BCBS Texas to stop offering PPO Plans in 2016

[GlennWest]

I will state this about coverage with health share. My wife needed surgery. Our BCBS PPO plan had a deductible of 12k and cost over 1k monthly. We would have to pay entire amount. We paid 1k and Liberty paid the rest and the clinic and hospital were well satisfied with it and bragged on Liberty. Also Christian Health Care has been around for decades. Health Share has been around for hundreds of years. Many fraternities had it. Check the history. The system works

[Big5er]

 

1.  

   Big 5er, Yes I specifically said the government is setting the minimum standards. I agree. I did not say otherwise.

2. Well on your second issue, not really Big 5er. Compulsion to buy a product would involve a criminal penalty, ultimately jail time if you don't comply. The ACA specifically says there is no criminal penalty for non compliance. Yes you need to pay a civil fine but not paying that fine does not equate tax evasion. Also, if money is not available you can apply for a hardship exemption from the obligation to purchase. Also, there are many exempt groups like the Amish and those like Glenn participating in health share ministries. Also, the over 65 crowd for the most part gets medicare so it is inapplicable, there are watered down provisions applicable to the under 30 crowd and the vast majority of americans are covered by employer plans.

 

Where does it say that compulsion requires a criminal penalty? I am required to pay income tax. If I do not, the IRS will seize my pay check, my house and many other things. If I do not pay the IRS their ACA penalty they will do the same thing, so while you claim there is no criminal penalty, I think seizing my money is fairly compulsive. "Do this or we will fine you", That is compulsion.

And you claim the ACA only applies to a small percentage of the population because old folks, the Amish and the ones in a share program don't count? Either you need a new calculator or there are a lot more Amish people than I knew about.

 

I am glad you are happy with the government forcing the ACA on you. Maybe you need help picking out your clothes too? What's next? Buy a Ford, any Ford you want as long as it meets our criteria, or we will fine you? Maybe they will force us all to take in a homeless person? Maybe they will fine us if we don't contribute to a food bank to feed the lazy? Gee that could end homelessness and hunger all at once. The federal government cannot control their own spending or balance their budget. I can do both in my household, I certainly do not them them mandating what I need for insurance coverage, maybe you do, but I do not.

[trostberg]

Dave H and Zulu I very much agree with your statements. I am the one from WI. At least in my county no national plans. I am now on a national plan that is out of Wyomng where I an currently working and living, however an agent cautioned that this may change. I suspect every state may continue to be in a state of change for insurance networks for some time.

 

I have long thought that the traditional states that are domiciles for many RVers are no longer valid for those of us under 65. Health insurance in an area I am actually going to spend my time is the only reason for my domicile choice.

[D&J]

 

• I agree Zulu. What interests me is that the three big full timer states, Florida, South Dakota and Texas have refused medicaid expansion and consequently are strongly resisting the implementation of ACA in those states. (someone mentioned Wisc offered no PPO national plans and I note Wi has also refused Medicaid expansion). I do not know to what extent, if any, this impacts the insurance options under the exchanges in those states but it certainly raises the question in my mind. I am out of Michigan (which did accept Medicaid expansion) and have seen nothing which would indicate that my ppo will be discontinued. Nevertheless, I want to be prepared for all eventualities and am interested in the options available in states that are actually friendly to the ACA. If the Escapees can identify a state that would be friendly to the health care needs to under 65 RVers, the availablilty of a health care insurance option would probably override all other domicile concerns. I am interested in hearing from anyone currently on a PPO plan from non traditional full-time rver states.

We home base out of Nebraska, I just started medicare but my wife has a PPO BCBS policy. Like I said before I'm glade we keep our domicile in Nebraska, 9 years ago we talked with a BCBS agent and were told not to give up our Neb address so we could keep our insurance it turns out that it was good advice.

 

Denny

[Kirk W]

I have long thought that the traditional states that are domiciles for many RVers are no longer valid for those of us under 65. Health insurance in an area I am actually going to spend my time is the only reason for my domicile choice.

At this time it is probably not practical for Escapees or anyone else to make major changes in their operations practices based upon health care plans because things are changing so rapidly. Most of those who are full-time in an RV do not want to move their insurance to a new state each time that they change locations and for most that isn't practical. I'm doubtful that most insurance companies would be willing to deal with you in the state where you happen to be unless you make that your current domicile, which is one of the things that most fulltimers try to avoid doing. That may work if you stop in each state for months at a time, but for those moving frequently it would not. The challenge is doubled when a couple are involved and for a family it becomes almost impossible.

 

Am I understanding you correctly that you plan to change domicile to each state in which you stop and spend time? Will your current insurance cover you if needed when you are traveling from WY to wherever you choose to spend the winter and until you find new health insurance in that state? I can't recall ever having heard of someone moving their health insurance on a frequent basis, but there is always a first time........ When you moved your health insurance, did you also move your vehicle insurance to WY? What about your driver's license and vehicle registration? If not, does your health insurance agent know this?

 

Those who travel constantly have always had challenges to deal with that those sitting in one spot do not and I suspect that may be one of the bigger reasons that so much of this group have traditionally been retirees. With more families and working folks taking up the lifestyle that does create a much greater need for new ways to do things and new problems to address. Health care insurance has long been one of the greatest financial drains for those not yet eligible for Medicare and for a family it must be daunting. All of this has really made me appreciate the fact that I was able to retire at 57 with company supported & supplemented health coverage for both of us.

We home base out of Nebraska, I just started medicare but my wife has a PPO BCBS policy. Like I said before I'm glade we keep our domicile in Nebraska, 9 years ago we talked with a BCBS agent and were told not to give up our Neb address so we could keep our insurance it turns out that it was good advice.

Health insurance has always been an important factor in choosing a domicile for those who have health or other insurance that is subsidized by a former employer and has become so for those who must buy it in the marketplace more and more. There are far more things one should consider than simply lowering their tax burden. I was fortunate to have worked for a company that has employees & retirees in all states and whose health plan was the same in them all. Portability is probably the best feature of the Medicare plan.

[Velos]

 

• I agree Zulu. What interests me is that the three big full timer states, Florida, South Dakota and Texas have refused medicaid expansion and consequently are strongly resisting the implementation of ACA in those states. (someone mentioned Wisc offered no PPO national plans and I note Wi has also refused Medicaid expansion). I do not know to what extent, if any, this impacts the insurance options under the exchanges in those states but it certainly raises the question in my mind. I am out of Michigan (which did accept Medicaid expansion) and have seen nothing which would indicate that my ppo will be discontinued. Nevertheless, I want to be prepared for all eventualities and am interested in the options available in states that are actually friendly to the ACA. If the Escapees can identify a state that would be friendly to the health care needs to under 65 RVers, the availablilty of a health care insurance option would probably override all other domicile concerns. I am interested in hearing from anyone currently on a PPO plan from non traditional full-time rver states.

 

 

 

I don't know that there is one source to answer all the questions when deciding where to domicile but these websites may help with your analysis of where to domicile to improve your options for health care if you are a full time RV'er:

 

According to this study (if I read it correctly) North Dakota spends the most per "aged" individual on Medicaid and New York spends the most per individual with "disabilities. You can click on the arrows in the column headers to sort what you are looking for: http://kff.org/medicaid/state-indicator/medicaid-spending-per-enrollee/

 

I have use this several times to compare the cost of living between cities in the US: http://www.bestplaces.net/cost-of-living/

 

Here is a Summary: Spring 2015 Fiscal Survey of States which includes a comment on: "Medicaid Spending and Enrollment Growth Accelerates in Fiscal 2015,Projected to Slow in Fiscal 2016"

 

I don't know if domiciling in the most or least populous state would help?: https://en.wikipedia.org/wiki/List_of_U.S._state_budgets

