Insurance coverage in Florida

[Chamcook]

We are new to Escapees and are about to apply for a domicile in Florida. One concern we have is that we will be traveling outside the state for most if not all of the year. Will this be a problem for us getting health insurance? They always want an address and we are concerned that they will challenge our claims if they think we are not ‘actual’ residents of Florida. 

[LindaH]

Medicare or pre-Medicare?

[Kirk W]

2 hours ago, Chamcook said:

Will this be a problem for us getting health insurance?

It has not been a problem for anyone that I have seen reported. It is one of the reasons that it is important to actually establish yourself in your domicile state and not just get licenses and insurance there. Should the question ever arise you will have more to support your chosen domicile.  The following speaks of TX but the facts are pretty much the same in any state.

The Ten Commandments of Texas Domicile

[Chamcook]

Thanks for the advice! We plan on traveling most if not all the time outside Florida, so are there specific kinds of things we should collect beyond drivers licenses, vehicle registration, and the Escapee address to satisfy and insurance of our domicile status? And if you have any tip on what lawyer in Florida we might seek out for more help, we would be very appreciative. We want to do this all correctly!  Thanks, Chamcook

[Chamcook]

18 hours ago, LindaH said:

Medicare or pre-Medicare?

I’m 65 and have Medicare but my wife won’t be 65 until next December.

[2gypsies]

Medicare and Medicare Supplement covers you wherever you go.  Not as easy with Medicare Advantage plans.

[Blues]

On 10/14/2022 at 3:40 PM, Chamcook said:

We are new to Escapees and are about to apply for a domicile in Florida.

You don't really apply for domicile.  Nobody will declare you domiciled in Florida.  You just do whatever it is you would do if you were moving to Florida--get a driver's license there, register your vehicles there, register to vote there, get health insurance based on your Florida address, get vehicle insurance based on your Florida address (you'll need to get a "fulltimer" policy if you don't own or rent an abode in Florida and if you don't know what that is, do some research to find out).

5 hours ago, Chamcook said:

And if you have any tip on what lawyer in Florida we might seek out for more help, we would be very appreciative. We want to do this all correctly!

You don't need a lawyer.  Thousands of people have done just what you're wanting to do.  Just change the things mentioned above, and do a review of your personal situation to see if there is anything that still ties you to your current domicile (e.g., owning real property there), and do what it takes to break that tie.

I follow the pre-Medicare fulltimer health insurance landscape closely, and have never heard anyone report that an insurance company denied a claim by a Florida-address traveling fulltimer based on the fulltimer's use of a mail service as an address and traveling around the country and getting medical care, even lots of medical care, outside Florida.

I would suggest that you do what pretty much all the other pre-Medicare Florida fulltimers do, and get an EPO/PPO (not HMO) policy with Florida Blue.  If you want to deviate from this, then you need to research, research, research, to be sure it'll cover you how you want.  And actually, pre-Medicare health insurance is a primary reason many people domicile in Florida instead of Texas or South Dakota (the other two major players for fulltimer domicile)--neither Texas nor South Dakota has ACA PPO plans that have a nationwide network.  So Florida is it for them.

And be aware that Florida Blue EPO/PPO plans come in two different varieties:  Blue Options and Blue Select.  Blue Select plans are cheaper than Blue Options plans.  I have yet to find any explanation of the practical effects of the two different types of plans, but have concluded (after spending waaaay too many hours on this because nobody explains it) that the most significant difference between Options and Select is the network in Florida, and that the network outside Florida for Florida Blue members using the Blue Card program is the same for both Options and Select. 

That's just my conclusion, after noticing that Choice plans are offered in every county in Florida, while Select plans are offered in only some but not all counties in Florida (a clue!).  Then I did a zillion what-ifs to do provider searches all over Florida and all over the U.S., to look for differences when using Blue Choice vs. Blue Select. 

I concluded that if I were not going to be spending any time in Florida, a Blue Select plan would probably suit my needs (I say "probably" because there might be other differences lurking, but I didn't see any).  But if I were going to be spending time in Florida, a Blue Select plan might not suit my needs.  If I were going to spend some time in Florida and all of that would be in my domicile county, maybe Select's more limited network would be okay.  But maybe not, depending on who's in it. 

