Avera Health Insurance

[Richard & Nancy Meeks]

W e are fulltimers and domiciled in S.D. I,m 65 and wife is 62 she has Avera for health insurance and have not got letter canceling her yet, can she be domiciled in Texas to get insurance and me stay domiciled in SD ???

[Velos]

W e are fulltimers and domiciled in S.D. I,m 65 and wife is 62 she has Avera for health insurance and have not got letter canceling her yet, can she be domiciled in Texas to get insurance and me stay domiciled in SD ???

 

Here is a discussion of the matter on www.uslegal.com http://domicile.uslegal.com/domicile-of-particular-persons/married-persons/

 

I would suggest you read the whole article, it appears confusing as legal jargon tends to be, and the citing is 1967. So am not sure if there is a more current legal precedence.

 

For purposes of federal diversity jurisdiction, a married woman can have a legal domicile separate from that of her husband[ix]. In Napletana v. Hillsdale College, 385 F.2d 871 (6th Cir. Mich. 1967), the court held that if a wife lives apart from her husband without being guilty of desertion according to the law of the state which was their domicile at the time of separation, she can have a separate domicile.

Thus, the domicile of the husband is, for many purposes (except few), that of the wife and that his domicile fixes her domicile for purposes connected with the marriage relation and the duties of husband and wife.

 

Also the supreme court is going to hear another case regarding the new healthcare law and the exchanges. Apparently of the two that have preceded this one: one ruled in favor the other was ruled against.

[2gypsies]

It would be a lot less hassle not choosing South Dakota.

[Daveh]

Please kkep us informed how you reolce these iisues. Sorry to hear about all the inconvenience you are suffering.

[2gypsies]

Here's another full-timers views I just saw on iRV2 full-timing forum on medical plans of full-timing states:

 

 

Health Insurance Exchange 2015 (pre-Medicare Fulltimers)

Ok folks, open enrollment is just about to start. You can shop exchange plan rates now on HealthSherpa. I've been playing around on the site looking at our options (PPO plans only) and want to start a thread to share results. Please NO politics.

https://www.healthsherpa.com

-> Rates vary a lot by state, as expected. SD (Avera) offers the cheapest PPO plan of the "big 3" RV states (TX, SD, FL), but the we still don't know if they will accept fulltime RVers in 2015. Latest word (last month) was "no", but they may be reconsidering. Kyle told me today that he is still waiting on a final word from them (expected sometime this week). Even if Avera accepts RVers they may not offer care (except emergency) outside of SD.

-> Subsidies vary a lot by state and zip! This was a surprise to me. TX is actually the 2nd cheapest state EXCEPT if you qualify for subsidies. Subsidies are significantly higher in FL.

Here's some numbers for 2 people (mid 40's) with and without subsidies. This is for PPO plans only:

SD Exchange (zip 57106 Minnehaha County)
Avera Bronze PPO 6200 ($6200 deductible) $492
Subsidy $60,000 level = $107 ==> $385
Subsidy $50,000 level = $186 ==> $306
Subsidy $40,000 level = $306 ==> $186

FL Exchange (SKP Bushnell zip 33513)
Assurant Bronze PPO 001 ($6000 deductible) $622/mo
Subsidy $60,000 level = $177 ==> $445
Subsidy $50,000 level = $256 ==> $366
Subsidy $40,000 level = $376 ==> $246

FL Exchange (St.Brendans Isle zip 32043 Clay County)
Assurant Bronze PPO 001 ($6000 deductible) $634/mo
Subsidy $60,000 level = $221 ==> $413
Subsidy $50,000 level = $300 ==> $334
Subsidy $40,000 level = $420 ==> $214

TX Exchange (SKP Livingston zip 77351)
BCBS Bronze PPO 006 ($6000 deductible) $584/mo
Subsidy $60,000 level = $71 ==> $513
Subsidy $50,000 level = $150 ==> $434
Subsidy $40,000 level = $270 ==> $314

I have yet to look into plan details (out of network caps etc.) so I have more work to do...but this is a preliminary landscape look.

Nina

__________________
12 paws, 40 feet and the open road
http://wheelingit.us

[Jack Mayer]

Yes, same as what I am finding......

 

A personal comment.No matter WHAT Avera says in the end I would not trust them. They change their minds many times....If making a domicile decision NOW, and needing health care outside of medicare I would not even consider SD. The insurance situation there is tenuous at best. At BEST there will only be one provider. MAYBE. This is not a good place to domicile if you need insurance. To me it would not even be a consideration.