 

Here is a breakdown of states populations by age according to the 2010 census: http://www.census.gov/compendia/statab/2012/tables/12s0016.pdf

 

Avoiding states in bankruptcy: Here is a map of states and specific city governments in Bankruptcy: http://www.governing.com/gov-data/municipal-cities-counties-bankruptcies-and-defaults.html

 

The full list of America's 32 insolvent states is below, sorted in order of bankruptedness source: http://www.zerohedge.com/article/32-states-now-officially-bankrupt-378-billion-borrowed-treasury-fund-unemployment-ca-mi-ny-w

 

California $6,900 Michigan 3,900 New York 3,200 Penn. 3,000 Ohio 2,300 Illinois 2,200 N.C. 2,100 Indiana 1,700 New Jersey 1,700 Florida 1,600 Wisconsin 1,400 Texas 1,000 S.C. 886 Kentucky 795 Missouri 722 Connecticut 498 Minnesota 477 Georgia 416 Nevada 397 Mass. 387 Virginia 346 Arkansas 330 Alabama 283 Colorado 253 R.I. 225 Idaho 202 Maryland 133 Kansas 88 Vermont 33 S.D. 24 Tennessee 21 Virgin Islands 13 Delaware 12

 

 

 

 

[NJTroy]

Coming back to the question of which states might be best for below 65 full timers.

 

I think I'd start with the states who have taken the Medicaid expansion. That reduces costs on the exchanges by the value of the subsidy for many of us. This offsets any state income tax burden. The biggest issue then becomes whether any of those states take a PMB address or whether one would have to actually establish a physical domicile.

 

States with Medicaid expansion.

 

http://familiesusa.org/product/50-state-look-medicaid-expansion

 

I poked around trying to figure out which states would take a PMB as a permanent address without any luck. Anyone know of such a resource?

[Daveh]

_{NJtroy I also think states with the Medicaid expansion are at a cost advantage as they decrease the uninsured population. I think that may be a good starting point. I am also interested in the best way to research the domicile issue. I also have been considering whether the population of the State should be a factor as JM suggested.}

 

_{I guess a list of states that offer nationwide PPO plans would be a start and then we could apply factors such as domicile, Medicaid expansion, population to narrow down the choices. I would think an influx of middle to late aged RVers to their health system would be more of a concern to less populated states?????}

[Kirk W]

I poked around trying to figure out which states would take a PMB as a permanent address without any luck. Anyone know of such a resource?

I think that this has a lot to do with the present popular states. In the past many folks just checked to see if the insurance they had already would move with them and then took the state that they thought would cost least in taxes. There are a lot of other things that I believe should be considered, but I'm not sure how many people realize that changing domicile is the same as physically moving there, in legal terms. Life isn't getting less complicated for fulltimers!

[Daveh]

5'er and Mariner. I have read the entire ACA twice and also read the supreme court opinions. 5'er claims I am a fan of the ACA but I have never said that and my purpose here is attempt to resolve an issue for Under-65 RVers caused by the ACA.

 

5'er here are the actual penalty provisions of the ACA word for word.

 

 

 

 

 

‘(g)
Administration and Procedure-

‘(1)
IN GENERAL- The penalty provided by this section shall be paid upon notice and
demand by the Secretary, and except as provided in paragraph (2), shall be
assessed and collected in the same manner as an assessable penalty under
subchapter B of chapter 68.

(2)
SPECIAL RULES- Notwithstanding any other provision of law—

‘(A)
WAIVER OF CRIMINAL PENALTIES- In the case of any failure by a taxpayer to
timely pay any penalty imposed by this section, such taxpayer shall not be
subject to any criminal prosecution or penalty with respect to such failure.

‘(
LIMITATIONS ON LIENS AND LEVIES- The Secretary shall not—

‘(i)
file notice of lien with respect to any property of a taxpayer by reason of any
failure to pay the penalty imposed by this section, or

‘(ii)
levy on any such property with respect to such failure.’

 

Additionally 5'er the individual mandate applies to about 6% of the population. I mentioned some exemptions only as examples. I also note the second paragraph of your post is simply a political diatribe and should be taken down.

 

- See more at: http://www.ncpa.org/sub/dpd/index.php?Article_ID=24951#sthash.T9BwmtsP.dpuf

http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412533-The-Individual-Mandate-in-Perspective.PDF http://cbo.gov/sites/default/files/cbofiles/attachments/45397-IndividualMandate.pdf

http://www.forbes.com/sites/beltway/2014/06/12/good-and-bad-news-about-the-aca-penalty-tax/

[Daveh]

I think that this has a lot to do with the present popular states. In the past many folks just checked to see if the insurance they had already would move with them and then took the state that they thought would cost least in taxes. There are a lot of other things that I believe should be considered, but I'm not sure how many people realize that changing domicile is the same as physically moving there, in legal terms. Life isn't getting less complicated for fulltimers!

Yes, that is what led me to stick with Michigan for the time being. If your current home state offers a ppo then that would most likely be your best domicile solution for those under 65 that need insurance. I am gradually going to work my way through the plans on the exchange for other states to see what others offer workable PPO plans. Perhaps Kyle has this information.

[Velos]

Coming back to the question of which states might be best for below 65 full timers.

 

I think I'd start with the states who have taken the Medicaid expansion. That reduces costs on the exchanges by the value of the subsidy for many of us. This offsets any state income tax burden. The biggest issue then becomes whether any of those states take a PMB address or whether one would have to actually establish a physical domicile.

 

States with Medicaid expansion.

 

http://familiesusa.org/product/50-state-look-medicaid-expansion

 

I poked around trying to figure out which states would take a PMB as a permanent address without any luck. Anyone know of such a resource?

 

I don't know about other businesses/states etc if they are like banks but before the internet banks used a booklet with a list of all mail drops in the area and would deny new accounts to individuals that used them because of the cons that used mail drops for scams. Now that everything is digitized when you open an account the computer automatically tells them whether the address is a drop box/mail service or not.

[Velos]

I am behind on my E-mail but just read a recent Escapees Club News (8-4-2015)

RVer Insurance Exchange Launched!

As brokers with connections to all 50 states, the RVer Insurance Exchange team is able to shop multiple carriers to find each client the best coverage at the best rates. The ultimate goal is to be the number one resource for all RV lifestyle-related insurances including:

• Medical/Health-related products
• Individual and Family Health
• Medicare Supplement
• Medicare Advantage
• Medicare Part D
• Emergency Medical Transportation
• Telemedicine (which offers unlimited virtual office visits plus discounts on dental, vision, and Rx)

The complete article here: http://us9.campaign-archive2.com/?u=d8bc0f46a19a696e5c335f4d2&id=cdc7668082&e=35c6fcd3a6

[cmelkins]

 

I don't know about other businesses/states etc if they are like banks but before the internet banks used a booklet with a list of all mail drops in the area and would deny new accounts to individuals that used them because of the cons that used mail drops for scams. Now that everything is digitized when you open an account the computer automatically tells them whether the address is a drop box/mail service or not.

Escapees website is a wonderful resource for domicile knowledge on that page you will contact information for Shawn Loring. He is an attorney that counsels people on choosing the appropriate domicile for their personal needs. He is located at Rainbows End in Livingston. He is extremely knowledgeable on the needs of full-time RVer's and will help you with a personal assessment.

[Daveh]

JM, I happened to see that this AM also. Kyle posts here from time to time and they may have a list of states that offer PPO. I imagine they are still digesting this news re PPO plans being discontinued in Texas.

[trostberg]

Kurt

I have not had to change my legal domicile per the marketplace and also talking with a supervisor. I have a part time job via computer from WI my legal domicile where I am selling my home and where my HMO insurance said I had to cancel because I was going to be living outside of their Wisconsin service area. I am living and working another seasonal job in WY and they have a national plan. Not sure where I will go next ...maybe another position in WY? I will change my domicile when I find a place that will allow me to depending on my physical work location. My only interest is health insurance that I could actually use if I should need it and in a somewhat nearby location.

 

I actually have better coverage in terms of a larger network in WI with my Wyoming insurance.

[NJTroy]

Daveh,

 

It's not practical for us to keep our current domicile. We live in NJ, with the accompanying high cost of living, high income tax rates, high property tax rates, high estate tax rates and the fun practice of aggressively pursuing everyone who attempts to leave the state for taxes. We will not maintain a residence here. That's perhaps the only non-starter option for us. I have a family member currently living in another state and strictly practicing the policies necessary to avoid NJ's clawback efforts. It's a real risk for them given their situation and could be for us as well. Whatever we do, we have to be careful to avoid running afoul of that.

 

Interesting that you are in MI. My husband is from MI and it is perhaps the best alternative for us if we end up having to maintain a physical presence to protect ourselves. Even if we had to purchase property there, the overall situation might be the best answer for us. We and our children have connections there still and I have long envied the low cost of living (compared to NJ). Combined with the relatively reasonable income tax rate and the Medicaid expansion, it's at least worth having on the list.

 

We need eight years of insurance between our fulltime date and my eligibility for Medicare. That's a long time at this point, given the evolving situation. We were planning on FL, which as of today is still an option. But who knows what 2025 will be like?

[Daveh]

There is no big negative with Mich. The one thing we lack, as far as I know at this point, is the legal address services for domicile like offered by Escapees in Texas, Florida and S Dakota. Right now we are leasing our house but I am still able to use that address. When the house is sold we will use my Bro in law's address. If that runs into problems we will by some property. As you say, property is still reasonable and we would consider a very small place where we could home base now and then. Still, they could do what Texas did and stop offering PPO plans with a nationwide network and that would be a setback. We have 9 years to go to 65.

[airstream harry]

_{I know several folks that have a seasonal lot and pay the yearly fee. They use this as their address. They get so little mail it is not a problem. We live in our rig,but have not moved for two years. This is our permanent address.}

_{c u on the road}

[bigboomer]

NJTroy,

 

We are originally from NJ and like you planned on getting out due to all the circumstances you noted. When we first started FT we set up in SD but as soon as the ACA took hold we could not get healthcare because we had a PMB in Sioux Falls. None of the insurance companies in SD by law have to recognize the PMB. There have and we're folks who tricked the system online but that is risky at best.

 

So we moved to Texas this past spring so we could get healthcare and did thru BCBS Texas but of course now that is a dilemma. We more than likely will go with Liberty Healthshare as they look to be the most reasonable and affordable.

 

After that it is out of our hands but we have faith that all will work it lself out in the end.

 

The move to Texas was otherwise seamless and relatively simple.

 

Hurry up and get out of NJ before you are not allowed too!

[trostberg]

_{I know several folks that have a seasonal lot and pay the yearly fee. They use this as their address. They get so little mail it is not a problem. We live in our rig,but have not moved for two years. This is our permanent address.}

_{c u on the road}

I actually have crop land that I could call my physical address but no one has lived there since Rural Route addresses and there is no mail delivery only PO BOX in town. I asked the sheriff and emergency services for a physical address for the location. They will not assign a physical address unless you install a landline telephone. They just use cell phone coordinates if you do not have a landline.

[NJTroy]

Bigboomer,

 

Unless something changes, we are here until mid-2017. One more son to finish school is all we are really waiting on now.

 

It is frustrating. My family dates back in this area to before the revolution, but it's just not practical to stay anymore. I think our current plan is to use FL as a domicile with Liberty Healthshare and MI as our backup plans if there's no PPO in FL by that time.

