Health Insurance and the Affordable Health Care Act

[crazysuzy]

There are some off-exchange plans available, but the rates are at least double what they are on the exchange if you are eligible for subsidies. We are probably going to buy one of the barebones HMO Blue Advantage Plus plans and avoid going to the doctor at all next year if we can. In the meantime I have done the following, and I encourage all of you to voice your concerns to anyone who will listen as well. The more letters and complaints they get the more likely they are to take some action. It will be too late for us this year, but I cannot stand by and let the insurance companies walk all over us.

• Contact the Texas Department of Insurance at 800-578-4677. Say that you want to complain about Blue Shield dropping their PPO plans. They will tell you fill out the online complaint form. I resisted and was eventually transferred to a supervisor. I was forced to leave a voicemail for him. Haven't heard back yet.
• Write a letter/email to your Texas legislators. You will find them here (if your domicile is Livingston): http://www.fyi.legis.state.tx.us/City.aspx?CityName=Livingston You will get back a canned response, so if you have a little extra time a phone call to their office is also a good idea.

 

Here is a copy of my letter. Feel free to plagairize:

 

I am writing to express an urgent concern regarding the health insurance marketplace offerings for Texas, specifically in Polk County where my husband and I reside. We have 12 plans to choose from for 2016, all from Blue Shield and all are HMO’s in various forms. This would not be a problem if we lived 100% of the year in Texas. Unfortunately, we travel throughout the US in our RV and are rarely ‘home.’ As such, we seek care from various providers in different states depending on where we are. With our current PPO plan this hasn’t been a problem, but with the HMO we would be financially devastated if we ever need a significant amount of care outside of the network.

 

Here is an example from the brochure on the Blue Advantage Plus Silver HMO 102 plan:

• Deductible: Participating $3,250/non-participating $15,000
• Out of pocket limit: Participating $6,850/non-participating UNLIMITED

As you can see, for out-of-network care the deductible increases by 460%, and there is no limit to the out-of-pocket expenses. In my opinion, this violates the spirit of the Affordable Care Act by potentially bankrupting families who are forced to seek care out-of-network.

 

Our options are to buy one of these plans and hope for the best (along with saying goodbye to the doctors we have seen for decades), or go off of the exchange and pay at least $1,200 per month for a plan that would cost us $600 on the exchange (if one was available).

 

My husband is a retired police officer, and both of us are US Air Force veterans. I am a cancer survivor and a sole proprietor. We will not be eligible for Medicare for another eight to ten years. I think it is shameful that after years of government service that we should be left out in the cold like this.

 

I implore you to investigate how these Texas Blue Shield insurance plans were approved to be sold under the Affordable Care Act in that they do not provide an adequate provider network for their customers, and that the deductibles and out-of-pocket limits are beyond what is required in the Affordable Care Act.

 

Thank you for your time and consideration.

[chirakawa]

Suzy, I certainly understand your frustration and appreciate your situation. I'm not sure what you hope to accomplish though. You say that BCBS is the only insurer which offers any type of plan for Polk County, TX. Where are all the other companies? Why don't they offer some type of plan? Evidently, there is no requirement for any insurance provider to offer plans in any particular jurisdiction. So, why target BCBS?

 

Insurance companies are in the business of making money. If BCBS could make money under the conditions set forth by the exchange, then they would be offering plans as such. BCBS has stated that they lost money on PPO plans under the exchange in TX, so they no longer offer them. Would you have the Texas Dept. of Insurance force BCBS to offer plans at a loss? If so, then why not force all insurance companies which do business in Texas to also offer PPO plans in Polk County so that they too may lose money.

 

I wish you luck in your letter writing campaign, but I don't understand how you think it might help.

[crazysuzy]

You are right, a letter writing campaign will more than likely have absolutely no effect on the health plan offerings for 2016. But if we allow the insurance companies to skirt the spirit of the Affordable Healthcare Act this year without filing complaints, what will the health insurance environment look like next year? Blue Cross/Blue Shield has a corner on the marketplace and if they are successful at limiting their plans in one state based on nebulous explanations about losing money, what's to stop them from discontinuing their PPO's in all states? We all pay taxes to help support the subsidies on the health insurance exchange, so why should taxpayers in Texas receive less benefits than taxpayers in other states?

