Health Insurance & SD Domicile -> Are There Any Options Left For Younger Fulltime RVers??
Pre-Post Notice -> WOW. THANK YOU for the outpouring of love & comments in my last e-mail. I am humbled & amazed!! I am feeling the love today!
It’s finally time for me to talk about Health Insurance {{takes in a deep breath}}. Open Enrollment on the ACA Exchange started 10 days ago and if you want to sign a new plan for next year you need to sign by Dec 15th. When I first wrote about the ACA back in Feb, I foresaw that we’d be running into some serious issues with our SD domicile this year. Sadly I was right and, as it stands today, I would not advise ANY pre-Medicare newbie fulltimer to domicile in SD (NOTE/ Medicare-age RVers are OK & have options in SD. It’s just pre-Medicare that are the issue here & that’s the only group I will address today).
NOTICE #1 -> I am not a qualified insurance agent or doctor or health care provider. These are my purely personal observations & understandings based on agents I’ve talked to and material I’ve read online. I recommend doing your own homework and talking to a qualified agent before you make your own insurance decisions.
NOTICE #2 -> No politics please. This is meant to be a practical report of the options available to younger RVers. I do not want to talk about politics, and I will moderate comments the same way.
With that said, this is going to be another mega-post with alot of details, so let’s get started:
What Happened In SD?
Prior to ACA we were covered by Coventry with a high-deductible nationwide plan. Not too long after ACA was introduced Coventry announced they would be pulling out of the state and we got confirmation of that earlier this year. When our plan was up in Sept we were notified that they would extend coverage through end of the year (Dec 2014), but then we’d be on our own. Our hope was that there would be other decent options (either on or off-exchange) which would cover the gap, but the sad truth is that there are none.
NOTE/ For those of you who are new to ACA I recommend reading my initial article on how ACA affects fulltime RVers and what’s important for RVers when choosing a plan (e.g. nationwide coverage, out-of-network caps, friendly to RVers etc.). For those of you who understand all these details, here’s the run-down on the current situation in SD:
1/ NO on-exchange nationwide plans in SD -> There are 3 guys on the ACA exchange in SD -> Avera, Sanford and DakotaCare. Sanford & DakotaCare require 6-month proof of in-state residency meaning they will not insure fulltime RVers on the move. Avera was initially the same, then (last minute) decided to begrudgingly allow RVers to apply ON exchange, but their plan offerings are terrible. Their PPO plan offers NO out-of-network caps and basically has ZERO network outside of SD (none, nada, zip). It’s essentially just a SD-specific plan. They DO cover emergency care out of state, but for everything else you are on your own.
2/ Only ONE off-exchange plan in SD -> There is only ONE guy off-exchange who is openly accepting fulltimer RVers and that’s Assurant. They offer a good, solid nationwide plan, but their pricing is outrageous. For the two of us, the cheapest high-deductible plan would cost over $900/mo. Since this is off-exchange there is no chance of subsidies either.
So, current SD residents who need pre-Medicare insurance are basically hosed. You can either buy the Avera plan, which will only offer emergency care out of state, or you can pay 3x for Assurant. I’m not the only one who’s come to this conclusion. Check out this very good write-up from Kyle at RVerHealthInsurance: Kyle’s South Dakota Health Insurance Assessment for 2015
Isn’t Emergency Care Enough?
For younger RVers like us who are really only carrying insurance for catastrophic purposes, why not just go with Avera and rely on the emergency care clause? Well, this is where it gets tricky since the definition of emergency care is wishy washy at best. Here is the info I got from Kyle for the definition of “emergency care”:
“Under PPACA, a condition with acute symptoms of sufficient severity (including severe pain) that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in—(i) placing the health of the individual (or an unborn child) in serious jeopardy, (ii) serious impairment of bodily functions, or (iii) serious dysfunction of any bodily organ or part.”
What in the world does that mean for coverage????
Well basically the way I read it is that unless you’re deemed in “serious” danger, you may not be covered. So, let’s say you have an accident, get covered for the initial life-threatening stuff and then get transferred out of “emergency” into regular care. Now, you risk hundreds of thousands of dollars of non-covered expenses. Also, given that Avera offers NO out-of-network caps, if you end up in the terrible situation of requiring significant out-of-network care (which basically means ANY non-emergency care outside of SD) you will be liable for everything and have absolutely no limits on what you can be charged.
