Selecting a Domicile -- It's All about Counties

[Zulu]

I suggest every under-65 full-time RVer start with Kyle's excellent Guide to 2016 ACA plans for the most authoritative information on plans in the "big-3" states (FL, SD, and TX) for full-time RVers.

 

For those under 65, I think it's time to rethink the "Big 3".

 

If I had several years (or even a couple of years) of having to buy my own health insurance, I'd check into Nevada first -- Las Vegas, in fact, since the average weather is fairly good. Also, Las Vegas is in Clark County which currently offers the lowest priced Anthem BCBS PPO plans in the state. These PPOs have nationwide networks and out-of-network caps.

 

Ten Anthem PPO plans (4 Bronze, 5 Silver, 1 Gold) are currently offered in all NV counties. Compare these plans to what's now offered by the Big 3. Go to www.healthsherpa.com and use a Clark County Zip Code (like 89005).

 

In Kyle Henson's RVer Guide to 2016 ACA, Kyle asks Should you change your domicile to a state that offers better options in 2016?

 

He answers We generally recommend riding things out and not making drastic changes unless absolutely necessary to your healthcare.

 

Well, if I was currently domiciled in FL or even SD, I might ride it out, but not if I was domiciled in Polk County, TX.

 

On the other hand, if I was looking for a domicile, it would probably be NV.

[Mariner]

It's just amazing to me that just by moving from one county to another within the same state you have such a wide disparity in premiums. And this is supposed to be a better way?

[trostberg]

Balance billing is an issue that could add up financially. I see there is a disclaimer on the cap for in network and out of network maximums that the cap does not include balance billing. So the cap really is not as safe a stop gap as you might think.

[lb311]

Agreed Teri. I've only been "balanced billed" once this year for an out-of-network radiologist reading of an in-network x-ray (of course neither the facility or BCBS advised me upfront that the reading would be out of network). Argh! I so want the U.S. to join the rest of the civilized first-world nations and have something like "Medicare for All"! But, until that day ever comes, I'll be ideally looking for 1. a plan with the most nationwide "in-network" providers as I can find and afford, 2. a plan that caps both in and out of network out of pocket costs.

 

Zulu-- thanks for the suggestion of NV. Will put that one on my list too for future year's reference. I had look into NV briefly last year as a potential domicile, but got spooked by their very convoluted vehicle registration tax calculations (could never figure out how much it would cost, and others said it was much higher than the traditional big 3 states, so I didn't investigate further). Of course, if NV ends up being one of the few still offering a traditional PPO in future years, that will be far more important to me than any vehicle fees. thanks!

 

Lynne

[trostberg]

Long before ACA I was balance billed because the in network provider according to the insurance company billed over usual and customary. I think medical coding will have a bigger impact in this area since the new and much more complicated ICD 10 coding system will be on a learning curve for awhile.

[Mariner]

Will be changing our domicile from Maryland to South Carolina soon, and the savings in our secondary healthcare coverage will be over $1,200 a year. With disparities like these in premiums, pretty soon certain areas of the country will REALLY be filled with seniors.

[trostberg]

I am probably changing my residence from WI to WA but my premiums go the other direction (more expensive). But at least I have coverage out of state. My WI insurance told me if I leave the state I am out of their service area and have to drop their insurance.

[Sehc]

I have found the same difference in premiums for medicare supplement insurance. The coverage, mandated by medicare, is identical, but premiums vary by 100s $ month.

[Pieere]

I sure am happy that I have VA healthcare and can use it anywhere just so long as I re-register in the state I visit; and in an emergency just go to the nearest facility if it I believe it to be life threatening! I have Medicare and do believe it is made to difficult to maneuver to deter one from using it. I don't need the hassle.

[Kirk W]

 

I have found the same difference in premiums for medicare supplement insurance. The coverage, mandated by medicare, is identical, but premiums vary by 100s $ month.

Medicare costs everyone exactly the same in every location but the supplemental coverage does change by location. I am not aware of any differences that are hundreds/month but have seen one that was just short of $100/month difference in two different areas.

 

I have Medicare and do believe it is made to difficult to maneuver to deter one from using it. I don't need the hassle.

I have received care from both systems and at present am getting most of mine from the VA while Pam is under Medicare and our supplement. While the cost of the supplement is higher than my copay for the VA services, we find it quite easy to get care from Medicare and Pam uses the system a great deal. In terms of the quality of care, I have to give the edge to the hospitals and medical facilities used by by Medicare over those of the VA. Wait times are significantly shorter for her than for me and services are more available. In fairness you also need to realize that we have a Medicare supplement plan F for Pam which costs us in premium payments but we pay nothing at all beyond the premiums.

 

Of course, all bets are off it you compare the VA to one of the Medicare Advantage plans, which are basically a discounted HMO and are very different from the original Medicare program and the, so called, Advantage plans. About the only good thing that I can say of those for an RV traveler is that they are cheap.