

[Barbaraok]

We get all of our medical/dental done in Mesa, AZ area.  Now, if you aren't on Medicare, then your insurance may determine where your primary physicians are located.  Before we decided to spend our winters in Mesa, we also went to Tyler for medical/dental care.  Of course, we had lived there before retiring, so we just kept our primary care physicians.  

[Kirk W]

10 hours ago, RV Hooligans said:

 If I remember Kirk & Pam fit in this scenario (I'm sure along with others!) & just curious if there are any issues we might expect.    

 

We kept our same doctors when we were fulltime but that was in the Ft, Worth area and today we home-base near Tyler so have doctors there. (I type this sitting in a clinic in Tyler while waiting for Pam's latest procedure.) Very few people are ever challenged over their domicile but should you be it is nearly always a state issue and not one of immediate locality. In such case, your doctor's location being some distance away but in the same state is highly unlikely to become an issue.  There should be no problem in using Tyler doctors and hospitals as many people travel some distance for that. Livingston is also pretty close to Houston and that too is a major medical center. 

[RV Hooligans]

Thanks for the input: been periodically watching both your posts & blogs for about a decade & hope to meet you all in the future!   Glad Tyler is getting positive reviews.  We've been in the Chicago suburbs for 23 years & before that lived between LA & San Bernardino so we're looking to be away from that constant congestion & madness.  We're tired of living where the burbs just go on...& on...& on...  There seem to be numerous Texas SP not too far away making doable drives into Tyler for appointments, etc.   

Insurance wise I'm covered by Medicare & BCBSIL Plan F.  Larry will hit Medicare in Aug, currently BCBSIL PPO.  

 

[Barbaraok]

Look at "We RV Champions of Tyler" - it is a private park out by the airport.  Barebones, but has all of the amenities you need, quick run down the road to Starbucks, etc.  Yes, there are state parks around, but they are as expensive as the private parks and a longer drive into town, etc.

We lived in Tyler before retiring in 2006.  Nice town.

 

[dirtyboots]

I've not had any problem keeping my 'go to' Dr. in Eastern WA, and having my domicile in South Dakota.  Plus had to visit a Dr. in Northern California last year while traveling through, no issues.  My Medicare & Supplement don't seem to care,  everyone has my SD mailing address and my only phone number.  Haven't been doing this for years and years and years...but it's worked fine for me over the past 2.

[Kirk W]

Our current home-base is about 15 miles to the west of Tyler. I'd agree with Barb on a good place for cheap is RV Champions but if you want a nice place with fishing and more atmosphere and amenities, try the Boulders at Lake Tyler. Tyler state park  is not too far out of the city and rates are $24/day with an additional $6/day park fee for a total of $30/day.

[Blues]

On 9/28/2018 at 3:01 PM, Kirk Wood said:

Tyler state park  is not too far out of the city and rates are $24/day with an additional $6/day park fee for a total of $30/day.

The park fee is $6/day per person.  One of my beefs with camping fees at Texas state parks. 

You can pay $70 for an annual pass that will cover the entrance fee for both people if they arrive in the same vehicle.  But for short stays, that's not a good option.

[offroad]

But what about us Florida cousins and medical?  Have heard that the VILLAGES is a great place to get medical care while staying in Orlando area.  

[Dutch_12078]

Depending on just where you are in the Orlando area, the Villages can easily be an hour or more away, but they do have some good medical facilities there. My wife's FL oncologist had an office there as well as one near Bushnell.

[whj469]

Thirty dollars per day comes to $900 per month! Or $24 per day comes to $720 per month! While it seems that many of you like the Tyler, TX area, I would rather spend the Winter in South Florida. If anyone states that they like the late Spring, Summer and early Fall in the Tyler area, good luck. Having lived on a small ranch in SE Texas for the last 44 years I can be very sure that we have the worst summer weather in the Country. Tyler is a few hundred miles to the North but the Summer weather in brutal! It didn't seem to bother me as much when I was younger but I can no longer take it. We go to the UP of MI for five months during the summer.

All of our medical care is provided in the Houston, TX area. The only medical care we can receive in MI is emergency care. We can only hope that that works over the long haul? We don't want to pay $500 plus dollars per month for a supplemental policy.

[Kirk W]

4 hours ago, whj469 said:

If anyone states that they like the late Spring, Summer and early Fall in the Tyler area, good luck.

I very much enjoy the spring in the Tyler, TX area. If there is anywhere in the USA that has good weather in every season of the year, we must have missed it in our 45 years of RV travels. 

[whj469]

Kirk, you have to move north in the summer and south in the winter to get good weather. I have never been to HI, some say that they have good weather all year long? People like different areas for different reasons. Having lived in SE Texas for over 44 years I find the hot humid weather to much for this old man.

[Kirk W]

1 hour ago, rm.w/aview said:

I searched Zocdoc on this forum

I just visited it based on our zip code from Lindale, TX, the nearest doctors found were 52 miles away in Kaufman, TX, even though Lindale has 13 listings in DOCSPOT, 10 in HEALTHGRADES, and in looking through the phone listings there are actually more than 25 medical doctors who practice in Lindale. 

[Barbaraok]

I put in our old Tyler zip code and got back mostly Nacogdoches!   Tyler has a large number of physicians plus LARGE. Hospitals including a Level 1 trauma center.  So I would say that site is worth what it cost for me to look at it.😎

[2gypsies]

As we traveled we used Urgent Care facilities for simple things.  Serious issues - go to the ER. They won't refuse you.  We had no problem finding dentists along the way; particularly in smaller towns.  I'm not sure why you think you have to have care in your domicile state.  We easily did it before and after Medicare.  We were domiciled in Texas and never had medical/dental done there.  We didn't spend much time in Texas compared to other states.