Either way I could see getting into a major “discussion” (= months of extended battle?) with the insurance about whether what you had was really an “emergency” and what was and wasn’t covered. I’ve had my fair share of insurance “discussions” and they are not pretty. It’s a real risk and these kind of non-covered expenses are exactly the kind of thing that could bankrupt you.
So, What Are Your Options in SD?
As of today, as a pre-Medicare fulltime RVer with SD domicile you are faced with 4 simple options:
1/ Go Without Insurance – Something I never, ever recommend, specifically because of the big unknowns. It’s not the small stuff that gets you -> all the small stuff, routine care, health-checks, minor operations etc. can easily be handled via cash-pay (which is something we’ve personally done for years. For more see my 3-Part Series on this). It’s the catastrophic stuff, the stuff you can’t plan for that hurts. Major accidents, major illnesses. These will literally bankrupt you if you don’t have insurance and they will do it very fast.
2/ Stay in SD with Either Avera Or Assurant -> If you’re willing to take the risk on an insurance that only offers emergency-care out of state then Avera is a choice. I’m not particularly comfortable with it, especially considering they only begrudgingly accepted RVers (they really didn’t want to insure them), but your risk tolerance might be different. For those taking this option it might make sense to look into an add-on insurance that would transport you back to SD if you need extended care. It’s not ideal, but it could work. If you have the extra $$ Assurant is a real, viable nationwide option, but it is really pricey.
3/ Switch Domicile -> For the vast majority of younger RVers this is going to be the #1 choice and makes the most sense to do. It’s a hassle to switch domicile but it can be done. FL & TX are the two other “popular” fulltime RV domicile states. Both have a great history of no income tax, reasonable car insurance/registration rates & being friendly to fulltime RVers. Even better, BOTH states offer solid health insurance choices on the ACA exchange. See more about this below.
4/ Buy Short-Term Insurance -> For those RVers who are not able to switch domicile right away, or who want to delay their decision there is the option of buying short-term insurance. If you go this route you need to understand that these plans are meant as interim plans (NOT long-term plans) and they are NOT ACA compliant (which means they don’t accept people with pre-existing conditions, amongst other things, and you end up having to pay the ACA penalty on your taxes). But they ARE nationwide, they DO have solid spending caps and they are very reasonably priced. You can buy 6-month or 364-day plans, enough to cover a gap or delay your domicile switch. This is definitely not a long-term solution but may make sense for some in the short-term. Read more here: Short-Term Medical.
What About TX or FL As Domicile States?
With SD basically out of the running for younger RVers, TX and FL become the prominent choices. Both are excellent RV-friendly options, each having their own pro’s and con’s. Costs are close between the two, depending on what you need. Here’s a few details:
Health Insurance Options -> Both FL & TX currently offer excellent nationwide options on the ACA Exchange for fulltime RVers. Texas offers BCBS which has wonderful nationwide coverage (on their PPO plans) and very decent out-of-network caps. Florida offers Assurant which also has an excellent network and out-of-network caps (again, on their PPO plan). Dec 2 Update: I’ve now learned that FL also offers BCBS on their ACA Exchange. As long as you select a BlueOptions plan it is a PPO-type plan with an excellent, extended network.
Health Insurance Costs -> Pricing out health insurance (which you can do HERE) there are a few differences between the two states. Texas offers lower base insurance rates, but Florida tends to offer bigger subsidies. For those RVers who qualify for subsidies, it’s important to look into this since subsidy levels vary quite significantly from state to state (even by zip code within a state!). Here’s some price examples for us two:
TX Exchange (SKP Livingston zip 77351)
BCBS Bronze PPO 006 ($6000 deductible) $584/mo
Subsidy $60,000 level = $71 ==> $513/mo
Subsidy $50,000 level = $150 ==> $434/mo
Subsidy $40,000 level = $270 ==> $314/moFL Exchange (SKP Bushnell zip 33513)
Assurant Bronze PPO 001 ($6000 deductible) $622/mo
Subsidy $60,000 level = $177 ==> $445/mo
Subsidy $50,000 level = $256 ==> $366/mo
Subsidy $40,000 level = $376 ==> $246/moFL Exchange (St.Brendans Isle zip 32043 Clay County)
Assurant Bronze PPO 001 ($6000 deductible) $634/mo
Subsidy $60,000 level = $221 ==> $413/mo
Subsidy $50,000 level = $300 ==> $334/mo
Subsidy $40,000 level = $420 ==> $214/mo
RV/Car Registration Costs -> Initial registration fees (first-time fees) in FL are quite a bit higher than TX, but on-going RV registration is cheaper in FL. For our-sized RV plates cost around $80/year in FL compared to $340/year in TX. The toad costs ~$50/year in both states.