 

I don't mean for this thread to disintegrate into a political discussion. I just feel very strongly that we are being taken advantage of.

[chirakawa]

You are right, a letter writing campaign will more than likely have absolutely no effect on the health plan offerings for 2016. But if we allow the insurance companies to skirt the spirit of the Affordable Healthcare Act this year without filing complaints, what will the health insurance environment look like next year? Blue Cross/Blue Shield has a corner on the marketplace and if they are successful at limiting their plans in one state based on nebulous explanations about losing money, what's to stop them from discontinuing their PPO's in all states? We all pay taxes to help support the subsidies on the health insurance exchange, so why should taxpayers in Texas receive less benefits than taxpayers in other states?

 

I don't mean for this thread to disintegrate into a political discussion. I just feel very strongly that we are being taken advantage of.

 

I agree, don't let this become political.

 

I'm still not understanding where you get your beliefs about BCBS. How do they have a corner on the market? There are many insurance companies doing business in Texas. If there is money to be made with a PPO in Polk County, why aren't there several companies vying for the opportunity to sell it there? Why is BCBS the only company offering any type of plan there?

 

You could be totally right, of course. I just don't get where you have determined that BCBS is pulling a fast one. It appears to me that it is simply a business decision they have made, based on the market conditions.

[dbp]

Hi Suzy -

 

Thanks for the info.

 

There are some off-exchange plans available, but the rates are at least double what they are on the exchange if you are eligible for subsidies.

What companies are offering these off-exchange plans? Are they PPOs?

 

Thanks.

David

[RobertShelly]

There are some off-exchange plans available, but the rates are at least double what they are on the exchange if you are eligible for subsidies. We are probably going to buy one of the barebones HMO Blue Advantage Plus plans and avoid going to the doctor at all next year if we can. In the meantime I have done the following, and I encourage all of you to voice your concerns to anyone who will listen as well. The more letters and complaints they get the more likely they are to take some action. It will be too late for us this year, but I cannot stand by and let the insurance companies walk all over us.

• Contact the Texas Department of Insurance at 800-578-4677. Say that you want to complain about Blue Shield dropping their PPO plans. They will tell you fill out the online complaint form. I resisted and was eventually transferred to a supervisor. I was forced to leave a voicemail for him. Haven't heard back yet.
• Write a letter/email to your Texas legislators. You will find them here (if your domicile is Livingston): http://www.fyi.legis.state.tx.us/City.aspx?CityName=Livingston You will get back a canned response, so if you have a little extra time a phone call to their office is also a good idea.

 

Here is a copy of my letter. Feel free to plagairize:

 

I am writing to express an urgent concern regarding the health insurance marketplace offerings for Texas, specifically in Polk County where my husband and I reside. We have 12 plans to choose from for 2016, all from Blue Shield and all are HMO’s in various forms. This would not be a problem if we lived 100% of the year in Texas. Unfortunately, we travel throughout the US in our RV and are rarely ‘home.’ As such, we seek care from various providers in different states depending on where we are. With our current PPO plan this hasn’t been a problem, but with the HMO we would be financially devastated if we ever need a significant amount of care outside of the network.

 

Here is an example from the brochure on the Blue Advantage Plus Silver HMO 102 plan:

• Deductible: Participating $3,250/non-participating $15,000
• Out of pocket limit: Participating $6,850/non-participating UNLIMITED

As you can see, for out-of-network care the deductible increases by 460%, and there is no limit to the out-of-pocket expenses. In my opinion, this violates the spirit of the Affordable Care Act by potentially bankrupting families who are forced to seek care out-of-network.

 

Our options are to buy one of these plans and hope for the best (along with saying goodbye to the doctors we have seen for decades), or go off of the exchange and pay at least $1,200 per month for a plan that would cost us $600 on the exchange (if one was available).

 

My husband is a retired police officer, and both of us are US Air Force veterans. I am a cancer survivor and a sole proprietor. We will not be eligible for Medicare for another eight to ten years. I think it is shameful that after years of government service that we should be left out in the cold like this.