If I were going to spend time in different parts of Florida, I would be concerned that Blue Select's network wouldn't have a presence where I happen to be (I didn't drill down that far in my research, but anyone else is welcome to, and can share what they find).

If I didn't want to think about any of this and just go with the one most likely to provide the most comprehensive coverage regardless of where I am, I'd choose Blue Options, and think, "I've done what I can do."

And one more caveat:  My deep dive into Florida Blue's Select and Options plans was done last year.  I have no reason to think it's changed this year, but I'm not going to do it all over again.  Y'all are on your own!  😀

5 hours ago, Chamcook said:

I’m 65 and have Medicare but my wife won’t be 65 until next December.

Do you have original Medicare or a Medicare Advantage plan?  If it's original Medicare, all that matters is whether the provider accepts Medicare, regardless of where the provider is located and regardless of where your domicile is.  But if it's Medicare Advantage (a surprising number of people don't even know if they're on original Medicare or Medicare Advantage, even though it makes a huge difference even if you're not traveling), you need to do research into what MA plan you have and what type of coverage it provides; more than likely it has only a local network, which obviously doesn't work for traveling fulltimers.

Also, you may have found out already, but just in case:  original Medicare doesn't cover routine physicals, but ACA health insurance plans do.  So if your wife is the type to want routine physicals and has an ACA plan or another type of plan that covers routine physicals, tell her to get it before she goes on Medicare.  (Medicare Advantage plans often cover routine physicals, but MA is generally not a good option for traveling fulltimers.)

Edited October 15, 2022 by Blues

[Kirk W]

Blues has given you some good advice. Here is more information that you may find to be helpful.

Becoming a Florida Resident

[Chamcook]

Quote

Wow! What wonderful information. That must have taken you so much time to research and you have certainly set our minds at ease. We will start working on what options seem best for us now, but it is such a relief to understand that what we have been hoping for is realistic.  Thank you so much!

 

[2gypsies]

7 hours ago, Blues said:

Also, you may have found out already, but just in case:  original Medicare doesn't cover routine physicals, but ACA health insurance plans do.  So if your wife is the type to want routine physicals and has an ACA plan or another type of plan that covers routine physicals, tell her to get it before she goes on Medicare.  (Medicare Advantage plans often cover routine physicals, but MA is generally not a good option for traveling fulltimers.)

Original Medicare covers yearly and even, every 6m., Wellness Checks, and in our cases we have not found any differences between them and a so-called 'physical'.  We just had ours this month and one of us was asked to return in 6m. We go to internists and referrals to specialists, x-rays, MRI's, CT's, etc. are given if any concerns or problems.  Original Medicare A&B have always paid.

[GlennWest]

Yes, I got an email from medicare stating my first year is here and I should go get a physical paid with no deductible. Soon as I get some time off i will to

 

[Blues]

We're veering off topic here, but it needs to be addressed.

6 hours ago, GlennWest said:

Yes, I got an email from medicare stating my first year is here and I should go get a physical paid with no deductible.

Did the email actually call it a "physical"?  I'm betting not, but instead, a Welcome to Medicare preventive visit.  The Welcome to Medicare visit and subsequent annual wellness visits are not physicals as most people understand them.

This is how Medicare describes the Welcome to Medicare preventive visit:

Quote

 

This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these:

• Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
• Height, weight, and blood pressure measurements.
• A calculation of your body mass index.
• A simple vision test.
• A review of your potential risk for depression and your level of safety.
• An offer to talk with you about creating advance directives
• A written plan letting you know which screenings, shots, and other preventive services you need

 

https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit

It's not a physical examination; it's a review of your health and education and counseling about various matters.

Here is what Medicare says about subsequent annual wellness visits:

Quote

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

The bolding is theirs, no doubt because most people assume Medicare covers annual physicals.  But it doesn't.  Some Medicare Advantage plans do cover annual physical exams as most people understand them, but they are not covered under traditional Medicare. 