RV/Car Insurance Costs -> I priced out insurance costs with 3 different agents for both TX & FL and found very, very little difference. Both states cost around $1,200-$1,400/year for the RV and only a few hundred less for our car, which is about twice what we currently pay in SD.
RV Registration Requirements -> For our-sized rig TX requires a special Class B non-commercial driving licence (test), plus TX does require inspections on your rig when you pass into state. In FL there are no such tests or requirements.
Mail Forwarding/Domcile Services -> TX offers the most excellent Escapees organization. In FL there are several options including a brand new Escapees home base location, St.Brendan’s Isle, Good Sam’s, and MyRVMail. Escapees is undoubtedly the cheapest service, but doesn’t (yet) offer cool features like mail scanning and online mail viewing. Many younger RVers prefer the snazzy online services offered by the other FL guys.
Legality -> Escapees in TX (specifically) has fought in court to establish themselves as a legal domicile address for RVers, and do alot of advocacy work for RVers in general. Many, many RVers use FL too, but none of the services there have gone to court the way Escapees has. This may not matter to you, or it might matter alot.
This covers the basics, but there’s much more to domicile choice, especially if you own a business or have other things going on in your life. I really recommend the following articles for those who are choosing domicile right now:
- Technomadia -> Picking a Domicile State, Getting Mail & Voting as a Nomad
- Technomadia -> Setting up Domicile in Florida as a Full Time RVer
- Escapees -> How To Become A Real Texan (pdf download)
What Are WheelingIt Going To Do???
Oh goodness, this is where the rubber hits the road, so to speak. We’ve been going back and forth on our options for weeks and months. For various logistical and cost reasons our current leaning is to delay our domicile switch by signing a short-term insurance plan in SD. Since we have no pre-exsiting conditions this is a real, viable choice for us and the costs are reasonable ($265/mo for both of us combined on a 364-day STM 5,000/10,000 plan. The ACA Penalty would add around $80/mo** ontop of that).
Long-term, unless something significant changes in SD, we will need to switch domicile. Both TX & FL look good and it’s about a wash between the two. Overall costs are actually lower in FL, especially with health subsidies included, plus Paul has family there (which does tie us to the state), but I also really like the Escapees organization (in general). We will likely decide to switch domicile towards the middle or end of next year, and since moving is considered a “Qualifying Life Event” according to the ACA we will be able to sign new insurance right away when we do.
We’re getting all our insurance info & signing our plans with Kyle RVerHealthInsurance.com. He’s a qualified broker and a fulltime RVer himself and I’ve used his website & expertise as our go-to source for info since ACA started. I definitely recommend him (Dec 11th Update: Kyle has announced he will focus on Medicare-age RVers going forward and is bringing on a new insurance agent to help with non-Medicare RVers. So, RVHI will now be a team of two!)
**NOTE/ You can sign a short-term insurance plan for up to 3 months before you incur the ACA penalty. Click HERE for more info.
PHEW!! Hopefully that gives you all the details of what’s going on in SD, what options you have if you are currently domiciled there, and what the options look like today in FL & TX. If you’re a younger RVer who’s about to go fulltime RVing within the next year and you need health insurance (i.e. you’re not bringing it from your job) I would recommend you AVOID SD at all costs. For current RVers domiciled in SD I would recommend looking at switching domicile over the long term, even if you don’t do it right away.
How About A Video On Health Care???
Well, funny you should ask, but this is exactly what Technomadia arranged while we were boondocking in Trona last week. Cherie & I had a casual chat about health care options for younger fulltime RVers, what concerns you should look at, self-care options and so forth. If you prefer to see my mug in all it’s live streaming glory, click here to view the archived version:
Related Posts & Links:
Why is it that all the health care discussions I read never consider health sharing organizations as an option?
Health Sharing is certainly another way to go, but they do have some limitations. These are generally faith-based organizations so members typically have to agree and abide by the tenets of the faith (e.g. could be a pledge to the faith, a pledge not to drink, not to do drugs etc.).
