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GreyDawg

domicile/residence rule for OFF-EXCHANGE insurance?

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In another thread Zulu posted a link to ACA FAQs

         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.

Elsewhere on the same thread was the statement: 

       Healthcare.gov has provisions for homeless people without an address, and for snowbirds who have two different houses   (emphasis mine).

 

QUESTIONS:

1)  It looks like the FAQs apply only to policies purchased ON-EXCHANGE, correct?    If one  buys a policy OFF-EXCHANGE   -- say a BCBS-FL policy -- do the same FAQs apply?   Can someone please supply a link/reference for this situation so I can research this further?

2) can someone please provide the link to the healthcare.gov  information on snowbirds with two houses?  I can't find it, and again, I am specifically interested in the rules for purchase of OFF_EXCHANGE insurance.

Thank you.

 

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Residency requirements for off-exchange plans are likely to be more stringent than on-change plans because with off-exchange health plans, you're dealing directly with the insurance providers.

Edited by Zulu

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I agree with Zulu.  In a serious claims situation, an insurer could investigate the validity of the application and if they determine the address/domicile was fraudulent, rescind the application....and thus skate out of the claim.

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I would use your domicile address, where your vehicles are registered and your drivers liscense is from. Your vehicle insurance should be the same as your health insurance. 

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It is my understanding that each insurance company would have their own regulations for off exchange plans.  healthcare.gov only covers the exchange plans and regulations.

In my experience an HMO has a much more restricted service area resident requirement.   Also an EPO may have the same issue.

I think you would have to speak in person to the insurance company

 

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On 12/9/2018 at 9:16 AM, GreyDawg said:

2) can someone please provide the link to the healthcare.gov  information on snowbirds with two houses?  I can't find it, and again, I am specifically interested in the rules for purchase of OFF_EXCHANGE insurance.

You're asking about healthcare.gov information, but saying you're looking for information on off-exchange insurance, so I'm not sure what you actually want.

Anyway, the part about snowbirds is in the FAQ you linked to in your original post.

Quote

Q11. If an individual travels between homes in different Exchange services areas throughout the year, where is an individual’s residence for the purposes of Marketplace coverage?
If an individual leaves his or her primary home to visit a secondary home for a short duration, the departure will be considered a temporary absence, and the individual will remain a resident of the service area of the primary home. During that time, the individual will not have an “intent to reside” in the location of the secondary home and will not meet the Marketplace residency standard for that location.
In contrast, if an individual has two primary homes where he or she spends time for an entire season or other long period of time, then the individual may live and intend to reside in both locations. In such situations, the individual may establish residency in either or both locations.

and

Quote

Q13. Can an individual who meets the residency requirement in more than one location qualify for the Permanent Move S E P?
As described in Question 10, in limited circumstances an individual may meet the residency requirement in more than one location. Such individuals may qualify for the Permanent Move S E P to enroll in or change plans when they move between Marketplace residences, but they should consider whether they would benefit more from enrolling in a QHP that offers a national provider network or out-of-network coverage instead.

People who meet the residency requirements in more than one location (snowbirds) can change their insurance when they switch locations, or find a plan that covers them in both places and keep that plan year-round.

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I should point out that if someone changes his insurance when he switches locations, the deductibles and out-of-pocket maximums reset. 

Logistics and practicalities tend to rule out people who travel fulltime changing their insurance as they change where they're living, but even if it could be done, it might not be a great idea.

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