RVer Insurance Exchange Health Insurance?

[Mike.gibble]

1 hour ago, Kirk W said:

If you look to the upper, right hand corner of the window of the Escapee header you will see your name and a down arrow. If you click on that down arrow a menu will open, click on account settings there and another window will open down the left side with a series of choices. Go there and click on signature and you can set up a signature your signature which will show at the bottom of each post that you make. You can make a link there to you website or one or an email to you, or pretty much anything you wish to put there, within reason. 

Thanks Kirk.  I will take a look and put all this information on my profile

[Mike.gibble]

22 hours ago, Kirk W said:

If you look to the upper, right hand corner of the window of the Escapee header you will see your name and a down arrow. If you click on that down arrow a menu will open, click on account settings there and another window will open down the left side with a series of choices. Go there and click on signature and you can set up a signature your signature which will show at the bottom of each post that you make. You can make a link there to you website or one or an email to you, or pretty much anything you wish to put there, within reason. 

Again, thanks Kirk. I got it set up I think...

[Blues]

On 3/31/2020 at 2:34 PM, Mike.gibble said:

Blues; you are correct in your analysis.  These are major medical type coverage. 

Okay, major medical type coverage, not major medical, as most of us understand it.

Which plan are you selling?  The only one I can see that has a deductible is the SecureAdvantage, and for that one, you get a specified disease/sickness plan, and apparently have to get an additional plan to cover "doctor office visits, x-ray, laboratory and prescription drug coverage," and yet a third indemnity plan to get "wellness and health screening services."  Is that the one?

If so, what is the significance of its being called a "Specified Disease/Sickness Plan"?  Are only specified diseases covered?  If so, what are they?  I can't find a list anywhere on the website, or even a description of what it might mean with respect to the type of coverage is offered.

[Mike.gibble]

11 hours ago, Blues said:

Okay, major medical type coverage, not major medical, as most of us understand it.

Which plan are you selling?  The only one I can see that has a deductible is the SecureAdvantage, and for that one, you get a specified disease/sickness plan, and apparently have to get an additional plan to cover "doctor office visits, x-ray, laboratory and prescription drug coverage," and yet a third indemnity plan to get "wellness and health screening services."  Is that the one?

If so, what is the significance of its being called a "Specified Disease/Sickness Plan"?  Are only specified diseases covered?  If so, what are they?  I can't find a list anywhere on the website, or even a description of what it might mean with respect to the type of coverage is offered.

Ok. Let me try to review everything.  This post may get a little long so bare with me.

We offer 3 kinds of coverage products available for sign up year round and cancellable at anytime because they are off the ACA.  All are on the Cigna Nationwide PPO.  Two of those products the party must qualify for from a health perspective and are underwritten. The other is a guaranteed approval coverage. All the plans are broken out into 3 parts, sickness/disease, accident and health/wellness because the benefits are different depending on the plan options.  So let me go through the 3 coverage options;

SECURE ADVANTAGE (Major Medical TYPE Coverage also a hybrid of the best parts of most medical options on the market) - underwritten coverage from a health perspective - No Co-pays or money due at any doctor visit

- Fixed deductible options for sickness/disease and accident (80/20, 70/30, 60/40) with deductible options set at $5,000, $7,500 or $10,000.

-Coverage is guaranteed for any major medical occurrence until client is 65 yrs old with the exception of mental/emotional disorders and maternity.

- The health/wellness part of this plan is a fixed indemnity coverage where the client is guaranteed to get that monetary benefit amount regardless if the doctor charges less for the visit.  If the doctor charges less for the visit, the client will get a check in the mail for the difference.

- Supplements to this plan are additional accident protection (you can get money to match funds spent towards the deductible), critical illness protection (maximum check amount to cover ancillary bills like morgage etc during treatment), income protection (up to $1,500 for 12 months while recovering from any treatment), Dental and Vision Plans are available also.

PREMIER CHOICE (Fixed Indemnity Coverage) - underwritten coverage from a health perspective - No co-pays or money due at any doctor visit

- No deductible plan and has 3 levels of fixed benefits for everything except mental/emotional disorders and maternity. This plan is also broken out into sickness/disease, accident and health/wellness.

- Riders included to guarantee insurability, even during a claim, to move up benefit levels 

- Rider included to guarantee insurability to a $4,000 deductible during a catastrophic event covered up to $25 million.

- All 3 levels of this plan is a fixed indemnity coverage where the client is guaranteed to get that monetary benefit amount regardless if the doctor charges less for the visit.  If the doctor charges less for the visit, the client will get a check in the mail for the difference. If the charges are over the benefit amount, the client will be responsible for the difference.

