Handling Health Care

[Paul]

Hey All,

I am 55 and retired. We live in Colorado and plan on selling our home by years end and starting our domicile in Texas using the mail forwarding service. I understand that we will start doing business in Livingston (banking, cars tags,insurance, voter reg, etc.) My biggest question is with health care and how everyone of my age handles these issues. My wife is diabetic so we typically mail order her medicine in 3 month volume. Also we need to purchase a new health care plan. That means that we need to be in network. So the question are...

How does diabetic receive there medicine on the road ?

Does everyone who use the mail forwarding service have a medical plan  in that address? ( Like Livingston Texas )

I can't imagine everyone using the mail forwarding service using the Livingston area medical facilities.

( By the way I went to the ACA website to see what was available for Livingston and a few other cities. Livingston had 1 provider and a few plans, San Antonio offer several carriers and a lot of different plan options. Some was not to badly priced. I know this will all change with the new health care bill in the senate but I have to start some where.)

I would prefer to get set up in San Antonio with medical and figure out how to get mail order drugs. ( As of now we are traveling several month and going back home to receive the medicine and take care of house.....then taking off again)

Thanks Paul

[Daveh]

If you go to the Health section of the forum there are a few long threads about healthcare for those under 65. You will need to wade though a bit as the posts can drift off into a policy debate at times.

The big issues are that (1) you need to change your domicile to the one you will be ordering insurance through. Simply having  a mailing address in a state is not enough. There are  articles about domicile in the information section and we have members familiar with the requirements. (2)  For under 65's getting coverage on the  ACA exchange can be difficult or impossible in some states since we need  a policy that will provide out of state coverage. I am not up to date on the details but generally the three big RVer domicile states---Fl, Texas and South Dakota do not offer plans that provide good out of state coverage. Almost all, if not all, plans provide coverage for out of state emergencies however the issue is what if you need regular care out of state or what if you are somewhere and there is a dispute whether a condition which requires your hospitalization still constitutes emergency care. Because of this concerns under 65's seek out plans with out of state coverage. These plans are most often called PPO plans (this is different that multistate plans which just means the plan is offered in several states, not that it provides coverage in all states). The problem is that if insurers aren't getting out of the ACA market all together they are limiting their network of coverage and getting away from the PPO plans. So the pickings are getting slim and you may find it is best to maintain your residency using a friend or relatives mailing address if they have better offerings than Texas, Fl. I have maintained my residency in Michigan for insurance purposes mostly for medical insurance reasons.

 

As far as prescriptions many just get there prescriptions at the big chains as once you are in the system with them you can go online and just change the pharmacy where you will pick it up. Also, many of us use the mail order places such as express scripts for 90 day supplies and you again can just go online and put in your mailing address.

http://www.rvnetwork.com/index.php?/topic/125570-state-residency-and-aca-obamacare-health-plans/

http://www.rvnetwork.com/index.php?/topic/127027-an-aca-obamacare-strategy-sep/

http://www.rvnetwork.com/index.php?/topic/126062-where-will-healthcare-go-in-the-near-future/

http://www.rvnetwork.com/index.php?/topic/124397-20152016-aca-ppo-plans-in-26-states/

 

[SWharton]

I have RA and take a biologic that I get a 90 day supply for on the road. No problem whatsoever. I schedule shipping and know what day it will be arriving at the cg and just wait for it. Just make sure before you order the insulin that the cg you are at will accept packages. A majority do.

Some RX programs allow you to use Walmart, Walgreen's or CVS to pick up your supply. We use Express Scripts since that is what of drug plan calls for. 

Livingston is closer to Houston than San Antonio. You also have Conroe and the Woodlands(we have lived there) which has good medical. Huntsville might be another option.

[Paul]

Thanks for the reply's.

I figure we would have an HMO for insurance and I would have to make all my trips back to the area I decide to get Insurance. Being a diabetic my wife has to have regular blood test and a specific doctor to monitor sugar levels and adjust if needed.

What I have a hard time wrapping my head around is my mailing address is in Livingston, If I get Insurance in San Antonio the Insurance company don't question the out of area mailing address? 

My current Insurer is very specific about only using there in-network hospitals and nothing else or they pay nothing.

I typically use the Insurance company mail order pharmacy so I can get the full discounts. They have my home address and ship there. I am guessing I will have to use another pharmacy to ship where ever I am. As we all know drugs are very expensive as well as health care coverage, I am trying to save every dime.

I will read through the links Daveh supplied.

Thanks!

 

[SWharton]

HMO's are not conducive to the full-timing lifestyle. I would seriously consider a PPO, I think that is the name now so you are not limited to a specific area for health care.  I have never found a doctor that would not cooperate with our lifestyle. I also need lab test for my RA, all I do is .take a pile of orders with me and stop at a Lab Corp on the road. Results are sent to me and my doctor. After that, if something is amiss, email each other.