 

I implore you to investigate how these Texas Blue Shield insurance plans were approved to be sold under the Affordable Care Act in that they do not provide an adequate provider network for their customers, and that the deductibles and out-of-pocket limits are beyond what is required in the Affordable Care Act.

 

Thank you for your time and consideration.

Thank you Suzy!

[jloux2012]

dpb,

I spoke with Coleen from Kyle Hensons group, we don't qualify for subsidies so there are ppo off exchange. I will be talking with her more after the 1st of Nov. It will be pricey.

Suzy,

Heck, when they first came out with this Act, I email the president and told him it was great what he was trying to accomplish but to punish people for not taking advantage of the insurance was not right. I told him I think he should punish the insurance companies if they didn't take a patient with pre existing conditions and don't charge outrageous prices if they did. That would be a better then the currant law, but I digress.

[KHenson]

Some of you might find our RVer Guide to ACA Open Enrollment 2016 useful. It covers a lot of the issues being discussed here, like:

 

• Changes to Health Insurance in 2016
• Choosing an insurance carrier and plan
• Subsidies and Penalties
• ON Exchange vs. OFF Exchange
• Healthcare providers that “Don’t take Obamacare”
• How to Enroll in the shortest and easiest fashion possible
• What to do if you currently are enrolled in Obamacare
• The lack of PPO plans in 2016 and what to do about it
• Multi-State Plans
• Alternatives to Obamacare?
• Medicare Open Enrollment
• 2016 Market assessments in Florida, South Dakota, and Texas

[mkc]

Great guide Kyle! I've shared it with a number of RVer friends who might not be on Escapees' forum.

 

Michelle

[TxYellowRose]

Have been wondering about the availability of coverage under a BCBSTX HMO when out of Texas for 2016. Specifically, was curious if there was going to be some sort of provision for folks who might be working long-term assignments (90+ days or more) out of Texas. With some other plans, there has been the Away From Home Care Program; however see this taken from the BCBSTX site in fine print:

 

Also, the Away From Home Care Program is not available for Medicaid plan members or for HMO plan members on the Blue Advantage network.

 

Here's the link to the page where that info was found: http://www.bcbstx.com/member/advantages-of-membership/blue-card

 

The HMO plans I'm looking at are in the Blue Advantage network, so looks like we will be forced to stay in Texas or take our chances. (The only reason we returned to TX in October is because of health insurance, as I knew this would happen, i.e., no coverage out of state.) Having had a ruptured appendix with emergent surgery out of state a few years ago (when we had an excellent 80/20 PPO policy prior to the ACA), I can tell you the unexpected expenses of a major health event could be devastating if one does not have health insurance. The bills were outrageous even with our good coverage and reasonable deductible.

 

So . . . at this point, we have no options. We will be staying in Texas. As full-timers since 2010, the ACA has changed the direction of our lives.

 

I do plan to call BCBSTX and ask specifically what happens if I am traveling out of state and need care. Of course, I bet if I call twice, I will get 2 different answers.

 

If you are getting coverage on the Exchange and have zip code 77399 as your domicile, there is no option but BCBSTX. They are the only provider listed, although there are a few plans available, all of them HMOs. Opting for a plan that does provide out-of-state coverage? Not in my budget, and I'm not talking monthly premium. The one I perused had extremely high out-of-network deductibles, 50% coinsurance responsibility and an unlimited out-of-pocket. We're just not willing to take that sort of chance.

 

As far as writing letters, I did so before the enactment of the ACA. I wrote letters to all my representatives and had lengthy conversations with quite a few. We see what good that did, with the exception of my venting my frustration and concerns. Unfortunately, the concerns I voiced in those letters and conversations are coming to pass. Having worked in the medical field, including insurance billing, and having been both a patient and caregiver, there is much more at stake other than rising monthly premiums. That, however, is an entirely different conversation.

 

I wish everyone the best in finding options that work for your unique situation.

[BUGOUT20162018]

Does anyone know what companies provide health insurance that cover you in all the states and maybe Canada? My wife and I hit the road in august 2016 and don't know where we will end up after a planned three years on the road. Currently our address is California but we hope to drop that by December 2016. My wife is really the only one that needs some kind of insurance because I'm covered by the VA and Medicare. Our initial plan was to just pay out of pocket for whatever needs she has but maybe it would be wise to have a catastrophic type plan. We think we have her medication issue figured out.

Any insight would be appreciated.

[Daveh]

Bugout, in short, it is complicated for those under 65. What is your state of residency? A plan needs to meet the minimum requirements of Obamacare or you will need to pay a penalty. Generally, a PPO plan under Obamacare is one that will provide out of state coverage. Some states offer PPOs and some do not. This is a problem for under age 65 rvers. You may need to consider establishing residency in a state that offers a good PPO plan. If you buy a plan under Obamacare you may be entitled to a subsidy to pay for the plan depending on your income. Some RVers have looked into using a one of the health share plans available. These are not really insurance plans but do provide some coverage. Many folks use Kyle at the RVer Insurance Exchange to help work through these issues. https://www.rverinsurance.com/ If you do a search you will see other discussions of these issues. Otherwise it may be helpful for you to start another topic with your specific question as this is somewhat buried. Dave

[Jim & Alice]

Bugout, our experience...

 

We retired and left Michigan in January of 2013. Wife was 61, and I was 63. We went with United Health Care's Goldenrule medical Insurance, primarily for their more extensive coverage through the States. Not all States, but quite a number of them. Our policy was/is a $5K deductible, 0% co-pay after deductable met (intended to be more a 'disaster' policy). It is a Grandfathered policy with respect to ACA, and is no longer available after 2017. We will both be on Medicare by then.

 

We have encountered need for medical treatment, from ER (broken fingers) to moderate surgery. In all cases, having insurance made treatment readily obtainable (Arizona, Texas, Louisiana, Michigan), no cash up front, and (I believe) a lower negotiated rate by United Healthcare. We utilized HSA accounts, of course. Our policy premiums (since late 2012) have gone up by a factor of about X3.

 

Even tho the policy is Grandfathered in from ACA, the defined coverage for 'Wellness' was changed by ACA... and I had to pay more for some normal annual checkup tests that 'ACA said' were not needed. One other thing, we did encounter mass confusion in Medical coding for billing by United Healthcare. After successfully appealing denial of some long-time 'Wellness' tests, we/they also found that a lot of procedures (surgical) had been mis-coded and had to be re-done. We received refunds totaling $1K - $2K.

 

In hindsight, I would recommend United Healthcare... just realize, they are coping with a changing landscape like a lot of insurance carriers. But we would be very reluctant to go on the road (which we love) without some kind of insurance.

Jim

[Mariner]

Also keep in mind that when looking for a PPO plan in a particular state, it may not be available in every county of that state. That can really make it confusing. You just have to do your due diligence.

[trostberg]

Premera is a Blue Cross plan that has one 6500 deductible for a single plan that will cover you in multiple states that is available in WA and Alaska at least in 2016. I had to call and only then found out which one of the plans was the multistate plan. It is not always easy to figure out.

 

Good luck

[mkc]

Premera is a Blue Cross plan that has one 6500 deductible for a single plan that will cover you in multiple states that is available in WA and Alaska at least in 2016. I had to call and only then found out which one of the plans was the multistate plan. It is not always easy to figure out.

 

Good luck

 

"Multi state" only means that the same plan is offered in multiple states. It doesn't refer to out-of-state coverage.

 

rverhealthinsurance.com website https://www.rverinsurance.com/uncategorized/rver-guide-to-2016-aca-open-enrollment/

 

"Multi-State Plans have little to do with a plan’s network and are NOT an indicator of network availability. Here is the official definition of a Multi-State Plan from the federal government:

A

Multi

–

State Plan

is a private health insurance

plan

sold through the Marketplace under a contract between the U.S. Office of Personnel Management (OPM) and an insurance company. OPM is the federal agency that administers health insurance

plans

for federal employees, retirees, and their families.

Yeah, that’s about it. Pretty boring, huh? Notice it says nothing about coverage across state lines. Our advice is to ignore that identifier on any plan and focus on the plan’s actual benefits and network (PPO vs HMO vs EPO) instead."

[trostberg]

It does cover out of state. That is why it is good to have the discussion and explain the situation to the insurance company representative.