[kountryguy1]

Yesterday Avera said that they will cover us with PMB addresses, but will not cover routine things out of network. That is not great news, but I think we are going to try to get by until medicare eligible. That will save the hassle of changing everything to TX. We'll see how it goes.

[Jack Mayer]

Yesterday Avera said that they will cover us with PMB addresses, but will not cover routine things out of network. That is not great news, but I think we are going to try to get by until medicare eligible. That will save the hassle of changing everything to TX. We'll see how it goes.

Out of network, or out of state? There is a big difference. Or is out of network the same thing as out of state?

[Smitty77_7]

Until the dusts settles, those Pre 65 without some form of other Health Insurance (Company Retirement or Government, etc.), I think Jack is spot on about no longer considering SD as a Domicile State. Usually this leaves Texas and Florida as the two most accommodating to Full Timers.

 

Dust settles? Well lots of moving pieces related to ACA - and while things may still stack against SD in the future, a possibility exists for changes that may make it a good state to continue to consider. How long? No one knows.

 

Best to all,

Smitty

[kountryguy1]

Jack,

The way I understand it is that Avera has its own network that is mostly if not entirely in SD. When we originally enrolled they offered PHSC Multiplan as their provider for out of network services. Apparently the only services that will be eligible for coverage are urgent or emergent services.

 

For polic

i

es effective in 2015, routine and preventive services will be processed to your in-network benefit only when you receive services from in-network providers in the Avera Health Plans service area. When you are traveling, any urgent or emergent services that may occur can be accessed from our extended network of PHCS providers. Routine services accessed outside of the Avera Health Plans service area will be processed to your out-of-network benefit. Please note services such as preventive, chiropractic and durable medical equipment do not have out of network benefits. Please check your coverage documents for more details.

If a member or potential member has a South Dakota mail forwarding address but do not reside in South Dakota, we recommend you purchase a policy from a carrier that has a national network or is a multi-state plan that allows you in-network coverage for routine services.

We will not renew or issue

off exchange

(emphasis mine) policies for individuals not able to prove a permanent home address in South Dakota.

This was the message sent to me by our agent, Kyle Henson, yesterday.

[2gypsies]

Wow! This would be a non-brainer for us....forget South Dakota.

[Jack Mayer]

Wow! This would be a non-brainer for us....forget South Dakota.

Yup....which is why I've said SD is pretty much a non-starter for those needing heath care.

[kountryguy1]

It must have something to do with the PMB thing. I can not figure out what difference that should make.

[Kirk W]

Plus South Dakota is so much cheaper and easier in every other way--vehicle registrations and insurance, ease of getting a driver's license, etc.

If you don't mind, how about some factual examples of these items? Your facts just do not fit with those of many others so document that statement, please. . Or is this your opinion?

[RobertShelly]

As I know Escapees are always there to support and standup for RVers, what has been &/or is there involvement/advocacy in this?

[kountryguy1]

I have not heard of any. Escapees has mentioned offering mail service in SD, but I don't know much about that either. It would be great if they did get involved, however maybe they should not spread themselves too thin.

[Velos]

As I know Escapees are always there to support and standup for RVers, what has been &/or is there involvement/advocacy in this?

 

When it comes to advocacy it comes down to money and how many people are affected to make it cost effective to pursue. The Escapees market for the most part appears to be the "frugal" no frills RV'er but there is the Escapees Legal Defense Fund** that may be able to help. You can click on the link to make a donation.

 

**'During Escapees RV Club's 30 years of service, it has always worked to uphold the rights of full-time RVers but with no legal funds set aside for this purpose. In March 2001, Escapees officially announced the establishment of a Legal Defense Fund. The funds generated in this account are to be used solely for the protection of RVers' rights. Your donation to the legal defense fund is not tax-deductible"

 

With regard to Texas Vehicle Inspections it appears that is not longer an issue according to this article: Texas DMV Update by Jim Koca, Advocacy Director so that may make Texas Domicile more inviting for those that don't travel to Texas that often?

 

In the Sept/Oct 2014 Escapees Magazine regarding South Dakota Mail Service an update is hoped by the end of 2014. They are also in the process of adding a state of the art mail scanning option for Mail Service Subscribers. And "The new “Escapees: Home” center is now open in Florida as a mail service option."

 

Lots happening at Escapees Headquarters.

[Kirk W]

As I know Escapees are always there to support and standup for RVers, what has been &/or is there involvement/advocacy in this?