[sandsys]

9 minutes ago, 2gypsies said:

As we traveled we used Urgent Care facilities for simple things.  Serious issues - go to the ER. They won't refuse you.  We had no problem finding dentists along the way; particularly in smaller towns. 

When I had a scare about my eyes I visited a doctor in New Mexico and had wonderful care. I also used Urgent Care facilities and had pre-ordered lab work done while traveling. No problems with any of it.

Linda Sand

[SWharton]

We have the Livingston address and have doctors in the Phoenix area and Williamsburg VA area. No problems with having doctors not where you are domiciled.

[Clay L]

During our 10 years of full timing we had doctors in NH and CO and our domicile was SD. Also had rotator cuff surgery done in Parker AZ ( near Quartzsite).

Our docs in NH were the ones we had when we started full timing. Since we spent time each summer when we first started full timing  we were there for our yearly visits. Also had docs in CO where spent time each fall visiting relatives. Had the rotator cuff surgery done in AZ because we spent all or part of winters there and waiting until we went to CO was not an option since the repair needed to be done before the tendon retreated so far it couldn't be reattached and I was not going to CO in the winter. 

[docj]

Since we enjoy spending our winters in the Corpus Christi/Rockport area we have migrated all our doctors and dentist to that area.  Under our Medicare supplemental and our dental insurance that isn't an issue.  But that hasn't prevented us from seeking urgent care and even specialist care when issues have arisen while we were traveling.  It's worth noting that some Medicare Medigap policies contain provisions for covering emergency care outside of the USA. Not all plans cover those.

[sandsys]

I probably should say that when we changed our domicile to South Dakota, we kept our primary doctors in Minnesota and went for physicals every year when back visiting that area. If Minnesota has chosen to challenge our change of domicile that would have counted against us. At that time, though, I was not planning to ever spend another winter in Minnesota. I hadn't realized then what a draw it would later be for Dave.

Linda

[trostberg]

I am not Medicare age yet but trying to educate myself on supplements.   It looks to me like some supplements are only offered in certain states like the new MSA medicare savings account plans.   It looks like WA my domicile state does not offer these yet anyway.

Also do Medicare Advantage supplement plans and some $0 plans restrict where you get services?

 

[Dutch_12078]

I can't speak for all Medicare Advantage Plans, but our zero additional premium United Health Care plan uses in-plan doctors and other providers, although we can use out of plan providers with a higher co-pay. Urgent and emergency care are always covered. Geographically, we're normally limited to our home region, but UHC has a "Passport" feature that we can activate to get services almost anywhere in US at our normal co-pays. The feature is limited to 9 cumulative months a year, but we're in our home region often enough throughout the year that's not a problem for us. Personally, I also have the VA as an option, so our travels are well covered health wise.

[docj]

4 hours ago, trostberg said:

It looks to me like some supplements are only offered in certain states like the new MSA medicare savings account plans. 

One thing you need to do is to get your terminology correct.  Medicare "supplements" are a particular set of plans available in all states.  These plans are described with letters, such as Plans F or G.  All plan F's, for example, will have exactly the same benefits in all states although the companies that offer plans in specific states will vary as will the premiums they charge.  Sometimes these supplemental plans are referred to as "Medigap" plans because they were initially created to cover "gaps" in traditional Medicare coverage.

In addition to these plans, there are an entirely separate set of plans called Medicare Advantage (also called Medicare C plans).  These plans use a managed care approach to providing healthcare services.  Depending on the plan users can choose from in-network and out-of-network healthcare providers for regional and/or national coverage.  The MSA plans you referred to are a specific subset of Advantage plans.

Choosing between the Medigap and Advantage plans is a very personal decision and each person should make the choice that is best for them.  The higher cost supplemental plans (Plans F and G) essentially cover all out of pocket expenses for both physician visits and hospital stays.  OTOH many Advantage plans have less expensive premiums but have some degree of cost-sharing associated with both physician services and hospital inpatient and/or outpatient care. Supplements can be used with any physician or facility that accepts Medicare whereas Advantage plans usually have network and/or geographic limitations.

I'm not trying to make this summary reflect all differences between Medigap and Advantage plans.  Although the Medigap plans are standardized, there is a lot of variation in Advantage Plans by insurance company and by the states in which plans are offered.  Making the correct choice for you can be complicated.

I hope this helps you; I've spent the past ~6 years trying to understand the subject.

Joel (AKA docj)

 

[RV_]

On 1/3/2019 at 5:11 PM, Kirk W said:

I very much enjoy the spring in the Tyler, TX area. If there is anywhere in the USA that has good weather in every season of the year, we must have missed it in our 45 years of RV travels. 

Kirk,

San Diego has the best weather year round on the either coast. Here is their website and scroll down for the monthly average lows and highs. No freezing and no temps over the mid 70s.

https://www.sandiego.org/plan/weather.aspx

	Temperature	Rainfall	Humidity	Sunshine
JAN	65/48	2.11"	63%	72%
FEB	66/50	1.43"	66%	72%
MAR	66/42	1.60"	67%	72%
APR	68/55	0.78"	70%	72%
MAY	69/58	0.24"	74%	59%
JUN	71/61	0.06"	74%	58%
JUL	76/65	0.01"	74%	68%
AUG	78/67	0.11"	74%	70%
SEP	77/65	0.19"	72%	69%
OCT	75/60	0.33"	70%	68%
NOV	70/54	1.10"	66%	75%
DEC	66/49	1.36"	64%	73%