This is what is included in an annual wellness visit:

Quote

 

Your visit may include:

• A review of your medical and family history.
• A review of your current providers and prescriptions.
• Height, weight, blood pressure, and other routine measurements.
• Personalized health advice.
• A list of risk factors and treatment options for you.
• A screening schedule (like a checklist) for appropriate preventive services.
• Advance care planning

Your provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease.

 

https://www.medicare.gov/coverage/yearly-wellness-visits

Here's an article about the difference, called "Costly Confusion:  Medicare's Wellness Visit Isn't The Same As An Annual Physical":

https://khn.org/news/medicare-covers-wellness-visit-not-annual-physical/

It explains:

Quote

When the Medicare program was established more than 50 years ago, its purpose was to cover the diagnosis and treatment of illness and injury in older people. Preventive services were generally not covered, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids.

(This time the bolding is mine.)  Traditional Medicare is prohibited by law from covering routine physicals. 

People will say, "But they cover mine!"  It depends on the coding.  If the visit is coded as being for diagnosis or treatment of a medical condition, then it's covered.  But if it's coded as an annual physical, it's not.

It's particularly confusing because one of the features of Obamacare is that an ACA plan is required to cover an annual physical without copay or deductible.  So people get their free annual physical under their ACA plan, and when they turn 65 they schedule it like normal, and find out Medicare doesn't cover it.  You'd think Medicare, of all programs, would cover annual physicals, but you'd be wrong.

There was a similar situation with shingles vaccines.  You'd think Medicare would cover them because they're for old people.  But traditional Medicare doesn't cover them; coverage is under Part D (prescription drugs) or Medicare Advantage.  And the amount they'll cost under Part D depends on the tier level and deductible for the various plans.  I've even read about healthy people, who typically just pick the lowest premium Part D plan available, planning to get the shingles vaccine and crunching some numbers to find that a higher monthly premium would be offset by better coverage of the vaccine under the plan.  

That's changing for 2023, pursuant to the Inflation Reduction Act.  Shingles vaccines will be covered in full, with no deductible or copay, BUT that's only if you have prescription drug coverage under either Part D or Medicare Advantage.

But that's a lot of machinations for a vaccine that people who are Medicare should have.

[GlennWest]

Annual Wellness visit is what it is called. Just reread email.

[Dutch_12078]

"Annual Wellness Visit" is how our doctor lists our annual physicals under our United Healthcare Medicare Advantage plan, but in reality, she conducts a full on get naked exam complete with an EKG and other tests, preceded by blood tests tailored to our history. Our cost is zero, as is our monthly plan premium other than the standard Medicare deduction from our Social Security. And our UHC plan is good anywhere in the country with any UHC in-network providers. Or out of network at higher co-pays.

[sandsys]

At one time I had to decide if I wanted an annual physical or a wellness visit. Now my doctor is able to both in the same visit. I don't know how she makes that work. BTW, the time on the clock has always been 11:10 but the three words change.

Linda

[2gypsies]

Our Wellness exams with the internist does cover blood work,  eye, nose, throat, ear checks, blood pressure and referrals for mammograms, etc.  Medicare pays for it.  If we had specific problems we'd be referred to a specialist like orthopedic, neurologist, cardiology, etc.  Normally, one would go to a specialist for specific issues.  I can't even remember when we last paid a medical bill and never a co-pay.  We've had serious issues and surgeries. We have Medicare and a Supplement.

It seems like the whole medical system needs an overhaul.  People seem to be paying for things that they shouldn't.

[GlennWest]

Sounds like it. I remember when family doctor done about everything needed

[Kirk W]

7 hours ago, 2gypsies said:

I can't even remember when we last paid a medical bill and never a co-pay.  We've had serious issues and surgeries. We have Medicare and a Supplement.

Which supplement plan do you have?  We have plan G and we pay the annual Medicare deductible, then nothing more.  Like any insurance policy, the plans that pay more also have higer premiums. 

How to compare Medigap policies

[2gypsies]

8 hours ago, Kirk W said:

Which supplement plan do you have?  We have plan G and we pay the annual Medicare deductible, then nothing more.  Like any insurance policy, the plans that pay more also have higer premiums. 

How to compare Medigap policies

We're grandfathered into Plan J (not available anymore).... similar to F, I believe.