I doubt that there is much that Escapees could do since the lack of coverage problem is a large group of companies and is probably related to the insurance laws in SD. Escapees is a pretty small organization to take on an issue like that, but it wouldn't hurt to contact the office and ask about it.

[RobertShelly]

I doubt that there is much that Escapees could do since the lack of coverage problem is a large group of companies and is probably related to the insurance laws in SD. Escapees is a pretty small organization to take on an issue like that, but it wouldn't hurt to contact the office and ask about it.

 

Well I feel that I must try to do something, so contacting our Reps/Sen/State Insurance Commissioner. We sure are 'smaller' as individuals than as a group/organization....

 

Here are some SD links if you're interested:

 

http://legis.sd.gov/Legislators/Legislators/default.aspx?CurrentSession=True&cookieCheck=true

 

http://legis.sd.gov/Contact/LegislatorEmail.aspx?CurrentSession=True&cookieCheck=true

 

State Insurance Commissioners Office

Dept. of Commerce & Regulation

500 E. Capitol

Pierre, SD 57501

Main Phone: 1-605-773-3563

Fax: 1-605-773-5369

 

Sure may not make a difference Or at least for this year but who knows if we don't try.

[Barbaraok]

Problem is that SD has such a small population base that insurance companies will not want to take the risk that a significant number (remember small total population) will be incurring charges from places like Texas, Florida, Arizona, California, etc., in the winter, all of which have higher medical costs. Lots of difference between what is available for oncology in SD with just what is available at one cancer hospital like MD Anderson.

 

Barb

[RobertShelly]

Funny when we lived in Delaware we had insurance options out the yin yang (although small, likely more population than SD). Insurance companies where there because of state laws (pro Business/Corporations), not so much because of population or health. Sure a good percentage of fulltimers may be seniors but I would argue they are likely more healthy than average as we are likely more active. I'm sure UnitedHealthcare and others are pulling out is because of the costs it would take to make all their plans ACA compliant for the fairly small amount of policies. Have no clue if there really is a significant medical costs difference in places/states.

 

Robert

[Rotis]

Where did you get this information from?

[2gypsies]

RE: Avera...why would you want to go with an insurance company while a full-timer and traveling out of South Dakota, and only having coverage in an emergency? Avera has been wishy-washy this past year.

 

Also, what is their definition of an emergency?

 

What if you develop cancer? Are you willing to go back to South Dakota for treatment without any good cancer facilities such as there are in other states? Go back in winter?

 

You would not be covered for mammograms, blood work, etc.

 

That is very risky, in my opinion.

[Rotis]

 

The South Dakota health insurance agent sent us this information from the legal department at Avera, and I have heard that the legal departments of other companies such as Sanford have made the same determination:

 

"Latest info from Avera management as of 11/18/2014

 

If you have an Avera policy that was purchased on the Marketplace, you will be able to keep this coverage in 2015, however , claims will not be covered, at in network benefits unless the services are for urgent or emergency services.

 

So things like Preventative Medicine, durable medical equipment & maintenance chiropractic treatments will not be covered as in network benefits, again their words are only network benefits for urgent or emergency services.

 

Your polices will have their full benefits if used at in network providers in SD."

 

I don't know about the way in which deductibles are figured, but Michael Monson (the agent we use) should be able to answer any specific questions.

 

Hope this helps everyone out!

 

 

 

 

This isn't any different than what was announced earlier in the month, you still have to be in SD and use an in network provider to get full benefits. The urgent and emergency care will be billed as being "out of network" and there is no dollar cap for that care so you could be balance billed. That is a very big risk to take. Also what happens when you are released from urgent/emergency care and still need a hospital stay or follow up care, you have to get back to SD to be in network or again risk being balance billed. Not a good situation to be in for a full time RV'r.

[Phil and Micky]

After reading this thread I thought I'd use y'all as a sounding board so here it goes. It seems odd to me that any insurance company in SD engaged in the business of providing health care insurance can deny coverage to anyone claiming to be domiciled in that state... physical address or not... verifiable or not.

The ACA law requires that everyone apply for and be covered by a health care policy or pay a fine, they call it a tax but everybody knows what it is. Also, an insurance company can not deny coverage to a person based on pre-existing conditions so how can they deny someone because they don't have a physical address?

How do the homeless in SD acquire health care insurance? Certainly they have no verifiable physical address! Does that mean they don't live there? Are there no homeless folks in SD? I know those are rhetorical questions but I thought I'd ask anyway.

l should think that any insurance company in SD refusing to sell a policy to anyone who claims to be domiciled there is leaving themselves wide open for legal action by the federal government.

Thoughts?

Phil