The big advantages of health sharing is that, since they are faith-based, they are typically exempt from the ACA penalty, and since they spread out costs between members they are typically inexpensive. The disadvantages of health sharing is that they are not regulated, and the acceptance (covering) of bills is typically a process of judgement by a jury. There is no guarantee of coverage.
If you have a strong faith, and are willing to abide by whatever tenets the health share requires, they can certainly be a way save costs, but they are definitely not for everyone.
Nina
Excellent article on SD ACA options. We retired in early 2014 and have been full-timers based out of Florida ever since. We lived in Florida before retiring so other than making a few address changes over to Good Sam’s mail service, keeping our domicile here was hassle free.
Last April, we signed up for a Blue Cross PPO Silver plan that allowed us to keep all of our doctors and with the subsidy it’s quite affordable. It has excellent nation-wide coverage which we’ve used on multiple occasions. We’re back in Florida at present for the holidays and have seen our all of our previous doctors for checkups. Our out-of-pocket expenses have been much less than what we paid while employed by a Fortune 500 company. So far, we’ve been very pleased with our insurance under the ACA not to mention the ACA allowed us to retire early. Without it, we’d be working until age 65. I do worry about the case before the Supreme Court challenging subsidies on Federal exchanges. Since Florida does not have it own exchange, this could have a big impact later in 2015.
It’s great that the health plans have worked out for you. In general, the folks that qualify for subsidies are able to find very reasonable options.
Nina
You know I’ve been on other threads with you on ACA as the collective pool of the RV’ing community has strategized, shared successes and frustrations along this decision journey.
Great summary, and I like the short term coverage approach to buy time – for many this is a reasonable and economic way to go.
Fingers crossed that changes in either ACA or South Dakota Insurance Company policies – will require us all to regroup and do this analysis again during 2015!
I will share that America’s Mailbox suggested I network with another Insurance Broker. (I’ve had phone calls and emails with Kyle, and respect his difficult decision to advise Pre 65 South Dakotan’s that no real reasonable policy exists…) This gent did tell me that BCBS would accept mail forwarding addresses to register for 2015. He said when he specifically asked them about the 6 month in resident requirement, they just smiled. To him, that indicated a shift in policy. When asked if he felt he could get something in writing from them that Non In State 6 Month domiciled individuals would not be ‘kicked out’ at a later time – or worse, when they needed coverage for a real problem – he said he did not believe they would. I share this, as I was advised that ‘viable policies existed’… and to me, that is dangerous input and not what I have found (and what Kyle’s analysis summary reported). So as you commented, – due diligence and qualified professional Insurance Brokerage guidance is highly recommended.
Best to you, paul, all those critters above the paws, and all,
Smitty
Yeah, I really hope that SD opens some more options.
I’ve got friends of mine who’ve managed to apply and get coverage with BCBS in SD (they “slipped in” through the cracks), but I’m not totally comfortable with it myself. We applied once and were rejected because we could not provide sufficient “proof of in-state residence”, and even if we’d managed to get in, I would be terribly worried about being dropped after the fact. It’s a risky proposition IMHO.
For now, the short-term insurance will work for us. We’ll see what happens next.
Nina
Perhaps it is my background as a former gun-smith, or maybe it’s the 24 years I served as a police officer, supervisor, and Chief of Police but Concealed Carry also comes to mind. I don’t know about the other states but South Dakota is perhaps the easiest place in America to get a CC permit that is recognized in 34 States besides, of course South Dakota. The process is simple, walk into the Sheriffs office in the county of your residence “according to your Drivers License” plop down a ten dollar bill, your Drivers LIcense, and you will receive in return a 30 day permit. Before the end of that 30 days you will receive, from the Secretary of State, your permit good for 3 years. The Secretary of State does a background check. SD is a Shall Issue State. Just something to consider, it may be just as simple in Texas or Florida, I have never checked, and I don’t know how many of you feel it is necessary to carry a firearm while you are discovering America, and living in “the wild!”
Most definitely. If gun ownership and carry laws are important to you, it’s another factor to consider for domicile choice.
Nina
Nice article and vid! Something not addressed was the case of many fulltime RVers not earning enough (less than about $20K/yr for couples) to qualify for ACA subsidies. Sounds dumb, but true.
Originally Medicaid was supposed to handle this, but two big caveats about Medicaid: First and foremost, Medicaid is NOT Medicare. You only have emergency coverage outside your state of domicile—NOT good for RVers who widely travel.
Second, over 40% of the states still do not extend Medicaid coverage to childless adults—and SD, TX, and FL are among them. So they would all make bad domicile choices for an RVer relying on Medicaid.
The Medicaid gap is most definitely a problem for couples earning below the minimum for ACA and above the maximum for Medicaid. None of the 3 popular full time states FL, SD, TX participated in the expansion so there is a definite gap that put a specific slice of low-earning population in a very difficult position. Terrible stuff.
And it’s a good point on Medicaid. No portability at all.
Nina
Another fantastic post Nina! Very thoroughly researched and composed. It’s no wonder you’ve hit 3 million visits!
Love your blogs!
The only thing I would take issue with is the Obamacarefacts.com pros/cons of Short Term Medical where they state “Limited selection of doctors” as a CON. That certainly would be a CON for RVers, but it is not necessarily accurate. The Short Term Medical plans offered in SD (IHC Group) allow nationwide access to providers in the PHCS Multiplan Network. Coverage even extends beyond that network–just not at their contracted rates.
Thanks for pointing that out Kyle!! I noticed that discrepancy when I first looked at the site, but for some reason I forgot to make a note of that detail when I added the table to the post. Very important point esp. For us fulltime RVers!
Nina
Hi Guys,
Sorry this is turning into such a hassle for you. Great article and very helpful. My wife and I are planning to be part-timer RVers starting mid-next year and this is helpful. We are quiting our jobs and will be looking to the ACA for coverage eventually, but we’ll likely use COBRA for a while (up to 3 yrs is allowed, if my memory serves).
We will be based in Montana. Montana has some real advantages for RV registration. However, there are income taxes unlike TX and FL. Assurant does operate in Montana (we checked).
One other point, if you were military or a parent was an officer, USAA is offering HC via Assurant as well. I haven’t noticed any major discount, but it may make finding insurance easier for those that need it. Just a thought, hope it might help someone. We were lucky enough that my father-in-law was an officer. Good luck!
Cheers for the tips. That may well be helpful for others.
Nina
Great write up Nina! I was thinking I’d move my domicile to TX after I sell my house in IL this Spring, but I had only been looking at the base rate for BCBS, and didn’t realize subsidies vary so much from state to state. Thanks for the heads-up on that. I don’t qualify for subsidies at the moment, but might squeak in & make it next year.
FYI– one thing I just discovered this week (that might be a viable companion to your short-term insurance plan & help you avoid the non-ACA plan tax penalty) are the health care “ministries.” These aren’t true insurance plans as they are completely unregulated and unpredictable, but there are 3 or 4 of them that DO qualify as an exemption to the ACA tax penalty (the ones I looked into are HCM, Samaritan, and Liberty Healthshare).
I wonder if pairing one of these minimal ministry offerings with a real (short-term) insurance plan would be a viable alternative until you can move your domicile?
I’d never rely solely on a ministry plan due to the reimbursement risks involved, but perhaps when used in combination with real insurance, they might be more attractive for their tax benefits alone.
I too was surprised by how much the subsidies vary by state (and even zip code!). Actually before I researched it I didn’t know this and I was under the mistaken impression the subsidies were a fixed number. Now I know they depend on cost-of-living in the specific zip code you’re looking at, so they vary quite a bit.
The health care ministries are certainly a choice for some and could make a decent short-term choice. However since we have no specific faith-allegiance, we would not qualify for them.
Nina
Hi Nina & Paul, good post and we just went through the whole ordeal ourselves. Last year when we were still in MN and knowing that we were going fulltime in 2014, we were planning SD to be our domicile. We got a mailbox, registered the MH and tow vehicle in SD in August of 2013 then in March of this year starting shopping the insurance and found out quickly that SD just wasn’t going to work so started the research on FL & TX and chose Texas. We went fulltime in June, started working on getting healthcare at that time for a start date of 9/1 then headed to Texas in September for drivers license, driving test and vehicle insurance. We had created our mailing address through Escapees in June. The longest wait is getting scheduled for the driving test as Livingston did not have any instructors at the time. Huntsville was a month out but Conroe could get us in within the week so just a heads up with that. Regarding BCBS, I am not enamored with them as they cancelled my insurance by mistake, reinstated it but still don’t know how to setup monthly deducts from my checking account…I have been working on this for 2 months..ugg. On the bright side, we LOVE being Texans!!!
Good to know about the wait on the drivers licence test. I wouldn’t even have thought about that!
Nina
Thank you for your research on this topic, Nina. We are less than 3 years from full-time, and will be pre-Medicare for a few years after that. The domicile decision will be interesting – but no doubt there will be many more things to consider (i.e. changes) before we have to make a decision. Boy, do I wish either me or my hubby’s employers still offered affordable coverage to their retirees! That seems to gone like ashes in the wind. Not stopping us though – no sir-ee Bob! Onward ho! All the best to you and your wandering crew!
Yeah, all you can really do is roll with the punches. I have no idea what the health insurance (or even political) landscape will look a year from now. Everything could change or nothing could change. You just have to make do and find the best option with what’s available. That’s what I try to do with the blog….lay out the options. Next year I’ll do it again.
Nina
Another absolutely wonderful in depth post of invaluable information. You are worth your weight in gold.
One of the big advantages of having BCBS as we do with out Texas insurance is that we get all of our medical services doen at one of the Mayo Clinics. With one in Florida, Arizona and Minnesota we are always going to be pretty near a major medical facility.
The Mayo Clinic offers a nice, centralized service, but it’s always been too pricey for us. We have high deductibles and pay all our routine checks out of pocket (most of what I need, for example yearly mole checks, are not covered by ACA preventative care) so I generally look elsewhere for cash deals since Mayo Clinic is pricey. But for those with more comprehensive plans Mayo can be a great service. It’s really, really nice that BCBS has them in-network.
Nina
We are not full timers but spend around 8 to 9 months on the road and away from our home state of Michigan. We are also pre-Medicare but are fortunate that one of us took a very generous early retirement from an employer who provides a good medical plan for its early retirees so we do not have to deal with the ACA. Fortunately, this plan is with BCBS which has a nationwide supply of “in-network” providers. This has proven to be useful on occasion and we do appreciate being able to find in-network providers pretty much wherever we are. I bring this up to point out that BCBS may be the only non-Federal government insurer with such a comprehensive nationwide network of providers and this may factor into the FL vs. TX decision which Nina discusses in her post. I’m not sure if Assurant (the FL alternative) has such a comprehensive network. So, if you are deciding between FL & TX, I recommend that you take this issue into account and do your research. I’ve got to believe that there is nothing more disappointing than finding yourself in an out-of-network situation in a medical emergency. I should add that the in-network benefit of the BCBS coverage extends to routine and non emergency items as well. It’s a real convenience to to have to travel back to the home state for non emergency care.
Absolutely. Network size is one of the critical factors that I recommend RVers look into as part of their insurance choice. Assurant has a very large network, although I do believe BCBS has a larger one. They are both very strong nationwide networks though, and good options for fulltime RVers.
Nina
Full Time RV’er or not nice blog regarding health insurance in general. We are not full time yet however did have to change our insurance (2 years in a row now) due to ACA. We live in Indiana and do not have a State Exchange. Healthcare.gov carriers are not an option for us so we went outside of that from Assurant (Good company and good plan but whose premiums have gone through the proverbial roof)to United Healthcare which is saving us approximately $400 per month from what we were paying in 2014 with Assurant. We are pre-medicare so liked your article for one main reason.. paying attention to where we would domicile assuming we went RV’ing full time. Thanks.. Jim and Shari
Glad the article was helpful..and thanks for sharing your own details as that may in turn help others. We’re all about sharing the knowledge here.
Nina
We are full time RV, pre-medicare and we choose BCBS gold level using our brendan isle Green Cove Springs FL address.
Brendan isle mail forwarding also knows how to setup your FLA domicile. We think FLA will save you money when you factor in medical insurance and government fees.
Based on my research FL is slightly less expensive overall, with everything factored in. Costs are close though. Both states have their pros and cons.
Nina
Just wanted to let you know that Escapees is also in FL and just started a mail forwarding service for people who choose to domicile in FL.
Yup, I mentioned them in the post and Bushnell (the SKP FL location) is one of the zip codes I’ve researched for health care costs.
Nina
Great posting and research, as usual. A couple of caveats as folks start thinking about the future and their options.
* Re: “moving is considered a “Qualifying Life Event” according to the ACA we will be able to sign new insurance right away when we do.” Be very careful in assuming this is a simple and starightforward as it sounds. I spoke with a BC/BS agent in western PA (some of the lowest ins rates in the country) who informed me that you can’t simply move to another state and qualify as one would think. They do not approve many “moves” as qualifying life events. The language is much more simplistic than the reality.