HEALTH ACCESS (Fixed Indemnity Coverage) - plan is guaranteed approval with no underwriting - No co-pays or money due at any doctor visit.

- No deductible plan and has 1 levels of fixed benefits for everything except mental/emotional disorders and maternity. This plan is also broken out into sickness/disease, accident and health/wellness.

- Level of this plan is a fixed indemnity coverage where the client is guaranteed to get that monetary benefit amount regardless if the doctor charges less for the visit.  If the doctor charges less for the visit, the client will get a check in the mail for the difference. If the charges are over the benefit amount, the client will be responsible for the difference.

- This plan comes with an independent business association membership which includes programs like; tax talk, WebMD (24/7 doctor website visits where prescriptions can be written over a web video call), catastrophic medical coverage etc.

 

Obviously there are many more details depending on the person's resident state and options.  But I tried to outline the highlights of the coverage options. Please keep asking questions or reach out to me with them privately.  I'm here to help as much as I can for my fellow RVers and campers. I hope everyone is staying safe and well during this trying time!

 

[whj469]

I was unaware that people selling things, health insurance, were allowed to solicit business on this forum?

I see those deductibles $4,000 and up and think that before I retired my deductible was $500. They don't seem like a plan that I would want to participate in. For the most part you get what you pay for. Each person has different needs, younger people my choose to take more risk with huge deductibles if they are healthy.

I think that I am lucky because I only travel about five months per year and am enrolled in a Medicare Advantage plan with no cost and it is the best health care that I have ever had. If I am away from my plan's service area, a few counties in and around Houston, TX, they only cover emergency care. I did look at those nationwide plans but with a supplement at almost $600 per month for two of us, it didn't seem like that was what we were looking for. The Advantage plan that I am enrolled in is the only 5 star plan in Texas. Others may not be as good but I do know RVers who use Livingston, TX as their address and use the same Advantage plan.Good Luck

[Blues]

On 4/3/2020 at 6:21 AM, Mike.gibble said:

Ok. Let me try to review everything.  This post may get a little long so bare with me.

You don't need to review everything, because indemnity plans are a dime a dozen, and usually that's about what they're worth. 

What you said was that you knew of a major medical plan with a nationwide PPO, and would share the details if anyone was interested.  So I posted expressing interest, because a major medical plan with a nationwide PPO is the holy grail for fulltimer RVers.

And it's taken how many requests for you to explain the plan at all?  It took multiple requests just to get the name of the insurance company, and I had to figure out myself which plan it was you were selling, which I did by finding the company's website and then examining each plan myself and finding the one that had a deductible.  And it's not, in fact, a major medical plan as most people understand it.

Then I asked you some specifics about that plan, and still don't have an answer.  Instead, you gave information about a bunch of other products that you sell, including indemnity plans, which are often mistaken by people to be actual insurance. 

And I asked in particular about why these plans are called "specified disease" plans, and you not only haven't answered, you haven't used that term in any of your descriptions, even though that's what each of these plans is called on the insurance company's website.

This is frustrating.  I've spent hours trying to figure out what exactly it is you're selling, which shouldn't be the case when you offered to share "all the details" in your first post.  Then again, you've perfected getting your contact information inserted into your signature line, so there is that. 

The problem for the health insurance consumer is that there's no way for him to find out he doesn't have what he thought he had until it's too late.  Sure, sure, caveat emptor, etc. etc.  It'll be our fault for not reading the policy, or for not understanding the policy.  

It's bad enough on the ACA exchanges, where sometimes you can get plan documents and sometimes you can't.  But at least with ACA plans, there's a basic framework for the products offered, and there are known requirements and expectations, so you're not flying completely blind even if you can't read the actual policy before signing up.

But that's not the case with the plans you're selling.  Every single thing in there is because someone at the insurance company wants it there, and consumers would be extremely foolish to assume anything about what's in them or how they work.  In fact, consumers need to put aside everything they think they know about how health insurance works when dealing with plans like this; I think that's how a lot of people get confused when these plans are pitched. 

Given this landscape, it's disappointing to feel like I'm pulling teeth to get any information about the plans at all, especially when I'm asking only because I've tried to find the answer myself, on the US Health Group website as well as websites of other agents selling the products, and have been unsuccessful.  This lack of transparency, especially coupled with offers of one-on-one consultations in lieu of specifics, doesn't inspire a great deal of confidence.