For now, use your current doctor if he is in your new plan and you will be returning to that  area. If not, wherever you winter, find a doctor there. Most doctor's like to see you every year, some every 6 months but have no problem writing scripts for a year.

You could also just keep your doctors in CO if you are in a PPO.

You mention San Antonio. Are you planning to winter there each year?

 

[SWharton]

Sorry, My cat walked across the keyboard

For scripts, you will need to use whatever mail order pharmacy your plan is associated with.

We use Express Scripts and have several addresses on our account and just check off which one we want our script's sent to. Just like Amazon. I have 6-8 addresses in the system.

[Paul]

Yes I think we will end up in the San Antonio area for winters.

I thought HMO because it is a bit cheaper than then a PPO. Currently we are paying around 1250 a month and PPO was either not offered or more expensive.

[SWharton]

That is a personal choice. I have no experience with ACA as our insurance is with our previous company and we elected to have a PPO(having had a bad experience with an HMO and a child with scoliosis).

It is something to think about and your decision to make. Maybe AARP has a plan, I have no idea, worth a look.

[SWharton]

Other places to look on ACA is SD and FL. Many people establixh domicile there. Escapees has addresses in both those states also. Essentially they are drop addresses for registration and drivers license but that is where your domicile would  be. You use the TX address for everything else.

There are threads on this and info on the Escapees site.

[SWharton]

Another thought. check the Escapees site there is an Rv Insurance Exchange, has health insurance listed.

[trostberg]

At this time of year you will have to prove a move or some other qualifying event and submit paperwork to prove it.  My domicile is WA.  I am workamping in ND and changed my insurance without changing my domicile because I have a contract to work that shows my new physical address which is general delivery Medora ND.

There are extremely few PPOs anymore.  My WA insurance would not have covered me out of state except minimally for an emergency to stabilize and transfer back to WA.

There is a short thread the gives the references for using a state other than your domicile that helps snowbirds with 2 or more residences.  You have to submit utility bills or some other proof of your address.

Search under SEP and you might fond the links to that thread.

[itgeekgal]

Short answer = good luck.  We went full time in 2010 with a South Dakota mailing address without issue.  In 2012 South Dakota stopped offering nationwide policies for folks under 65 so we switched to our son's address in Nevada and again had our choice of plans. In 2017 Nevada coverage options dried up also, we ended up with "faith based" non-insurance coverage for now, who knows what options will be available in n the future.

[Zulu]

5 hours ago, Paul said:

I am 55 and retired. We live in Colorado and plan on selling our home by years end and starting our domicile in Texas using the mail forwarding service. I understand that we will start doing business in Livingston (banking, cars tags,insurance, voter reg, etc.) My biggest question is with health care and how everyone of my age handles these issues. My wife is diabetic so we typically mail order her medicine in 3 month volume. Also we need to purchase a new health care plan.

You need to change your domicile thinking from "mail forwarding service" to what state (or rather what state county) offers a good health plan. While the Escapees mail service and the fact that Texas has no income tax used to be prime domicile considerations, these factors pale in comparison to heath care costs for those under 65.

You'll have to ante up for your own health care for a decade.

Currently, with the ACA you can use its SEP (Special Enrollment Period) to effectively RV to a better health plan. You can start looking here -- Where the PPOs Are. Keep in mind the data I collected was for the ACA's 2015/2016 plans, and a lot has changed since then.

If possible, I'd seriously recommend postponing your retirement for at least a year to see how the "new" ACA shakes out. As of today, it's not looking good.

[Blues]

7 hours ago, Paul said:

Does everyone who use the mail forwarding service have a medical plan  in that address? ( Like Livingston Texas )

I can't imagine everyone using the mail forwarding service using the Livingston area medical facilities.

I'd bet that the vast majority of people who use Escapees for mail forwarding are on Medicare, and they're covered nationwide and don't have the same issues as people under 65.

 

6 hours ago, Daveh said:

For under 65's getting coverage on the  ACA exchange can be difficult or impossible in some states since we need  a policy that will provide out of state coverage. I am not up to date on the details but generally the three big RVer domicile states---Fl, Texas and South Dakota do not offer plans that provide good out of state coverage.

I agree about Texas and South Dakota not having plans that have access to out-of-state networks, but has something changed about Florida?  Blue Cross has EPOs there my understanding is that they have access to a nationwide network without having to get a referral from a primary care physician.  Am I misunderstanding it?

 

5 hours ago, SWharton said:

Other places to look on ACA is SD and FL. Many people establixh domicile there. Escapees has addresses in both those states also. Essentially they are drop addresses for registration and drivers license but that is where your domicile would  be. You use the TX address for everything else.

The South Dakota option is really only for people on Medicare because the under-65 health insurance choices there are no good at all. 

[trostberg]

My experience with EPO networks in WA is that they have limited networks and do not go out of state.  I am sure every network is slightly different but they all seem to be getting smaller.