* Short-term insurance – Be very careful as most of these plans (maybe by regulation?) have three major potential drawbacks (flaws?). 1) Some or most can only be used for a certain number of consecutive months and within a certain time-frame. I believe that once you have been on one for 11 or 12 months you can’t re-enroll for some period of time. 2) Since no ST plans qualify under ACA regs, most deny ANY coverage to ALL pre-existing conditions. That is a major difference from any compliant plan – or Medicare. 3) ST Plans in some areas will allow you to have a ST plan for 12 months BUT only allow you to buy the plan in maximum 6 month increments. What this means is that although, you are theoretically covered during the first 6 months, if something happens during that period, it will not be covered during the ensuing “next period” you enroll for! A sobering thought.
* Re: subsidies – If one member of a household is going on Medicare during the year, the household income will stay the same but the number of enrollees will be down by one, likely knocking any subsidy out of the picture. This is definitely happening to us “if” we even get a subsidy at all.
* In my research, I found neither FL nor TX to be all that competitive in the Health Insurance realm. We came to the conclusion that staying with VT residency was still economically and psychologically the best option. A couple hundred $$ a month in cheaper health insurance costs combined with much cheaper vehicle insurances and registration fees go a long way to offset a bit higher income taxes.
Just some more food for thought ….
Steve
Regarding the moves, if you move state as a fulltime RVer you do qualify to sign new insurance. I’ve known several RVers who’ve done this in the past year and have also personally talked to BCBS in TX who confirmed the same. In fact the agent confirmed that I could sign on as soon as we got our address. Not sure why the PA agent was telling you different, but I suppose it could depend on the State?
For the Short-Term insurance it’s absolutely true that they do not insure anyone with pre-existing conditions and are not ACA compatible. I did point out both of those items in my blog post. They are meant as *interim* solutions only and will absolutely not work for the long term. The plan were looking at is a 364-day plan and allows one renewal, but we do not to extend it beyond the initial period.
FL and TX are definitely not the cheapest states out there, but they are very friendly and easy to set up as domicile for fulltime RVers. Most other states are much more difficult to domicile which is why I don’t cover them in my choices. If you have ties to another state that is less expensive, it’s definitely worth trying to keep domicile in that state when you go fulltime.
Nina
Thanks for the clarification Nina.
What I was not clear in explaining is that the actual wording for using a move to qualify for signing up outside normal Open Enrollment Period is:
“… Qualifying life events include: …. you lost your coverage because you moved to another state or a part of the same state outside of your health plan service area, or ….” The four tricky words are “you lost your coverage” – they make all the difference!
It does sound as though you guys are not going to make the switch until next year’s Open Enrollment, though, so it shouldn’t be an issue.
Given that it is the states and Feds who set the rules, NOT the carriers, I would take anything I heard from a carrier with a grain of salt. I was told by BC/BS VT that they really recommended that Susan and I get separate individual plans for 2015 since I’ll be going on Medicare in March. They said it would make the dropping of me (a “qualifying life event!”) a whole lot easier on everyone – meaning us, the carrier and the state. They also said another advantage was that it would lower our deductibles down to each of us having $5000 that we had to meet as opposed to $10000 for the family. VT Health Connect, the state’s administering agency, said absolutely no way we could do that. If you are married, especially filing a joint return, you must be on the same plan. So much for BC/BS knowing the rules!
Maybe it is a state thing, but methinks it’s federal law and I’d really double check TX BC/BS – if you’re going to try to enroll outside the open period.
On a related note, we did enroll in our remaining Short Term policy (to get us to 1/1/2015) with two individual policies. Our deductibles are individual and not aggregate so coverage for either of us essentially starts when either of us reaches our individual deductible — not when we reach the doubled “family” deductible. They are not bound by the constraints of being an ACA plan so I guess they don’t care how you enroll. Since there is no economy of scale, the cost of our two individual plans vs. both of us on one plan was the same premium. There was a slight difference in our individual rates based on age and gender.
In VT at least, the Obamacare plans do not vary by age or number of people covered – the cost for a couple is simply 2X the cost of an individual, regardless of age or gender.
Thanks again Nina for putting all the time into this very important issue, Steve
As a fulltime RVer, by definition if you switch domicile you will lose your health care in your original domicile state and need to re-buy insurance in your new state. If you’re moving with a job, say, this may not be the case….or you’re part of someone else’s insurance plan….etc.