[Zulu]

2 hours ago, Blues said:

This lack of transparency, especially coupled with offers of one-on-one consultations in lieu of specifics, doesn't inspire a great deal of confidence.

Kudos, tx for doing the heavy lifting.

[Mike.gibble]

10 hours ago, Zulu said:

Kudos, tx for doing the heavy lifting.

Blues and Zulu, I've tried to explain things as best I can on the forum since the plans have a great deal of details and options but these vary from State to State. As you can see in my signature line, I'm licensed in just 5 of them so can't simply blanket post brochures of the coverage as the variations would be false advertising depending on the specific State the person is in.  The US Health Group knows this as well which is why it can be taken that they are not being transparent but, in fact, they are trying to abide by the health insurance regulations for the Feds and every State on one website.  We just had this issue where I live in Maryland where outside agents within our own company were not used to the different details for the State and told  potential clients curtain details that were not true for the coverage available here.  Due to this, Maryland and Pennsylvania have close their borders to outside non-resident agent.  So only resident agents can sell the coverage within their home State.  I'm not trying to make excuses but the details and insurance regulations vary ALOT between States so I'm just trying to explain. But I can definitely understand how it can be taken as a lack of transparency!

All I can say is reach out to agents and they will review the plans, options and details until there are no more questions.  We are required to do in person or screen share presentations to all potential new clients to review the coverage and answer all questions.  

[theodore6WB]

Mike.gibble, thanks for detailed information. I've been using secure advantage couple of years ago, and it's pretty nice basics in the sphere of insurance. Anyway, few months ago I've found this resource on the web ( here: https://www.americaninsurance.com/benefits-anonymous-car-insurance-quote ), and it seems like they have the most reliable and profitable options about insurance for their potential customers.

Edited May 6, 2020 by theodore6WB

[Blues]

On 4/5/2020 at 4:54 AM, Mike.gibble said:

All I can say is reach out to agents and they will review the plans, options and details until there are no more questions.  We are required to do in person or screen share presentations to all potential new clients to review the coverage and answer all questions

I think that's the point--make people have to talk to a salesman to get information.  And my problem with saying that all questions will be answered is that the customer has to know there's a question to be asked. 

Like what is the significance of the plan being called a "Specified Disease/Sickness Plan"?  I asked upthread what this means, and didn't get an answer.  Major medical plans as we know them aren't called "specified disease/sickness plans," so what's the difference? 

It's common wisdom that when buying an extended warranty on an RV, it's better to buy one that covers the RV but with certain stated exclusions than one that limits its coverage to specific items listed.

And I notice that you didn't call it a "specified disease/sickness plan" in your first post.  You called it a "major medical plan," which we now know it isn't, but only because I pressed. 

Even if there are variations from state to state, there apparently is a basic framework for the plan, and there's no reason why the basics couldn't be explained on a website or in a post.  And there's definitely no reason to call it a "major medical plan" when it is not, if the only reason for lack of transparency is that plans differ from state to state.  It would also probably be best not to post in a public forum, "I am willing to share all the details if you are interested," if those details are available only to people from one of five states who have to call you to get the details.  That's not sharing with others--that's selling to individuals.

[Mike.gibble]

13 hours ago, Blues said:

I think that's the point--make people have to talk to a salesman to get information.  And my problem with saying that all questions will be answered is that the customer has to know there's a question to be asked. 

Like what is the significance of the plan being called a "Specified Disease/Sickness Plan"?  I asked upthread what this means, and didn't get an answer.  Major medical plans as we know them aren't called "specified disease/sickness plans," so what's the difference? 

It's common wisdom that when buying an extended warranty on an RV, it's better to buy one that covers the RV but with certain stated exclusions than one that limits its coverage to specific items listed.

And I notice that you didn't call it a "specified disease/sickness plan" in your first post.  You called it a "major medical plan," which we now know it isn't, but only because I pressed. 

Even if there are variations from state to state, there apparently is a basic framework for the plan, and there's no reason why the basics couldn't be explained on a website or in a post.  And there's definitely no reason to call it a "major medical plan" when it is not, if the only reason for lack of transparency is that plans differ from state to state.  It would also probably be best not to post in a public forum, "I am willing to share all the details if you are interested," if those details are available only to people from one of five states who have to call you to get the details.  That's not sharing with others--that's selling to individuals.

That's right, I am trying the help individuals and families try to obtain what, in my opinion and I haven't found anything better for my personal family as we have this insurance, the top coverage on the market. You have to qualify. Period. But if you do, it will not disappoint. 

I do not know why it is called, "specified disease/sickness plan" and yes there are exclusions that vary from state to state which is why you have to reach out to a licensed agent in that State. I am only licensed in 6 States so can't talk to all of the details in all of them.

There is no perfect Health Insurance plan. It doesn't exist. We deal with what is available. Every plan has exclusions, every plan has the fine print. Regardless of the carrier.  Just like RV insurance.

[Zulu]

8 hours ago, Mike.gibble said:

I am only licensed in 6 States so can't talk to all of the details in all of them.

If you buy a plan in one of these 6 states, is the plan "portable" (ie, usable in any state)?

Finally, it would sure help if there was some kind of state-by-state grid that showed what is/is not covered.

[Mike.gibble]

6 minutes ago, Zulu said:

If you buy a plan in one of these 6 states, is the plan "portable" (ie, usable in any state)?

Finally, it would sure help if there was some kind of state-by-state grid that showed what is/is not covered.

Yes. The coverage is on the Cigna Nationwide PPO so the insurance policy taken in the person/families' home state is the coverage that travels with them.

[Blues]

On 5/6/2020 at 6:22 AM, Mike.gibble said:

I do not know why it is called, "specified disease/sickness plan"

So the only way for us to get information on this plan is to talk to you, and you don't actually know what it is.  And in fact called it a "major medical plan" until challenged.  Wow.

[Mike.gibble]

49 minutes ago, Blues said:

So the only way for us to get information on this plan is to talk to you, and you don't actually know what it is.  And in fact called it a "major medical plan" until challenged.  Wow.

Correct, don't know why they title it that way. And yes, it is a major medical plan. Any challenge accepted my friend. I stand behind the coverage that I have for myself and my family. If there's anything better on the market, please bring it to my attention so I will produce those plans. 

[Blues]

On 5/7/2020 at 11:49 AM, Mike.gibble said:

Correct, don't know why they title it that way.

Don't you think you should?  They didn't just pull "specified disease/sickness plan" out of thin air, as a catchy title for it.  It means something.  The materials available to the public don't explain it, so I would think the agents could.  But apparently not.

 

On 5/7/2020 at 11:49 AM, Mike.gibble said:

And yes, it is a major medical plan.

Here we go again.  You first said it was a "major medical plan."  But when I took the initiative to try to look into the details and quoted the language from the plan's website that said it was not a "traditional major medical plan," you said I was correct, that it was a "major medical type" plan.  But now you're back to saying it's a major medical plan.  Even though the plan's own website says it's not.  A website, I might add, that is woefully (and I'd assert purposely) lacking in details but does at least make this clear.  Well, clear, if you include the fine print in the footnotes.

 

On 5/7/2020 at 11:49 AM, Mike.gibble said:

If there's anything better on the market, please bring it to my attention so I will produce those plans. 

I think most people agree that ACA plans are better than non-ACA plans.  They may be more expensive, but we're not talking about cost here; we're talking about coverage--what the plans actually are.  And if a major medical plan (which ACA plans are) were not better than what you have, you wouldn't keep trying to make people believe that what you sell is a major medical plan.

And here's the thing.  What you sell might very well be a suitable option for someone.  But people get into loads of trouble because they don't understand what they're buying, and it doesn't help when they can get details only from someone who has a financial interest in selling it to them.  Offering to answer all questions sounds great, but it also provides an out by someone who finds out what they bought isn't what they thought they were buying:  "I answered all of your questions."

You came into this discussion offering what you said was a major medical plan with nationwide coverage, and offering to provide details.  If I hadn't pressed, repeatedly pressed, that would have been the end of it for you, as you sit back and take calls from people to whom you can sell insurance.  I'm sure it's better for you than paying for leads.  But it's not better for the users of this forum.

[Steven@146]

The wife and I just went fulltime. She retires in Oct and we lose our healthcare Oct 31 so we are looking. I just turned 64 and the wife is 62, no major pre-existing conditions. We need some coverage for at least a year until i turn 65 and things change again with me going on Medicare. We have lived in Texas for 17 years with a stix and bricks, now fulltime. We have changed our address to Escapee's Livingston.

I will tell you we are totally frustrated and fed up with weeding through all the crap. All we wanted was to get some quotes from different insurance providers with coverage information so we can best decide what to go with, but no you have to talk to an agent. Once they get your phone number the vultures swoop in! I had to turn off my cell phone to keep the vultures at bay receiving 35-40 phone calls in one day all wanting to sell me their health insurance. One told me I need to go out and apply through ACA, I looked at it on healthcare.gov, never got so much as a dimes worth of  information before I was shoved over to signing up and supplying a god awful lot of documents and crap,  that was a total disaster! I am sick of it and we are no closer to finding something.

Now we got some information through the Escapee's  forwarded to the Philadelphia American Life and health insurance as others have talked about here. Yes it says right up front its an Indemnity plan. Received a whole lot of information and statements in little tiny print with a quote of $1200 per month for both of us. About the same amount as if we went with a cobra plan from my wife's old employer.

Isn't there anywhere a person can go to get unbiased information without having to go through an avalanche of agent phone calls only hawking their specific crap from god knows where in the country? One of our questions is, whats the problem with an indemnity plan?  Except that as a fixed benefit your bill for services, somewhere in the country, maybe way over what they will pay, but it works anywhere in the country. Some of it doesn't take effect for 90 days after you sign up and some until after a year after you sign up. One person told us we need a PPO plan, or something that works across the whole country no matter where we may be, well no kidding, that much we figured out on our own!

PPO,s Major Medical, Blue Cross Blue Shield of Texas, HMOs, Indemnity Plans, the whole quagmire pot full of mud, we are not any closer to getting good unbiased information and making a decision than we were a couple months ago. And changing our residence to FL is a non starter. 

I'm ready to go out and scream, I'm mad as hell and I'm not going to take it anymore!

Sorry for the rant,

[Zulu]

5 hours ago, Steven@146 said:

We have changed our address to Escapee's Livingston.

If your income is low enough ($65,840 for a married couple with no kids), then you can qualify for an ACA plan subsidy so you don't have to pay the full cost of a health plan.

Next, you want a "portable" health plan, one that can be used in any state without excess costs. Typically, this means a PPO (or EPO) health plan from Blu Cross Blue Shield (BCBS). Most health plans are NOT portable.

Since you're both under 65, of the three no-state tax domicile states (TX, FL, SD), FL is the best since it offers BCBS EPO plans that have nationwide coverage. TX and SD are not good domicile choices for those under 65.

 

5 hours ago, Steven@146 said:

I will tell you we are totally frustrated and fed up with weeding through all the crap.

 

Welcome to US healthcare.

 

5 hours ago, Steven@146 said:

One of our questions is, whats the problem with an indemnity plan?

Ask Blues.

[Blues]

11 hours ago, Steven@146 said:

I will tell you we are totally frustrated and fed up with weeding through all the crap. All we wanted was to get some quotes from different insurance providers with coverage information so we can best decide what to go with, but no you have to talk to an agent. Once they get your phone number the vultures swoop in! I had to turn off my cell phone to keep the vultures at bay receiving 35-40 phone calls in one day all wanting to sell me their health insurance.

Heh.  When I was directing questions at the insurance agent who showed up in this thread, someone PMed me and suggested I contact the agent directly and ask the questions.  No way I'm giving an insurance agent my phone number or email address!

 

11 hours ago, Steven@146 said:

 One told me I need to go out and apply through ACA, I looked at it on healthcare.gov, never got so much as a dimes worth of  information before I was shoved over to signing up and supplying a god awful lot of documents and crap,  that was a total disaster!

That's not my experience.  Or maybe we define a dime's worth of information differently. 

If you go to https://www.healthcare.gov/see-plans/#/ you can enter your zip code and then answer questions about your age and your wife's age, etc.  When you get to the screen about income, you can go down to the bottom to SKIP THESE QUESTIONS click on SEE PLANS NOW and look at all the plans available to you.  For each plan, you can click on PLAN DETAILS and it will give you, well, details about the plan.

So you'll know the premium, deductible, copays, out-of-pocket maximum, and in the plan details, specifics about some of the coverage.  Since they're all ACA plans, you'll generally be comparing apples to apples.  And you can get even more information by clicking on PLAN DOCUMENTS and then SUMMARY OF BENEFITS.  That's pretty detailed, and will show things like whether hearing aids are covered (not required under the ACA). 

None of this requires signing up or revealing anything other than zip code and ages, and certainly not submitting any documents.

The problem, however, is that if you're using an Escapees address, the only choices on the ACA Exchange are HMOs, which are ill-suited for traveling fulltimers.  Other counties in Texas offer PPOs on the Exchange, but with only a local network.  Not a good choice for a traveling fulltimer, either.