 

[Paul]

I gave a  lot of thought to the best state for me to use as a domicile. Texas

No state tax was an important factor and we have some kids living in the in the state. As well as weather and a few other factors. Mostly I have been researching Health Insurance. Texas ranks in top 10 states in most articles I read. I use the ACA web site as I can input hypothetical income values and see what is available and how much they cost. Then I can compare  states as well as county in the states. This is how I came up with Texas and San Antonio. ( I spent a lot of time on the ACA web site. LOL)

Most insurance companies want a mountain of information before they can give you a quote in that given state/county.

Health care is going too be a real issue I think. I have given into the idea that we will have to travel back at least once a year ( if not more) for Dr visits as the most affordable health care will be a HMO. ( unless things change).

 

 

[SWharton]

Years ago we needed health insurance for 3 months. We found a broker and he suggested "catastrophic" health insurance. It kicked in after we paid $3K out of pocket. I have no idea if that still exists or if brokers for health insurance still exist.

I know you probably want a drug plan but buying from/in Mexico or Canada might be an economical option.

[richfaa]

Healthcare is one of the primary reasons we are not full timers but "long timers" keeping our S&B and Domicle in Ohio. We  have a BC/BS employer  provided PPO that  we carried over into retirement. It has very good coverage and is affordable. We do travel all over the country like any full timer and have no problem at all with coverage , payment or doctors. Prescriptions can be had at any Wall mart, CVS, etc anywhere in the country.  ACA is income dependent and the higher the income level the lower the subsidy at our income level we would not be eligible for a subsidy and any plan would be expensive having to bear the entire cost.

We are both over 65 and Medicare is our primary coverage with the BC/BS being secondary. The wife did have  surgery a couple of years ago and the total bill was over 60K at the time she was under 65 so no Medicare coverage. Her out of pocket was 3,300.00. I have not had a "You owe the provider" block filled in since we went on Medicare years ago. We are among the more fortunate.

 

 

 

[Kirk W]

Since nobody has yet done so, I welcome you to the Escapee forums, Paul.

13 hours ago, Zulu said:

You need to change your domicile thinking from "mail forwarding service" to what state (or rather what state county) offers a good health plan.

From my observation, I think that Zulu has done the most research on healthcare coverage of most anyone I see on the forums. We were fortunate to have had coverage until 65 from my previous employer and continue to have supplemental coverage to Medicare from them so have not had to deal with most of the current issues. I can tell you from experience that what county you physically claim isn't normally an issue in TX but you may have to be careful with the address issue for your insurance company, If you have kids in San Antonio whose address you might use for most things it would make Escapees mail quite usable with little issue. We moved to Medicare well before the ACA and the recent issues that have come with that so I'm sure that Zulu is much better informed on the healthcare side of things but we did leave much of our business and our voter registration in Ft. Worth for varying lengths of time when we went on the road and none of it was ever a problem.

9 hours ago, Paul said:

Health care is going too be a real issue I think. I have given into the idea that we will have to travel back at least once a year ( if not more) for Dr visits as the most affordable health care will be a HMO. ( unless things change).

For anyone who requires continuing care, returning to the same doctor for physicals and follow-up care is the best approach as much for health reasons as for insurance ones. Doctors seldom accept tests and diagnosis of other medical people who they do not know and so want the patient to go back through things if you seek any form of continuing care. On the other hand, while we did return to the same doctor for all continuing care annually and later biannually, we never had any problems with visiting one of the outpatient clinics for short term illness along the road. For most things, TX and Livingston are difficult to beat for most fulltime services, but recent political activities have made the medical issue very difficult and it doesn't look to be over in the near future. 

[trostberg]

15 hours ago, SWharton said:

Years ago we needed health insurance for 3 months. We found a broker and he suggested "catastrophic" health insurance. It kicked in after we paid $3K out of pocket. I have no idea if that still exists or if brokers for health insurance still exist.

I know you probably want a drug plan but buying from/in Mexico or Canada might be an economical option.

I had a $10,000 catastrophic plan before ACA but it is no longer allowed if you are over 30 years of age.

[whj469]

I had to wait until I was over 65 to retire because of health insurance. Unless your prior employer helps with health insurance it is not easy to pay for health insurance without Medicare. Good Luck

[GlennWest]

We full time and I still work. We use Liberty Health Share. It is Christian medial share system. Check it out and see if it meets your needs. It is not restricted to any doctor or state. 

[Daveh]

Glenn How many states have you used this in and have you had any problems with Drs not taking it? Do you need to discuss  prices with them ahead of time? Insurance cos have the clout to negotiate prices and sometimes the prices for those without insurance are much higher.

[GlennWest]

Louisana,  Texas, Colorado so far. Never been turned down. And you are always quick to jump on me. All I stated works for us and for them to check it out. 

[Kirk W]

6 hours ago, GlennWest said:

Louisana,  Texas, Colorado so far. Never been turned down. And you are always quick to jump on me. All I stated works for us and for them to check it out. 

 

Remember that the health share programs are faith-based, so there will always be those who are skeptics.