[Zulu]

Does anyone know what companies provide health insurance that cover you in all the states and maybe Canada? My wife and I hit the road in august 2016 and don't know where we will end up after a planned three years on the road. Currently our address is California but we hope to drop that by December 2016.

 

I looked at about 1/2 of the counties in CA and all of the counties I checked had at least 10 BCBS PPO ACA on-exchange plans that range from Bronze to Platinum. Plan costs were in line with BCBS ACA on-exchange plans in other states. To check what's available this year on the ACA exchange, use https://www.healthsherpa.com/

 

The BCBS plans had national networks and also had caps on out-of-network costs. BTW, unlike what someone else said, just because a plan is a PPO does not mean it has a nationwide network of providers. Be sure to check a plan's network provider list.

 

However, the CA PPO BCBS plans are "Tiered PPO" provider plans (just one more hoop to jump through) -- you can check providers by the "tiered" here: https://www.anthem.com/ca/.

 

Locate "Find a Doctor" under "Useful Tools". The BCBS plans use the "Pathway X - PPO Tiered" providers.

[Mariner]

Bugout, you also mentioned Canada. I had to have a non-surgical procedure done in Dawson Creek. I had to pay out of pocket because they wouldn't accept my BC/BS. But when we got back to the states BC/BS reimbursed me for the entire amount.

[Jack Mayer]

Plan type is dependent on the state and COUNTY within that state. So until you look for the county you domicile in you cannot understand what is available to you. Be very careful making assumptions about networks. Really, the ONLY way you can tell WHERE you are covered is to look at the plan details. As others have said, do not assume anything. Especially do not assume that a PPO covers you anywhere except your domicile....things are far different than you may be used to.

[Daveh]

I apologize if this sentence of mine is the source of some consternation.

 

Generally, a PPO plan under Obamacare is one that will provide out of state coverage.

 

My wording was sloppy. As others have said, not all PPO plans provide out of state coverage. However, most plans that do offer out of state coverage are PPO plans.

[Jack Mayer]

 

My wording was sloppy. As others have said, not all PPO plans provide out of state coverage. However, most plans that do offer out of state coverage are PPO plans.

Or EPO plans. Both CAN cover out of state - in the case of EPO plans it is usually restricted to their network. In the case of PPO plans it often is out of network as well as in network. But not always. You really have to look carefully these days.

[BUGOUT20162018]

Bugout, in short, it is complicated for those under 65. What is your state of residency? A plan needs to meet the minimum requirements of Obamacare or you will need to pay a penalty. Generally, a PPO plan under Obamacare is one that will provide out of state coverage. Some states offer PPOs and some do not. This is a problem for under age 65 rvers. You may need to consider establishing residency in a state that offers a good PPO plan. If you buy a plan under Obamacare you may be entitled to a subsidy to pay for the plan depending on your income. Some RVers have looked into using a one of the health share plans available. These are not really insurance plans but do provide some coverage. Many folks use Kyle at the RVer Insurance Exchange to help work through these issues. https://www.rverinsurance.com/ If you do a search you will see other discussions of these issues. Otherwise it may be helpful for you to start another topic with your specific question as this is somewhat buried. Dave

THANK YOU!

[BUGOUT20162018]

I am getting so frustrated with this issue of finding some affordable catastrophic type insurance for my wife. I'm not a stupid man but this is really hard to understand. If anyone knows of a human / broker in the Stockton Ca. area I can physically talk to, let me know.

Plan B if we don't get her some kind of coverage; we'll just die after we run out of cash.

[Zulu]

I am getting so frustrated with this issue of finding some affordable catastrophic type insurance for my wife. I'm not a stupid man but this is really hard to understand. If anyone knows of a human / broker in the Stockton Ca. area I can physically talk to, let me know.

Plan B if we don't get her some kind of coverage; we'll just die after we run out of cash.

 

I believe catastrophic health insurance is only available if you're under 30 or qualify for a health insurance exemption. Otherwise, I think you would have to pay the fee for not having health insurance.

 

However, I know of someone on these forums who just bought a catastrophic plan & paid the "no insurance" fee. BTW, your state (CA) has BCBS PPO plans -- the cheapest Bronze plan in your county (San Joaquin) is $517 (based on a 63-year-old female).

 

As previously mentioned, check out www.rverinsurance.com.