Blues

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.

I hope he's dead wrong on the rally atmosphere.

I went to the website for US Health Group. On the first page, it says, "Apply anytime of the year." My understanding is that major medical plans (what most of us consider to be "health insurance") are available only during open enrollment or if a person qualifies for a special enrollment period. Enrollment any time of the year is usually a hint that a plan is not major medical, and is probably short-term insurance or an indemnity plan or somesuch. So I dug some more, trying to find a major medical plan. I couldn't. There are three that look like health insurance: "PremierChoice," "SecureAdvantage," and "HealthAccess." But all of them are called "Specified Disease/Sickness Plans" (without any indication of which diseases will be covered), and state that they are not "traditional major medical plans" (in footnote 2 of each plan's description). Where can we get information on the major medical plan with a nationwide PPO network that US Health Group offers?

What is the insurance company that's offering these plans?

Not the ACA, so not pertinent here, not to mention the fact that the vast majority of traveling fulltimers are on Medicare, presumably with supplements, and they don't report any problems. Regardless, apparently these people you mentioned were living somewhere where they could get a supplement based on where they're actually residing. That's not the case for a traveling fulltimer who changes location too often to meet the requirements to get a plan in those various locations. This has nothing to do with what a traveling fulltimer who has a plan with a nationwide network faces. In fact, it's the opposite. These people live in Arizona but chose to have a plan that would cover them only in California. Turns out they needed more care than they anticipated, which is annoying and costly for them, but Kaiser is still covering them. That has nothing in common with traveling fulltimers who pick a plan with a nationwide network. In fact, it shows that even in an obvious case like the one you present, where the people actually live fulltime in one place where they could/should get health insurance and choose to use a bogus address to get a policy elsewhere, the insurance company won't have any issue at all providing extensive care. That's great news for traveling fulltimers. It's nice to be able to fall back on the fact that basing their insurance on their domicile is the only practical option, but apparently that's not even necessary, based on the example you gave.

Actually, Zulu says that it's not your permanent residence/domicile that counts, but where you're physically located. This has been discussed at great length in previous threads, and Zulu's conclusion is that fulltimers can't base their ACA insurance on their domicile, but hasn't offered a solution for people who travel fulltime and can't meet the requirements to get a different plan each time they change location, never mind the burden of resetting deductibles and out-of-pocket limits each time a person gets a new policy.

So what is the major medical plan with a nationwide network that you're referring to? All the details would be really nice to have. Even using the Exchange, it can be hard to figure out a given plan's network, never mind subtleties, so it's invaluable when people post, for example, that Florida Blue has worked for them nationwide for routine care with no hassles.

Not sure what you mean by a "spam generator." From what I can tell, he's in the insurance business.

Why wouldn't people be interested? Of course they're more interested in plans on the exchange for which a subsidy might be available, but for those who don't qualify for a subsidy, the existence of any plan would be useful information.

What do you mean "placarded maximum pressure"? The max pressure I was referring to is the one written on the tire itself. What's on the placard in a car, like on the door jamb, is the recommended pressure. I once had an employee at a tire place argue with me about it on my car; he insisted the the tires should be filled to the max pressure listed on the tire, even when I pointed out the label on the door jamb giving the recommended pressures.

I'll never know where so many people have gotten the idea that the max pressure on the tire is what the tire should be inflated to. Do they not understand what the word "maximum" means? It's one thing to do it to one's own tires or even to recommend it to others, but entirely another to make people taking a driving test do it to their tires. I'm not sure I'd comply because it's just wrong, and the tester needs to get some "guidance" on this.

I don't know where you got those listings, but... In the first one, the website www.insurancebenefits.com redirects to domainmarket.com, offering that domain for $149,888. In the second one, on the website www.heinrichassociates.com, if you click on "Individual Medical," it goes to a page that has a link to get quotes, compare plans, and apply online. But when you click on it, it goes to a nonexistent page. The third is Farmers. Do they do health insurance?

