Health Insurance

[Livdreem]

How do people handle a home address for health Ins purposes when they are full timing and Escapees members?

I lived in Florida for many years and would like to keep my auto registration there.  But Escapees says we can only receive Dept of Motor Vehicle mail at the Ft Sumter RV park.

what do people do?

Thanks

Livdreem

[sandsys]

Some places will let you have both a mailing address and a home address.

[Zulu]

7 hours ago, Livdreem said:

How do people handle a home address for health Ins purposes when they are full timing and Escapees members?

Are you on Medicare? Or under 65 buying your own health insurance?

[2gypsies]

Here's a good article on health insurance for RVers - under age & Medicare age:

https://www.mortonsonthemove.com/health-insurance-for-full-time-rvers/

 

Here are two Step-By-Step How-To Domicile if you decide on Florida:

https://www.escapees.com/domicile-for-rvers/

https://rv-dreams.typepad.com/rvdreams_journal/2018/06/setting-up-our-florida-domicile.html

[Kirk W]

I think that you have misunderstood something. You do pay some extra postage expense when things go to the Sumter address, but you use it for anything that requires the FL address, including your insurance.

Quote

Note: As an Escapees mail service member, you may elect to use “Escapees: Home” as an additional mail service benefit. This service is specifically geared for full-time RVers who have sold their brick and mortar homes. Escapees: Home allows you to use Sumter Oaks RV Park as your physical address for state-specific documents (such as driver license, voter registration, and vehicle registrations.)

 

[LiveWorkDream]

The health insurance situation really depends on whether or not you are on Medicaid or still under 65.

We are under 65 and used our SKPs Livingston address to buy health insurance through the Healthcare.gov exchange. That address was sufficient to enroll, but our insurance was an HMO and only good in Texas. Recently we changed our Texas domicile to another state, and switched our insurance to that state. We still have an HMO, but since the company operates in most of the states where we roam, we have much better coverage.

So basically wherever you are officially domiciled, that is where your health insurance should be based. I hear Florida is a good state to domicile for health insurance reasons, since there are still PPO plans with national coverage. The majority of health insurance companies across the U.S. have nixed these types of policies, including Texas.

If you are under 65, this Escapees webinar about health insurance is very helpful:
 

 

[2gypsies]

Extra postage for using the Sumter Oaks, FL as your address is extremely tiny.  Your driver's license, vehicle registration, etc. only comes once a year, if that.  Some you can do online.   The major bulk of mail will go to Livingston, TX and you can request your mail to be packaged in one Priority pkg and shipped wherever you are every 2 weeks or even once a month.  People don't really get much important mail anymore.  Most things can be handled online and bills can be set up as AutoPay.

[Blues]

On 11/4/2021 at 11:14 PM, 2gypsies said:

Here's a good article on health insurance for RVers - under age & Medicare age:

https://www.mortonsonthemove.com/health-insurance-for-full-time-rvers/

Boy, I don't know.  They say South Dakota is a smart choice for people who need health insurance, and that's simply not the case. 

And they barely touch on Medicare, and don't mention Medicare Advantage at all, which is where fulltimers could trip up because Advantage plans usually don't emphasize that they usually are limited to local networks.

[Blues]

On 11/5/2021 at 10:45 AM, LiveWorkDream said:

Recently we changed our Texas domicile to another state, and switched our insurance to that state. We still have an HMO, but since the company operates in most of the states where we roam, we have much better coverage.

What state and what HMO?  I've found that even if a company operates in several states, its HMO networks remain separate.

[Dutch_12078]

5 hours ago, Blues said:

Boy, I don't know.  They say South Dakota is a smart choice for people who need health insurance, and that's simply not the case. 

And they barely touch on Medicare, and don't mention Medicare Advantage at all, which is where fulltimers could trip up because Advantage plans usually don't emphasize that they usually are limited to local networks.

I can't speak for all Advantage Plans of course, but our United Healthcare Medicare Advantage PPO zero premium plan lets us use any in-network provider anywhere in the country at home region co-pays, or out of network providers at higher co-pays. Emergency department and urgent care are covered everywhere at the same co-pays. I think the AARP version has the same benefits.