Some counties offer Ambetter on the Exchange, which has EPO plans.  They do not say they offer access to a nationwide network, but they do business in several states: https://www.ambetterhealth.com/health-plans/select-your-state.html

What I don't know is whether someone with an Ambetter EPO plan issued in Texas can use providers in, say, Arizona, and be considered in-network.  If so, then that might be an option for you (assuming you could change your domicile to a Texas county that offers Ambetter--Polk County doesn't) depending on where you plan to travel.  I'd definitely get it in writing that you're considered in-network in states where Ambetter does business other than Texas.

However, I just did this for Ambetter in Austin (Travis County) on the Exchange, and the premium was over $1500/month for a couple of people in their 60s.  If your wife's COBRA really is about $1200 and IF it provides access to a nationwide network, then you should very seriously consider COBRA if it's decent insurance.  The health insurance landscape is very unsettled (for example, more than two weeks ago, the president said on Fox News that he'd be signing a new health care plan within two weeks; not a peep since then).  COBRA would get you to Medicare, and I assume your wife could continue COBRA after that, until her eligibility expires. 

As Zulu pointed out, depending on your income, you could get a subsidy for a plan on the Exchange.  It's conceivable, for example, that depending on your income, you could get a very low cost HMO plan on the Exchange with your Livingston address, and plan to use it only for emergencies, which would be covered if you're out of the network.  It would make me uneasy because I've never gotten a good answer on when an "emergency" stops and you're suddenly out of network, but if it's very low cost because of a subsidy, it might be an alternative, and you can either travel back to Livingston for routine care, or pay for it out-of-pocket elsewhere.  Something to think about.

One other random thought is that if you do qualify for a very low-cost HMO plan because of a subsidy, you could get that and also get an indemnity plan to help defray your out-of-pocket expenses (which is really what indemnity plans are designed for). 

Also, something I have not been able to find out is whether any insurance company in Texas offers a PPO plan with a nationwide network.  I know that no insurance company offers one on the Exchange, but there are plenty of plans that aren't on the Exchange, and they might be ACA-compliant.  I'd be surprised if any could compete with $1200/month COBRA coverage, though (if the COBRA plan works for a traveling fulltimer). 

But I'd love to know if anyone has run across a non-Exchange PPO with a nationwide network available to Texas residents, just to know they exist, because it could be an option for someone who doesn't qualify for a subsidy and therefore doesn't need to buy a plan on the Exchange.  So far, I haven't seen any confirmation that they exist.

 

11 hours ago, Steven@146 said:

One of our questions is, whats the problem with an indemnity plan?  Except that as a fixed benefit your bill for services, somewhere in the country, maybe way over what they will pay, but it works anywhere in the country. Some of it doesn't take effect for 90 days after you sign up and some until after a year after you sign up.

The real problem with indemnity plans is that people sign up for them without realizing they're not major medical insurance as most people understand major medical insurance.  In my reading on them, I've concluded that they were originally a way to be compensated for things like lost wages if you get sick--they were marketed to high-income people like doctors, to protect their income if they can't work due to illness.  And these days, they can be a way to help cover copays and other out-of-pocket expenses that occur even when someone has insurance.

But the marketing on them doesn't make that clear, so people buy them not understanding what they actually are.  You could say that's the fault of the consumer, but I know what it's taken for ME to get up to speed on health insurance options, and I'm pretty smart and have received training in reading fine print and have the time and desire to devote to this.  The vast majority of people don't have any of this, and are at the mercy of what a salesmen on commission tell them. 

So the main problem with them is knowing what you're buying.  And in that vein, I'll point out that indemnity plans are unlike ACA plans in that they can refuse you for pre-existing conditions (also known as "underwriting," I believe), or maybe limit the care you can receive for those conditions (and possibly retroactively cancel the policy if it's deemed that you didn't divulge the appropriate information).  And they can have annual and/or lifetime limits; ACA plans can't.  It would behoove anyone considering getting an indemnity plan to read the entire contract carefully, because from what I understand, there are no "standards" like there are for ACA plans, so you can't assume anything. 

 

11 hours ago, Steven@146 said:

One person told us we need a PPO plan, or something that works across the whole country no matter where we may be, well no kidding, that much we figured out on our own!

Just to clarify--not all PPO plans work across the whole country.  Many (and more each year) are for only a local network, and don't provide any coverage out-of-network at all, except for emergencies.  In that case, the only advantage over an HMO is that you don't need a referral to see a specialist.  Not only that, a while back I looked at balance-billing protections for various states, and sometimes people with an HMO are protected from balance billing but people with a PPO aren't.  So in the case of being protected from balance billing, it could be that an HMO is preferable to a PPO.