If you're going to be traveling, you want a PPO (or EPO) with a nationwide network, if you want to be covered while you're away from your domicile. It's the nationwide network that's tricky. There are plans that are PPOs, but the network is only local, and there's no way to tell just by looking at them. So be sure to hammer on the nationwide network. (But remember that the indemnity plans tout that they're valid nationwide, and you can go to whatever doctor you want. The devil is in the details.) There are "local" plans on the exchange in Austin--Oscar and Ambetter--where there won't be any in-network doctors outside the immediate area. Or actually, I wonder about Ambetter, since they offer insurance in several states. I don't know if a Texas Ambetter policy would allow access to Ambetter in-network doctors in a different state, though. If it does, and you're sure you'll be visiting only those states, it could be an option. But I'd get it in writing. However, that's Austin, and I'm using it only as an example. As far as I know, the exchange doesn't have any PPO plans in Livingston. That's why I'm curious if anybody knows anything about off-exchange insurance plans--whether there are any in Texas that offer a PPO plan with a nationwide network. If a person isn't going to use a subsidy, it could be a good choice--if it exists. Like I said, the path of least resistance is often a Florida domicile, and a PPO plan from Florida Blue. To get completely up to speed, you might want to look at previous threads about health insurance for fulltimers. I'm pretty sure I've participated in all of them, so you could just look for my posts, and find the insurance threads among those.

You said elsewhere that you're using Escapees in Livingston as your domicile. I know that the ACA exchange doesn't offer any PPO plans with nationwide networks in Texas. Have you looked at any off-exchange plans? Since you're not getting a subsidy, there's no reason for you to limit yourself to what's on the exchange. I'm just curious if there are any off-exchange PPO plans with nationwide networks offered in Texas, by any company. I assume the only way to find out would be to talk to an agent, or to check with individual companies. Since I'm not in the market, I'm not going to do that, but if someone else has done it and has an answer yes or no, I'd like to know.

I'm aware that the ACA is a federal, not a state program. I was talking about establishing domicile, and a person has to pick a state to domicile in, and not all states are friendly to people using a mailing service (hence the suggestion of using a friend's or relative's address in those states).

Sigh. This really infuriates me. The only reason you found out what you would actually be buying is because you posted to an RV message board, and only because some random person decided to take some time to do some research into the company you mentioned's products and describe them to you were you able to find out you weren't actually being offered major medical insurance. You did everything you could--you presumably said you were looking for health insurance, you talked to two different representatives, and you went even further and were researching the reputation of the company. Shouldn't that be more than enough? And yet only by chance did you get an accurate description of what you were on the verge of buying. Not only that, I assume you were influenced by Escapees' endorsement of or partnership with RVer Insurance Exchange. We've been through this before. Check out this thread, where Escapees was taken to task by a few of us on their marketing of "healthcare solutions" (it started with a question about a similar program from FMCA--hence the thread title): http://www.rvnetwork.com/topic/131591-fmca-ppo-plan/ To their credit, Escapees has stopped making possibly misleading claims about what the healthcare solutions they offer. But to their discredit, they instead just slough you off to RVer Insurance Exchange's site. I looked at RVer Insurance Exchange's site, and there's a link for "health insurance," as Sehc noted. However, there's not even a mention of the primary issue that traveling fulltimers have--access to a nationwide network--and how they in particular can overcome that. But on the home page, there IS a link for "fixed benefit medical plan," with a "Top Choice" badge above it. Hmmmm. And if you go to that link, this is what it says, with all bolding in the original: Yes, they use "fixed benefit" twice (not bolded, of course), amid claims of how such plans are better than ACA plans, don't have deadlines, and will pay for hospitals, doctors, emergencies, etc. And yet you talked to two different people about the plan and apparently still didn't understand how it would differ from the major medical insurance you were seeking. This bears no similarity to what a person would write who wanted prospective customers to really understand that the product is not major medical insurance. They say it isn't, but only by saying it's an "excellent alternative to expensive major medical insurance" (which it's really not, even though they say it could be used as a "stand-alone nationwide plan," which is true, only if you don't mind that it's nothing like health insurance). And they say it's not an Obamacare ACA plan, but cite only its ineligibility for a subsidy as an issue with that, and goes on to tout its superiority to an Obamacare ACA plan. They don't mention that most indemnity plans require medical screening, while ACA plans accept people with pre-existing conditions. But you could think, "There's only so much space to describe it, and they DO make you call in order to sign up." Right. And we saw how far that got you. The bottom line is that there is no great solution for fulltimers who travel too much to have insurance based on their actual location. Most of them do it by using their mailing address, but there's a poster out there who will issue dire warnings that health insurance is based on your actual location, with no practical suggested alternatives for when getting insurance based on that location is literally impossible due to time constraints and documentation requirements. So the usual solution, if a person wants major medical insurance, is to have a Florida domicile, and get a Florida Blue PPO plan there that has access to a nationwide network. Or to use a different state, as long as a nationwide PPO plan is available and the state will recognize the mailing service address as valid for domicile (not all do) or there's a relative or friend who will allow the use of their address as your domicile. The path of least resistance is Florida, and there have been no reports of Florida Blue turning down any claims by a fulltimer using Florida as a domicile and getting based on that. The problem is that it's expensive, and people who don't qualify for a subsidy are desperately looking for an alternative. And they're easy prey for outfits that sell indemnity policies, or health sharing schemes I feel for you, Greenman. It sounds like you did everything right and still almost fell into the trap.

