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DonCoyote

States that offer nationwide PPO besides FL for premedicare FTers

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There is so much great information here. I didn't want to hijack a different thread so I'll start a new one.

Besides FL, what states offer a nationwide PPO through their ACA exchanges for 2019? In the meantime I'll start doing my own homework by muddling through healthcare.gov.

 

Edited by DonCoyote

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From what I can gather in my brief investigating, it all comes down to how easily it is to establish domicile. A great example is WY. Perfect sate with no income tax and national BCBS PPO on the exchange but you pretty much have to own property there. They DO NOT accept a mail forwarding address as a permanent address for establishing domicile. 

It's still the reason most full timers choose FL, TX or SD.

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2 hours ago, DonCoyote said:

They DO NOT accept a mail forwarding address as a permanent address for establishing domicile. 

It's still the reason most full timers choose FL, TX or SD.

The 3 states share that none have an income tax or a time in state requirement to be a resident as well as accepting a mail-service address for your domicile. There are others that will accept the mail-service address and some others don't have an income tax but only 3 states have all of those. 

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Thanks, Kirk,

Do you know what other states will accept a mail forwarding address for domicile? A list would be very helpful. 

 

Quite often I find in talking to people that zero income tax loses some of its priority once retired and living on more of a fixed income. 

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6 hours ago, DonCoyote said:

Do you know what other states will accept a mail forwarding address for domicile?

I have never seen any compiled list and it could be a major undertaking to create one and keep it current. Part of the problem is that each state has its own laws for what they usually refer to as residency for each issue. For example, the driving license laws spell out what you must do to be licensed in each state and usually when you must do so. Another section of the code will state what you must do to register your vehicles and yet another addresses your qualifications to vote in the state. A different section deals with residency for college tuition purposes and another for hunting/fishing licensing and so on. Domicile is not a clearly defined thing but rather it is a term of our courts and can be challenged for each situation. In some cases, you could have laws of different states which conflict and that means a ruling by the courts must be achieved to define who is right. Most RV owners look only at the laws of registering vehicles, driver's licensing, and voter registration but 

A few states do have some rules that use the word domicile, I know of no state that spells out what you must do in one rule. Even then it does not invalidate the laws of any other state. I am sure that is the main reason nobody has ever put together a single list. About 15 years ago I attempted to take on the making of a list but gave up because of the difficulty and legal conflicts. I was only working on the 7 states that have no state income tax and still had more than 50 hours of research when I gave up. At one time Nevada was pretty popular with RV people but doesn't seem to be now so it may have changed but they used to allow mail service use. Oregon does also but Oregon requires that you live in the state for a minimum of 6 months before they accept "permanent traveler" status, as they call it. 

The only state that I am aware of where the use of mail service has been tested in the courts is Texas. In the late 90's there was an election in Polk County, TX that was challenged in the courts over voting rights of the Escapee mail service members. That case went to the TX supreme court and was upheld. Since then, TX laws have been clarified to spell things out more clearly that it is legal but even here it is occasionally disputed by some official. 

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18 hours ago, DonCoyote said:

Besides FL, what states offer a nationwide PPO through their ACA exchanges for 2019?

Yes, I've only checked a handful of states, but for the 2019 ACA I think these states have nationwide health insurance plans:

  • Alaska (AK) -- Premera BCBS of AK. Preferred Plus Bronze - 6350 is the lowest cost PPO plan.
  • Alabama (AL) -- BCBS of Alabama. Blue Saver PPO is the lowest cost PPO plan.
  • Arkansas (AR) -- Arkansas BCBS. Bronze Plan 1 - PPO is the lowest cost plan.
  • Florida (FL) -- Florida BCBS. Blue Select Bronze Essential 1452 or 1419 are the lowest cost plans. These are EPO plans that have nationwide networks.
  • California (CA) -- Blue California (BCBS), Bronze 60 PPO is the lowest cost plan.

There are probably more. However, make sure to fully investigate before selecting a plan.

And now this . . .

YOU DO NOT NEED TO ESTABLISH DOMICILE FOR ANY STATE'S ACA PLAN.

One more time . . .

YOU DO NOT NEED TO ESTABLISH DOMICILE FOR ANY STATE'S ACA PLAN.

The ACA is concerned where you actually reside (see this 2016 Residency FAQ from the Dept of Health & Human Services), not your domicile, mailing address, etc.

For example, even though you're domiciled in TX, you still could sign up for a FL ACA plan if you're in FL long enough. How long? Read that FAQ above. If you still have questions, contact Healthcare.gov.

By the way, domicile and residency are not the same thing though many states act as if they are. Many times states mean "permanent resident" but only say "resident". However, for the ACA's purpose, you would be a non-permanent resident eligible under the ACA's SEP (Special Enrollment Period).

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4 hours ago, Zulu said:

YOU DO NOT NEED TO ESTABLISH DOMICILE FOR ANY STATE'S ACA PLAN.

Have you purchased a health care policy in a state where you have no mailing address? 

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41 minutes ago, Kirk W said:

Have you purchased a health care policy in a state where you have no mailing address? 

No, but we have purchased ACA policies for a couple of years.

I think what you're really asking is How would I know if I've never done it myself. If so, my answer is that I'll trust what I read in the 2016 Health & Human Services FAQ and other sources on ACA residency requirements.

Have you ever purchased an ACA health insurance policy?

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13 hours ago, Kirk W said:

The only state that I am aware of where the use of mail service has been tested in the courts is Texas. In the late 90's there was an election in Polk County, TX that was challenged in the courts over voting rights of the Escapee mail service members. That case went to the TX supreme court and was upheld.

I assume you're referring to the Speights case.  That case did not go to the Texas Supreme Court.

 

Quote

Since then, TX laws have been clarified to spell things out more clearly that it is legal but even here it is occasionally disputed by some official. 

None of the Texas statutes referred to in the court case have been amended since that case was decided.  Did they enact new laws for this clarification?  I haven't been able to find any.

 

1 hour ago, Kirk W said:

Have you purchased a health care policy in a state where you have no mailing address? 

If you want to change your policy due to a move and thereby qualify for a special enrollment period, good luck to an RVer submitting the required documents, which can include mortgage documents, utility bills, USPS change of address confirmation letter.  And never mind the timing problem caused by having to apply for insurance in advance (usually by the 15th of the month prior to the month you want insurance to be effective).  

That's why it's impractical or actually even impossible for people who travel full time to change their insurance every time they change where they actually reside.  And if they can't do that, then the obvious choice (and really, the only choice) is to use their domicile.

Or that's the only choice I've been able to come up with, and no one has been able to offer up a better one.

 

7 hours ago, Zulu said:

For example, even though you're domiciled in TX, you still could sign up for a FL ACA plan if you're in FL long enough. How long? Read that FAQ above. If you still have questions, contact Healthcare.gov.

To me, the issue of how long a person is going to be in Florida in your example is the least of the concerns.  The real problem is the timing and documentation required for getting insurance in Florida in the first place, regardless of whether a person is going to be there for a week or a month or a year.

 

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2 hours ago, Zulu said:

I think what you're really asking is How would I know if I've never done it myself. If so, my answer is that I'll trust what I read in the 2016 Health & Human Services FAQ and other sources on ACA residency requirements.

What I am expressing is a doubt that you could buy an insurance policy using an address located in a different state. I'm not saying that you can't, but only asking how you can be sure. And if you did so, then can that policy continue in effect after you move on from that state, possibly never returning to that state? 

2 hours ago, Zulu said:

Have you ever purchased an ACA health insurance policy?

I have not and that is exactly the reason that I leave the details to experts. 

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37 minutes ago, Blues said:

If you want to change your policy due to a move and thereby qualify for a special enrollment period, good luck to an RVer submitting the required documents, which can include mortgage documents, utility bills, USPS change of address confirmation letter.  And never mind the timing problem caused by having to apply for insurance in advance (usually by the 15th of the month prior to the month you want insurance to be effective).  

How do you know all the "required documents" you mentioned are necessary? Did you or someone you know try a SEP move?

 

37 minutes ago, Blues said:

That's why it's impractical or actually even impossible for people who travel full time to change their insurance every time they change where they actually reside.  And if they can't do that, then the obvious choice (and really, the only choice) is to use their domicile.

If you are always on the move, then using SEP isn't practical.

 

37 minutes ago, Blues said:

To me, the issue of how long a person is going to be in Florida in your example is the least of the concerns.  The real problem is the timing and documentation required for getting insurance in Florida in the first place, regardless of whether a person is going to be there for a week or a month or a year.

With a SEP move you can apply up to 60 days in advance of your move, not 30.

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1 minute ago, Kirk W said:

What I am expressing is a doubt that you could buy an insurance policy using an address located in a different state. I'm not saying that you can't, but only asking how you can be sure. And if you did so, then can that policy continue in effect after you move on from that state, possibly never returning to that state? 

The ACA requires you to report within 30 days of a "permanent" move.

If you're a full timer who never spends much time in any place, then SEP doesn't apply. However, if you work camp or winter in one place for months (not days or weeks), then you probably qualify for a SEP move. In that case you would probably use the work or winter campground as your mailing address.

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11 hours ago, Zulu said:

In that case you would probably use the work or winter campground as your mailing address.