[Steven@146]

Thanks, I was able to find a web site ehealth.healthsherpa.com where I can plug in our data and it comes back with multiple plans, and data for each plan, and monthly costs. We do qualify for a subsidy because we will be just under the 64K cut off when the wife retires and stops work in Oct and we lose our healthcare Oct 31.

All of the plans it comes back with are HMO plans through Blue Cross Blue Shield of Texas, ranging from $180 - $1200 per month, based on what deductible we choose and the coverage we want. Now that may not be so bad. Here's what I am thinking, we will do some traveling through the year but always return to Texas for the winter around December of each year, staying until around March/ April or longer, of the next year before traveling again.  Right now our GP doctor is in Austin, he accepts all the plans presented on the ehealth web site, and we could keep him and schedule a visit for our annual medical stuff Jan-Apr staying at an RV park near Austin. Once that's done we could move over to Livingston and get any vehicle registration stuff done if needs be. Then free to roam Texas until we head out again for parts unknown in late spring.

Now we probably have not paid enough of our deductible to be of any use in the first 4 months of the year but  annual physical stuff should be covered. At least it gets us through until I turn 65 in July of 2021, then I drop off and maybe get a supplement and go on medicare, the Wife can then pick a new plan for just her.

Now in the event that we are outside of the area and need medical attention it being only an emergency situation, the HMO plan would still pay some of the costs since it was an emergency. This happened to us for real back about 8 years ago when I wound up in a hospital emergency room in Middletown Ohio while visiting the kids for the holidays. The HMO plan through the Wife's work we had then did pay a lot of the costs since it was an emergency situation. Once we got back to Texas home base I went to our local hospital and had the surgery done.

A least that is my thinking now, still a little fuzzy but becoming a little clearer. At lease I have multiple plans to look at, all be it from the same healthcare provider and disect and drill into without a bunch of vultures hounding me daily!

Edited September 8, 2020 by Steven@146
corections

[Zulu]

2 hours ago, Steven@146 said:

We do qualify for a subsidy because we will be just under the 64K cut off when the wife retires and stops work in Oct and we lose our healthcare Oct 31.

Keep in mind that you have to buy an ACA plan from the exchange to qualify for a subsidy. If you buy a plan off the exchange, then no subsidy.

[Blues]

4 hours ago, Steven@146 said:

Thanks, I was able to find a web site ehealth.healthsherpa.com where I can plug in our data and it comes back with multiple plans, and data for each plan, and monthly costs. We do qualify for a subsidy because we will be just under the 64K cut off when the wife retires and stops work in Oct and we lose our healthcare Oct 31.

The cutoff is a little over $68,000 annual modified adjusted gross income (be sure to use that number and not just W-2 wages or whatever, and it's not the "adjusted gross income" that appears on your tax return). 

Be aware that if you end up going over that in a year that you have received the subsidy to lower your premium (advance payment of the premium tax credit), you have to pay back all of the subsidy you received.  I don't know what kind of income you're going to have, but you may have to "manage" it, especially if you're that close to the cliff (it's considered a cliff because a $1 difference in income can be the difference between qualifying for a hefty subsidy and no subsidy at all). 

You should also get some advice on how to calculate your income if enrolling other than during open enrollment, especially if your income is going to change a lot because your wife stops working at the point you're getting the insurance and subsidy.

 

4 hours ago, Steven@146 said:

Right now our GP doctor is in Austin, he accepts all the plans presented on the ehealth web site, and we could keep him and schedule a visit for our annual medical stuff Jan-Apr staying at an RV park near Austin.

You should double-check to verify not only that your Austin doctor takes Blue Cross, but that the practice is part of the HMO for a policy issued in Livingston.  I don't know if Blue Cross's HMO is state-wide or if it has different ones for different regions. 

 

4 hours ago, Steven@146 said:

A least that is my thinking now, still a little fuzzy but becoming a little clearer. At lease I have multiple plans to look at, all be it from the same healthcare provider and disect and drill into without a bunch of vultures hounding me daily!

I hope you didn't use the link that theodore6WB posted.  I tried it and it was a real cesspool.  I'm glad I always give fake phone numbers and email addresses on sites like that when trying to find out if they're going to offer any actual information.

 

[mptjelgin]

42 minutes ago, Blues said:

I hope you didn't use the link that theodore6WB posted.  I tried it and it was a real cesspool.  I'm glad I always give fake phone numbers and email addresses on sites like that when trying to find out if they're going to offer any actual information.

 

I notice that he has gone back and edited 3/4 of his previous posts to include links to business websites. Yet another case of the "new member" joining for just that purpose. 