My pleasure, Greenman. You said you talked to two different agents, and I'm assuming you told them you were looking for health insurance. And that you didn't come away from those conversations realizing that what they were offering isn't what you were asking about. Is that the case?

What are they saying they are? Or, more important, what are they saying they're selling? I went to the Philadelphia American website and I didn't see anything about major medical insurance, as most people understand the term--a plan that pays your providers for your medical care, subject to a deductible, copays, etc. Instead, they offer indemnity plans that provide fixed payments to you if you get treatment for certain conditions, regardless of how much the treatment actually costs, and critical illness plans, which provide a fixed payment to you if you get a certain diagnosis, like cancer. These products are intended as a supplement to major medical insurance--not as a substitute for insurance. They are intended to help defray out-of-pocket costs that people with health insurance still face, like high deductibles. If you're even considering a fixed indemnity plan, then you should do a very deep dive into how it works, and do NOT rely on the person selling it to tell you everything you need to know, or to even describe it sufficiently. If there's any thought in the customer's mind that he's being offered medical insurance, then it hasn't been described sufficiently. None of this is to say that there's no place for indemnity plans in the world. But this is one situation where any choice should be very informed, because there won't be any way to find out it wasn't actually a good alternative until it's too late.

What are we talking about here? Domicile, or residency? It sounds like domicile to me, but you've always asserted that domicile doesn't matter when it comes to health insurance--that's it's all based on where a person actually resides. When I asked what a traveling fulltimer is supposed to do if he changes his residence too often to get health insurance based on his actual location, you said "be physically present in your home state," and linked to an Escapees article about domicile. So are you now saying that domicile should be used for getting health insurance if someone's residence changes so often it's impossible to get it based on actual residence?

In capital cases, people who are strictly opposed to the death penalty are not allowed to serve, so capital juries are composed only of people who can vote for the death penalty, even though the guilt-or-innocence phase has nothing to do with capital punishment. Here's a pretty good article about the bias inherent in "death-qualified" juries: http://criminal-justice.iresearchnet.com/forensic-psychology/death-qualification-of-juries/