[Zulu]

On 11/5/2021 at 8:45 AM, LiveWorkDream said:

We are under 65 and used our SKPs Livingston address to buy health insurance through the Healthcare.gov exchange . . . basically wherever you are officially domiciled, that is where your health insurance should be based.

"Basically" is correct.

If you are using the ACA, then the ACA is concerned with where you actually reside. If that's your domicile, fine. But if it's a domicile in name only, and you don't really live there, then you should rethink that.

However, the ACA allows you to change health insurance if you move to a different location. It's called the Special Enrollment Period. For example, imagine TX was your domicile, but you never actually stayed there. On the other hand, you spend a length of time (beats me what that is) in FL, AK, AL, AR, CA, ND, and/or WY, then you could sign up for a nationwide PPO/EPO health plan in one of those states.

 

On 11/5/2021 at 8:45 AM, LiveWorkDream said:

If you are under 65, this Escapees webinar about health insurance is very helpful:
 

While Mr Goldstein (a part-time Escapee Staff Member) has done some health care research, he himself admits that he is not an expert. He proves this by delivering this quote at the start of his talk:

"You must get coverage in the zip code of your domicile"

For an ACA health insurance plan, this is just not true.

[Jinx & Wayne]

I'm not sure there really is a problem.  Kirk is correct about the mail and Sumter Oaks.  We are domiciled at Sumter Oaks, Bushnell, FL and have Escapees Mail service out of Livingston, TX.  I am over 65 and Jinx is under.  She gets insurance through the exchange based on Sumter County.  I get medicare supplement based on the same address.  The insurance company sends the mail to Livingston, TX and they forward it.  Our DMV, voting and the few other mail/documents that come directly from the state go to Sumter Oaks and they forward it to Livingston.  All other mail goes directly to the mail service in Livingston.  Our credit cards use the Livingston address as billing addresses, even though we are paperless.  That is the zip code I enter when charging things.  It works well and has for over three years.

Wayne & Jinx
2017 F-350 diesel, dually
2006 Carriage Carri-Lite 36KSQ

[Kirk W]

13 hours ago, Zulu said:

If you are using the ACA, then the ACA is concerned with where you actually reside.

I know that you have done a lot of researching of this issue, but do you know of any cases of someone having a problem arise from using insurance purchased via the ACA while fulltime and not changing the address each time that they stop anywhere? Can you give us a specific example with general information about what actually happened? I'm not looking for the typical antidotal story of someone who knew someone, or heard about someone, but something that is documented and verifiable. I have read a lot of the information about it and understand your conclusion, but can find no actual facts. 

[Zulu]

3 hours ago, Kirk W said:

. . . do you know of any cases of someone having a problem arise from using insurance purchased via the ACA while fulltime and not changing the address each time that they stop anywhere?

Um, that's not how SEP works. Suggest you read the link I gave above.

 

3 hours ago, Kirk W said:

Can you give us a specific example with general information about what actually happened? I'm not looking for the typical antidotal story of someone who knew someone, or heard about someone, but something that is documented and verifiable. I have read a lot of the information about it and understand your conclusion, but can find no actual facts. 

I think you're asking 'Do I know anyone who was caught with a fraudulent address?'

Nope.

You (and others) have used this line of reasoning before which goes something like . . .
'Since you (or anyone) hasn't heard of anyone getting caught, then the risk is low or non-existent. Why worry about it?'

It totally ignores the issue of right or wrong, just 'Will I get caught?' I find this stance fascinating for an older group of typically conservative people.

But to answer your bait . . .

I do know someone who committed tax fraud, but I have no idea what happened to him.
Nevertheless, I'm not going to commit tax fraud.

On the other hand, I do not know anyone who committed murder.
Nevertheless, I'm going to avoid killing anyone.

[Kirk W]

11 hours ago, Zulu said:

You (and others) have used this line of reasoning before which goes something like . . .
'Since you (or anyone) hasn't heard of anyone getting caught, then the risk is low or non-existent. Why worry about it?'

That is simply not true. My only interest in this is an effort to keep the information on the forums accurate and valid. I have been on Medicare for a long time and I do not have a dog in this fight but, you are the only person I know of that keeps insisting that doing as most fulltimers do now is improper. 

I have made many efforts to find someone in the insurance industry or some branch of government who might agree with you, with no success. Based upon your answer to my question, it would seem that you are the only person I can find who holds that opinion. 

EDIT:  Consumer Information and Insurance Oversight

Edited November 13, 2021 by Kirk W
Add information.

[Barbaraok]

Zulu,  does the ACA cover people who are on vacation, or do they have to immediately file a change of address when they arrive at Disney World?   If one is traveling, and millions of people on all types of health insurance do, and one becomes ill, one does not schedule a cross-country jaunt that day to find out of the ankle is broken or severely sprained.   Usually a stop at an urgent care clinic or an ER is in order, and they will all take insurance payments from people visiting from all over the country.    Now, if one designates a primary care physician and has numerous visits with them outside of the coverage area for that insurance, then yes, the insurance company will flag that and probably refuse to cover it.    So when applying for the insurance, one should be in the area where they want to have a primary care physician.   

[Blues]

8 hours ago, Barbaraok said:

Now, if one designates a primary care physician and has numerous visits with them outside of the coverage area for that insurance, then yes, the insurance company will flag that and probably refuse to cover it.    

Do you have a source for this statement?  Or information about instances where this refusal has occurred? 

The tip for fulltimers who domicile in Florida (like the OP) is to get a Florida Blue EPO plan because of their access to the Blue Cross nationwide network when outside Florida.  These EPO plans don't require you to designate a primary care physician, so that's not an issue.  And I've never heard of anyone having claims denied because they were outside the coverage area.  Or did I miss it?

In fact, I'm fuzzy on this because it was quite a while back, but there was a woman who was a solo fulltimer who kept a blog.  She did a quickie Florida domicile change and got Florida Blue insurance and ended up needing a LOT of healthcare and eventually died from whatever it was she had, and my recollection is that she wasn't in Florida for any of it and Florida Blue covered all of it without a peep.

Obviously just because she didn't have a problem doesn't mean other people won't, but at least it's an actual situation that played out, and not just speculation on how things might go.  And if people were having problems using their Florida Blue insurance as fulltimers traveling around, I'm positive that we'd all be hearing about it, and there's been nothing that I've noticed.

[Dutch_12078]

My wife's primary is in upstate NY and UHC had no problem covering her cancer treatments in Florida. Her NY oncologist coordinated her treatments with her Florida oncologist with no complaints from UHC. As far as we know, her primary in NY just sat back and collected her copies of the reports. So far, I haven't needed any medical services other than some minor urgent care treatments while out of our home region, but with our UHC plans I'm not concerned about coverage when we are. I also have the VA to fall back on if needed.

[Zulu]

50 minutes ago, Blues said:

. . . if people were having problems using their Florida Blue insurance as fulltimers traveling around, I'm positive that we'd all be hearing about it, and there's been nothing that I've noticed.

It's not Florida Blue, but I think this counts . . . from Nov 11 RV Health Insurance . . .

RVers that domicile in South Dakota and enroll in health insurance are receiving letters from the insurance company, often months after enrollment, asking them to provide a utility bill to verify their residence. If the insured does not provide the documentation requested, they are dis-enrolled from the health plan. 

 

[Barbaraok]

Lots of insurance companies require one to receive primary care in the area they serve.  It is important to read and understand your coverage.  

[Kirk W]

12 hours ago, Blues said:

Obviously just because she didn't have a problem doesn't mean other people won't, but at least it's an actual situation that played out, and not just speculation on how things might go.

9 hours ago, Barbaraok said:

 It is important to read and understand your coverage.

Both of these are true, and important to note. One should always read every word of any contract that they sign and make sure that they understand what it means, whether buying insurance, arranging financing, or any other legal document but many people do not and yet go through life without major problems. Insurance policies are clearly the most difficult reading of any contract that I have ever dealt with. I have poured over our policies for hours and even so there are details that I struggle to understand. I suspect that the saving grace for us with insurance is the fact that insurance companies live by the reputations that they have and that they are government regulated. Due diligence is important, but we must also be careful not to invent problems where they do not exist. 

[Blues]

23 hours ago, Zulu said:

It's not Florida Blue, but I think this counts . . . from Nov 11 RV Health Insurance . . .