[Bill&Anneli]

We went thru the Costco website to find an ACA provider - they were really helpful and knowleagble about what we would qualify for etc. Didn't try to sell us anything, directed us to the website, to type in the info so we could narrow it down to what we qualify for etc. Then we could click on the plans, read the fine print to learn about the things that are of importance to us. After we were educated we could call back and ask specific questions, help signing up etc. This took weeks for us. Here is the link.  https://www.cbcins.com/

Remember, the income/subsidy thing for the ACA plans is a bit tricky and VERY important. - If you apply for insurance for 2021, you have to estimate your income for 2021. The exact amount of income on which your eligibility for the tax credit is based is not determined until you file your 2021income tax return (which you would do usually spring 2022). Say you take the tax credit. THEN, when you file your 2021 income tax return (usually in April 2022) - you will know if you either qualify for more of a credit than you got (ie your income turned out lower than estimated) THEN you get a tax refund, or the refund is applied to whatever you otherwise might owe the IRS for past years.

If your income turns out higher than you estimated, you may have to PAY BACK the tax credit to the IRS. I have seen folks owe as much as $18,000 to the IRS because they signed up for a $1,500/month plan, took the full tax credit and paid $0 premium per month. Only to be shocked when they filed their income tax return a year and half later (from when they signed up for that insurance), had higher income than they estimated and now have to pay all that money back to the IRS.

So estimate your income very carefully, err on the conservative side (ie estimate high), because you will eventually get all the credit to which you are entitled when you file your income tax return. I think its better to get money back from the IRS than to owe them money.... Ofcourse best is to estimate exactly right - but who has a perfect crystal ball. 

IF your circumstances change during the year after you sign up for the market place insurance and tax credit - NOTIFY the exchange immediately of your change in income so they can adjust your tax credit accordingly in the middle of the year. One example is if you cash in Retirement funds (IRA, 401K etc) - that is INCOME that counts for this purpose. This could wipe out your eligibility for the tax credit. So consult your tax professional about this!

There does not seem to be any PPO plans in the ACA network - all HMO, so geographically limited. We are healthy, and think maybe an HMO would work for us if we plan once a year trip to Texas, schedule our regular medical etc then. And supplement with a Skymed type plan (that flies you "home" in an emergency). The HMO plans we looked at do cover out of area true medial emergency, and then all follow up  treatment etc needs to be in the HMO area. This probably only works for people who don't go to the doctor often and are willing to pay for some office visits out of the area out of pocket if needed. This option gives us peace of mind that if we have a major medial event we are covered (albeit we have to go to Texas, we probably wouldn't do much traveling anyway if we had a major medical event like stroke, heart attack etc). And we have the option of paying out of pocket for minor things if we don't feel like driving all the way to Texas for a simple doctors office visit.

Now, maternity care is a totally different situation, you need regular appointments, and I for one, would prefer the same doctor to care for me thru pregnancy and deliver the baby.... so would think long and hard about traveling full time without ability to go see that one doctor. But we're all different.

Also, we found that the Fixed Indemnity plan thru RVer exchange specifically excludes maternity care, so you want to ask for that stuff in detail before signing up- they may have supplemental stuff  they could sell you for that. We spoke to John Fitzpatrick at the RV exchange, he was very helpful, sent detail/fine print etc so we could answer specific questions we had. 

I agree, this whole insurance thing is time consuming, frustrating, complicated and there are way too many people out there just selling stuff they don't fully understand. Take the time to research this and educate yourself, I don't know of any shortcuts. Good luck !

[Zulu]

11 hours ago, Bill&Anneli said:

We went thru the Costco website to find an ACA provider

I'd recommend HealthSherpa.

 

11 hours ago, Bill&Anneli said:

Remember, the income/subsidy thing for the ACA plans is a bit tricky and VERY important. - If you apply for insurance for 2021, you have to estimate your income for 2021 . . .

 

From the horse's mouth: How To Estimate Your Expected Income

 

11 hours ago, Bill&Anneli said:

There does not seem to be any PPO plans in the ACA network - all HMO, so geographically limited.

I believe AK, AL, AR, CA, FL, and WY all offer nationwide (typically, but not exclusively "PPO") plans.

It sounds like you are domiciled in TX. If you're under 65 and need an ACA plan, I think a FL EPO plan is still your best bet.

 

11 hours ago, Bill&Anneli said:

I agree, this whole insurance thing is time consuming, frustrating, complicated and there are way too many people out there just selling stuff they don't fully understand. Take the time to research this and educate yourself, I don't know of any shortcuts.

For sure.