But the document you linked to specifically addresses people who meet the residency requirement in more than one location. It doesn't make them change health plans when they move to their summer or winter home. Instead, it actually advises them that they should consider whether they would benefit more from choosing a health plan that has nationwide coverage and using it regardless of where they're living instead of changing their health plan when they go from one residence to the other. So no, the ACA doesn't strictly use where one "actually resides," because it allows people who "actually reside" in more than one location to choose which one to use to buy health insurance. And this is in spite of language that says the opposite: In the case of a person who splits his time among multiple residences and seeks health insurance based on one of those locations, he doesn't intend to remain in the Exchange area where he gets coverage, and therefore doesn't meet the residency requirement. Yet the ACA allows him to use that location anyway. Why? Because the goal of the ACA is to provide access to health insurance. In this case, they're actually bending over backwards because for people with a summer home and a winter home, it wouldn't be too terrible to require them to get a different policy in each location, but it would be more burdensome than if they didn't have multiple residences because each time they change their policy, the deductibles and out-of-pocket maximums reset to zero. To avoid this, the ACA allows them to choose to get a policy in a place where they don't actually meet the residency requirement. Now think about a traveling fulltimer with 50 residences a year. If they're going to let someone with two residences do a pick 'em on where to get health insurance, why would they prohibit the same solution for a traveling fulltimer? At least with two residences, it's conceivable that a person can get a different policy for each location, even if it's a hardship because deductibles and out-of-pocket maximums reset each time. But for someone with 50 residences in a year, or even 12 one-month stays in different locations in a year, not allowing him the same option as a snowbird would be tantamount to denying him insurance because even if he could meet the application deadlines, which he can't, his deductible would reset every single month. So what's the solution? Take the same reasoning the ACA uses with snowbirds and apply it to traveling fulltimers. In the case of a snowbird, there are obvious locations to base health insurance, and the ACA allows him to choose from among them. In the case of a traveling fulltimer, there are many many residences, none of which are practical. But there is a place where he receives his mail, also known as his domicile. Why do you keep calling me "Boomer"? Well, sure, living fulltime within the boundaries of a state is an obvious way to get health insurance. But as discussed above, the ACA doesn't actually require it in all cases. Never mind that living within the boundaries of a state is explicitly not what traveling fulltime is about. But okay, be physically present in your home state. Sound advice. So let's get some more advice based on that. At what point can a person travel out of state again, and keep the health insurance from his home state? One week? One month? Three months? A whole year? And then how often does the person have to come back? Every year? Every other year? Once every three years if the previous visit was between 75 and 90 days, but every five years if the previous visit was at least 180 consecutive days?

Did it end up going away on its own?

No That's what I thought. But yet you warn, "He probably won't be caught by the health insurance company as long as he's just paying premiums." I take that to mean there won't be trouble unless he files a claim, even though you don't know of anyone ever having a claim denied on this basis. You wife's friend actually lived in Arizona, and there was no reason for her not to have an Arizona plan. That's not the case for traveling fulltimers, which is who we're talking about here. I assume she goes to California to receive that care, because Kaiser's website doesn't show plans, or even any providers, in Arizona. Again, that's not what traveling fulltimers do. They receive their care where they're living at that moment, using a policy that is based on their domicile because they cannot meet the deadlines and requirements for changing an address and getting a new plan every time they move. No, my justification is that no one has offered any evidence, whether legal or anecdotal, that a person who has a domicile created by using a mail service and uses that domicile to obtain health insurance runs a known risk of having claims denied based solely on having insurance based at that domicile. ETA: The ultimate justification is, what other choice does a traveling fulltimer have?

That's what I thought. And I assume nobody has ever had a problem with the insurance company refusing to pay because the insured didn't actually reside in Livingston, or even intend to reside there, but used the mail service address for domicile purposes, including for Medicare and any Medicare supplement. The OP is in the same situation, only with under-65 health insurance--using a place as a domicile even though he doesn't reside there or intend to reside there. Yet people are issuing warnings that claims will be denied, even though the OP would be doing the same thing people with Medicare and Medicare supplements do--use the mail service address as the domicile. It's true that ACA plans are not Medicare supplement plans, but the underlying issue--where to base the insurance when someone doesn't live anywhere in particular--is the same.

How do you know all claims will be denied? Where do the over-65 Escapees mail service users get their Medicare supplement policies? I always assumed it was Livingston, even though I doubt they see doctors there, especially since plenty of them never go to Livingston. If that's what they do, are their claims denied? And I have yet to hear of any pre-Medicare people who have Blue Cross based on their Florida domicile having claims denied because they weren't in the area where their domicile is. Have you? I would think this would be very important information for the many people who have Blue Cross in Florida in order to have access to a nationwide network. Oscar Health has limited networks, and offers policies in only 15 states, and in those states. And in those states, it appears to be only in major metropolitan areas. Like in Colorado, it's the Denver area only. In Arizona, it's Phoenix only. Plus I'm not positive that a Texas policy would be "valid" in Colorado. I have the same question about Ambetter, which offers policies in several states, and might work for a traveling fulltimer IF the policy from one state works in all the other Ambetter states, but I wouldn't sign up without official word from Ambetter that that's how it works. But even if it does, neither Oscar nor Ambetter policies provide any out-of-network coverage at all. Here's what the Oscar website says about getting out-of-network care: