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Blues

Health insurance coverage when out-of-state

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The following was in a thread that is now closed, so I can't respond to it, but there's misinformation in it that needs to be corrected.

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Some people are saying to write off SD or Tx if one isn't on Medicare because of the lack of 'nationwide' health insurance.   And I really wonder about "nationwide" as each insurance company is registered in the state that they operate in and  expect that the people who buy insurance in that state use it in that state, even if it is a PPO.   While they will often pay for 'out-of-network' care, it will be less than if you are in their 'network' and I have a feeling that for expensive care over a period of time, the authorizations might be hard to come by or would only be authorized at a facility in that state (say a transplant, chemo, extensive orthopedic surgery).

This post appears to be saying that out-of-state care would be out-of-network, but that's not the case with a PPO plan from an insurance company that provides its members access to a nationwide network (like Florida Blue, a popular choice among fulltime RVers because members have in-network access to Blue Cross providers across the country).  I don't know where the poster got the idea that being outside the state would affect anything for a person who has a plan with access to a nationwide network and chooses a provider from that list.

As for authorizations for "expensive" care, has anyone with a PPO plan been forced to get treatment from one particular in-network provider instead of another in-network provider in order for it to be covered?  

 

 

Edited by Blues

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2 hours ago, Blues said:

This post appears to be saying that out-of-state care would be out-of-network, but that's not the case with a PPO plan from an insurance company that provides its members access to a nationwide network (like Florida Blue, a popular choice among fulltime RVers because members have in-network access to Blue Cross providers across the country).  I don't know where the poster got the idea that being outside the state would affect anything for a person who has a plan with access to a nationwide network and chooses a provider from that list.

I believe that particular post was about the lack of ACA health insurance plans that had out of state coverage (at the time that post was written).  It didn't in any way claim that there didn't exist some insurance with extended networks, but, at the time, such plans weren't on the ACA exchange at least in SD (and possibly in TX).

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The post with the misinformation was from a few days ago, in a thread that drifted into health insurance for fulltimers. The person who posted this said said that under certain circumstances, "going with an HMO might be a good option" for fulltimers, and I think tried to bolster the case by raising doubt about what the nationwide-network PPO plans cover, without any substantiation, or apparently even understanding of how the insurance works.

Here's the full comment:

http://www.rvnetwork.com/topic/137958-domicile-decisions/?do=findComment&comment=1005298

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I have checked this a lot, and from my experience, there are two things to pay attention to, your "permanent" residence when you buy insurance, and the network of that insurance.  The cost of a policy could vary greatly depending where your declared residence is.  For me, getting insurance through the AZ retirement system, the cost if I don't live in AZ  is almost double if I do. Both plans cover me in any state.

Second, its the network of your plan that matters. It may be national or regional. So your actual location doesn't matter as long as many in-network doctors are there. Some plans will pay less if you are not in-network, some plans won't pay at all for out-of-network.

But do read a policy before signing. More and more insurance companies are looking for ways to get out of paying, so anything is game.

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