[Kirk W]

Kurt

I have not had to change my legal domicile per the marketplace and also talking with a supervisor. I have a part time job via computer from WI my legal domicile where I am selling my home and where my HMO insurance said I had to cancel because I was going to be living outside of their Wisconsin service area. I am living and working another seasonal job in WY and they have a national plan. Not sure where I will go next ...maybe another position in WY? I will change my domicile when I find a place that will allow me to depending on my physical work location.

I am going to guess that this is addressed to me, even though the name isn't me? Having lived in WY for 18 years, it is a state that we love but the winters are too much for us now that our age has been creeping up there. We lived in the Cheyenne area and from there our occasional visits to the Jackson Hole area in mid winter were bone chilling. Winter weather is not much fun when your age gets up there. Even so, we consider WY to be one of the best places that our lives have taken us and it was a great place to raise our three sons.

 

Interesting that you are in MI. My husband is from MI and it is perhaps the best alternative for us if we end up having to maintain a physical presence to protect ourselves. Even if we had to purchase property there, the overall situation might be the best answer for us. We and our children have connections there still and I have long envied the low cost of living (compared to NJ). Combined with the relatively reasonable income tax rate and the Medicaid expansion, it's at least worth having on the list.

The biggest problem is most likely going to be a legal address. You really don't have to get your mail there, but you will need an address for your driver's license, vehicle registration, and all forms of insurance. I suggest that if you have not done so, you might find it helpful to read this article published in Escapee's Magazine a couple of years back on the subject. I wrote the article and so have it on our website.

[NJTroy]

Kirk,

 

The thought is that we would buy a small place so we would have a physical address there, most likely in the area where my DH grew up and my BIL & SIL still live. There's a number of advantages to us beyond the fulltiming issues. My older son is still figuring out where he wants to land and he has a lot of friends there since he went to university in MI. This could give him some options as well.

 

We still have time a lot of time before we make any decision. It's coming up fast though and given that we know NJ is not an option we're researching now so we can see all the moving parts when we need to make a final plan.

[Velos]

Read this article*** on another forum with a similar topic. The problem was a long time in the making and won't be fixed overnight but it may provide some long term solutions. Though implementing now may not help those already afflicted but education, pro-activity, prevention may be the formula for bringing down health care costs for Xscapers and beyond. IMHO common sense has left the school system bring back the 3 r's reading, writing and arithmetic plus nutrition and exercise. In the effort to be creative to interest students in their studies we see classes like these: 13 Bizarre College Courses Being Offered Right Now Read more: http://www.businessinsider.com/strange-college-courses-this-year-2014-10#ixzz3iW0DMqck.

 

***The Cost of Chronic Diseases and Health Risk Behaviors

In the United States, chronic diseases and conditions and the health risk behaviors that cause them account for most health care costs.

• Eighty-six percent of all health care spending in 2010 was for people with one or more chronic medical conditions.¹⁵
• The total costs of heart disease and stroke in 2010 were estimated to be $315.4 billion. Of this amount, $193.4 billion was for direct medical costs, not including costs of nursing home care.¹⁶
• Cancer care cost $157 billion in 2010 dollars.¹⁷
• The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Decreased productivity includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all because of diabetes.¹⁸
• The total cost of arthritis and related conditions was about $128 billion in 2003. Of this amount, nearly $81 billion was for direct medical costs and $47 billion was for indirect costs associated with lost earnings.¹⁹
• Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who are obese were $1,429 higher than those for people of normal weight in 2006.²⁰
• For the years 2009-2012, economic cost due to smoking is estimated to be more than $289 billion a year. This cost includes at least $133 billion in direct medical care for adults and more than $156 billion for lost productivity from premature death estimated from 2005 through 2009.¹¹
• The economic costs of drinking too much alcohol were estimated to be $223.5 billion, or $1.90 a drink, in 2006. Most of these costs were due to binge drinking and resulted from losses in workplace productivity, health care expenses, and crimes related to excessive drinking.²¹