Emphasis added. There lies what I suspect could be an issue. Since the ACA coverage is by private business, I suspect that the chosen company might have rules about an address which would apply. Other types of insurance policies do so and premiums are impacted by the policy address. It would be very helpful if someone could verify that they have actually done as you suggest that they can. Information about address issues given by either one of us is our opinion, but someone who has attempted to do as you suggest would have facts.

Edited by Kirk W

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4 hours ago, Kirk W said:

Emphasis added. There lies what I suspect could be an issue. Since the ACA coverage is by private business, I suspect that the chosen company might have rules about an address which would apply.

The ACA doesn't work that way. You apply though an exchange and don't deal with the health provider directly.

Remember, health providers on the ACA have to adhere to Federal rules in order to sell insurance on the exchanges. For example, homeless people are eligible under the ACA.

What does matter is residency. For example, full timers who have FL ACA insurance and are never actually in the state might have to worry.

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17 minutes ago, Zulu said:

For example, full timers who have FL ACA insurance and are never actually in the state might have to worry

If you could  elaborate on this please. 

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25 minutes ago, DonCoyote said:

 

47 minutes ago, Zulu said:

For example, full timers who have FL ACA insurance and are never actually in the state might have to worry

I don’t need info in becoming a Floridian. I was looking for you to elaborate on why full timers with FL ACA and who spend little time in the state might need to worry. Thanks

 

 

 

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38 minutes ago, DonCoyote said:

 

1 hour ago, Zulu said:

For example, full timers who have FL ACA insurance and are never actually in the state might have to worry 

If you could  elaborate on this please. 

 

Insurance companies keep track of and analyze a lot of information. If you had any policy, auto, health, etc. based on residence in a certain location and all your claims were paid to vendors in other locations; I would not be surprised if that set off alarms and resulted in questioning whether you were in fact a resident of the location you claimed.

Edited by trailertraveler

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33 minutes ago, trailertraveler said:

Insurance companies keep track of and analyze a lot of information. If you had any policy, auto, health, etc. based on residence in a certain location and all your claims were paid to vendors in other locations; I would not be surprised if that set off alarms and resulted in questioning whether you were in fact a resident of the location you claimed.

I would agree with that. Especially if you are receiving a large subsidy. 

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North Dakota also has PPO plans under ACA.

I spoke at length with ACA about my travels since I often workamp in national parks.   They told me I should have my ACA insurance where I am living and working. 

In fact my domicile state when ACA first came out would not allow me to keep my insurance if I was working out of state even for a short period of time since I was out of their service area.

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Is NDs PPO a national network ? I think when I was looking at that the other day I saw that they had a PPO but that it wasn’t a national network. Perhaps I just didn’t see it. 

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27 minutes ago, DonCoyote said:

Is NDs PPO a national network? I think when I was looking at that the other day I saw that they had a PPO but that it wasn’t a national network. Perhaps I just didn’t see it. 

From a check of a dozen ND counties (out of 53), it looks like BCBS offers plans under the names SimplyBlue, BlueDirect, and BlueCare.

If you check the plan Summary PDF for each plan (here's the cheapest PPO SimplyBlue Bronze 60), there's a link to Find a Doctor (ND) that takes you to a page that says:

"If you're planning a trip, or temporarily reside in another state or country, you don't need to worry about health coverage in case you become sick or injured while you're away. As a member of Blue Cross Blue Shield, you're automatically part of the national BlueCard program, which means that with your BCBSND identification card, you have the freedom to choose a Blue Cross Blue Shield provider anywhere in the United States."

Nevertheless, I'd call the 800-number, explain your RVer situation and be prepared to play phone tag as I don't think full time RVers are on their phone script.

Finally, wouldn't it be great if some one or some RV organization did all this research for you?

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1 hour ago, trostberg said:

I spoke at length with ACA about my travels since I often workamp in national parks.   They told me I should have my ACA insurance where I am living and working. 

Please tell us more. You have ACA experience that many people here have been looking for. Tx.

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2 hours ago, DonCoyote said:

I don’t need info in becoming a Floridian. I was looking for you to elaborate on why full timers with FL ACA and who spend little time in the state might need to worry. Thanks

My link was an example of what not to do.

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1 hour ago, DonCoyote said:
Quote

Insurance companies keep track of and analyze a lot of information. If you had any policy, auto, health, etc. based on residence in a certain location and all your claims were paid to vendors in other locations; I would not be surprised if that set off alarms and resulted in questioning whether you were in fact a resident of the location you claimed.

I would agree with that. Especially if you are receiving a large subsidy. 

What would getting a subsidy, regardless of size, have to do with anything?  It's just a form of payment to the insurance companies.  In fact, a person can get a subsidy without the insurance company ever even knowing about it by not claiming it against his monthly premiums but instead waiting to claim it when he files his income tax return after the end of the year for which he had coverage.

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