This is old news.  Here's a thread from 2014 about South Dakota health insurers disenrolling people who use a mail service:

https://www.rvnetwork.com/topic/111570-avera-health-insurance/

South Dakota insurers have made it clear for years that they don't want to insure fulltimer RVers.  And fulltime RVers shouldn't want to have insurance in South Dakota anyway, because even if it's a PPO, the network is local only (like many many other PPOs).  I can't imagine why a traveling fulltimer who's bothering to buy insurance (it's not required any more) would get a policy that doesn't work for his lifestyle.  Or actually, it's possible he just sees "PPO" and assumes (wrongly) that it provides access to a nationwide network. 

But I'll be honest--I'm not impressed with RVer Insurance (the site you linked to). Here's a post I wrote last year about the company that now owns it:

https://www.rvnetwork.com/topic/138198-rver-insurance-exchange-health-insurance/?do=findComment&comment=1036468

And it appears not much has changed.  When Kyle Henson had the site, he was definitely selling stuff but also was a good source of information for fulltimers trying to navigate the landscape when South Dakota was becoming hostile for health insurance, and later when Blue Cross PPO pulled out of Texas. 

Now the site is pretty much just a pitch to sell "alternatives to ACA plans," as they call them, which are indemnity plans that are very often confused with insurance.  And by the way, indemnity plans can be purchased any time during the year, and not just during open enrollment.  And they are subject to medical underwriting and exclusions for pre-existing conditions.  Somehow those details got left off that page.

[Zulu]

14 minutes ago, Blues said:

This is old news.  Here's a thread from 2014 about South Dakota health insurers disenrolling people who use a mail service:

https://www.rvnetwork.com/topic/111570-avera-health-insurance/

Or, it's happening again.

[Blues]

On 11/14/2021 at 7:46 PM, Zulu said:

Or, it's happening again.

Or it's been going on all this time and nothing has changed. 

As I said, I don't have a lot of faith in the site you linked to.  It used to have really valuable information for fulltimers looking for health insurance.  But not any more.

 

On 11/13/2021 at 5:36 AM, Kirk W said:

My only interest in this is an effort to keep the information on the forums accurate and valid. I have been on Medicare for a long time and I do not have a dog in this fight but, you are the only person I know of that keeps insisting that doing as most fulltimers do now is improper.

The thing is, the intent of the Affordable Care Act is to provide access to healthcare for all Americans.  And when there is ambiguity in a law, you look at the intent of the law to help resolve the ambiguity.

The focus on "residence" in the law makes things very clear for the vast majority of people.  But there are exceptions.

For people with two houses they alternate between seasonally, the FAQ explains how the ACA works for them, including that they will qualify for a SEP when they go to a different residence.  However it actually advises them that they should consider whether they would benefit more from enrolling in a plan that offers a national provider network or out-of-network coverage instead. 

Unfortunately, the FAQ doesn't address traveling fulltimers.  But if someone who is away from a residence for long periods of time because he's at his other house is told to consider getting a plan with a nationwide network instead of changing plans when he changes residences, that's a pretty good basis for inferring that the same applies to a traveling fulltimer, who has many residences--he could consider whether he would benefit more from enrolling in a plan that offers a national provider network than changing his insurance every time he moves.

Furthermore, it's not crystal clear a traveling fulltimer even could opt to enroll in a new plan every time he gets to a new place, even assuming it were actually possible (it's not, because of timing issues).  But assuming it were possible, the FAQ says a person who is in a new location without an intent to reside there doesn't qualify for a permanent move SEP, and that includes people who are there "for personal pleasure."  So it's not a matter of where you physically are, because people who are somewhere for personal pleasure are definitely physically there, but still don't qualify for a permanent move SEP.

So being somewhere for pleasure without the intent to remain there, which describes pretty much every place a traveling fulltimer spends the night, isn't the proper place to get insurance. 

The guiding principle is not "Will I get caught?"  It's "Where else can I  get insurance besides my domicile?"  The answer to that is, "Nowhere else." 

And the response to that has pivoted to the legitimacy of the domicile.  But this is the same domicile that is used for driver's license, vehicle registration, and vehicle insurance.  It's good enough for those, but not health insurance, even though there's a law whose intent is to see that every American has access to health care?  That doesn't make sense.