There may be cases where your original domicile plan continues to cover you for a limited time, but once you move as a fulltime RVer you have a Qualifying Life Event. I have RV friends who’ve done exactly this in the past year and have had no issues with it, esp. in the fulltime friendly states.
I can only assume VT has stricter domicile laws and/or some kind of state-specific requirements. BCBS rules DO vary from state to state -> For example, in SD BCBS requires 6-month in-state residency proof, in TX they do not. This is why I’m not able (as a fulltime RVer) to sign a BCBS insurance in SD, but I would not have a problem with it in TX. I have many, many RV friends who have BCBS in TX and were able to sign with them as soon as they got their Escapees address.
Nina
We pay a lot more in FL than you were quoted for car and RV insurance but then our address is in Pensacola (Good Sam Mail Service)so that may make a difference. We considered changing to SD a few years ago and are very glad we were too lazy to do it.
Interesting. I did not price out Pensacola, but it’s good to know.
Nina
Good Sam mail service is in Crestview FL which is in the Panhandle. I know when we changed the address for our truck and Airstream insurance from St. Petersburg FL to Crestview FL, our rates dropped significantly. I believe we also saw some savings with our ACA BCBS health insurance as a result as well.
Hi Nina and Paul… I have read your blog for a couple of years. Just watched the Healthcare video above. Wanted to let you know, I have Teladoc, and I have used it twice. I think its great… and I would recommend them to others. I do the video as I feel it’s probably better, however, I have used a telephone consult as well. Nice job on the insurance info!
Nice to know Teledoc worked well for you. We’re considering it ourselves.
Nina
Thanks for the well written and apolitical presentation on this very difficult decision a lot of us face, or will face in the future. Since we’re already Texans we’ll probably continue as such … just won’t live here in the summer anymore!
Again, thanks for working so hard on your blog and sharing your insights with us.
TX is a good spot to retain domicile when you go fulltime. Highly recommend the Escapees organization there.
Nina
I know states without income tax are important in deciding domicile. In the western US Nevsda, Washington, and Wyoming don’t have state income taxes. Washington and Wyoming are considered reasonable in licensing fees; I’m unsure of Nevada. And I don’t know what they’re like for insurances.
So why are there so few fulltimers claiming domicile in any of these three states?
The big issue is what it takes to establish domicile in each State and how they treat fulltime RVers. In WA for example, we would not be able to establish domicile without buying property. In OR we would need to live in-state for at least a year before we could qualify as “continuous travellers”. In NV both heath care and vehicle registration fees are very high. In WY you have some of highest ACA health insurance fees in the country.
In SD, TX and FL you do not need to own property, there are no required stay limits, and there are many agencies who cater specifically to fulltime RVers. Even the local counties are RV friendly. For example, when I got called to Jury Duty in SD all I had to do was write “fulltime RVer” and I was excused. They are easy states for fulltimers and why most fulltime RVers choose them.
Nina
Thanks for the reply, Nina. I was unaware that Washington had those requirement, in spite of the fact I’ve lived here for years. It’s good to be enlightened.
It appears that, barring a significant improvement in SD, fulltimers are being left with only two choices. Kind of sad but so it goes…
Many of the states that would otherwise be considered, are eliminated from consideration because they require a physical street address to establish residency and obtain a drivers license. Of course folks who live there in rental units qualify, but fulltime RV’ers who travel the country don’t want to rent an apt just to get a DL; and many of these states will not accept a mail forwarding type address. If you have family or close friends in one of these states and are willing to trust them with your mail it can work. But most fulltimers want an experienced professional mail forwarding company, and those exist primarily in the states which accept them as an official address & drivers license address.
This was my question too. As a non-RV’r, I get a little confused as to the seemingly limited options for fulltimers. Here in CO, I once rented a mailbox at a local shipping store, which gave me a street address and “apartment” number. Would this not qualify as a domicile or resident address?
Are the unwritten domicile/residency rules essentially being re-written due to healthcare requirements?
Thanks for your informative posts and all the research you’re doing.
The domicile requirements have nothing to do with the health care law. It’s entirely up to the individual state as to what constitutes legal domicile, and it’s always been this way. Some states are just more stringent than others.
For the vast majority of states a local shipping address is not enough. They might require proof of residence in the form of utility bills, for example, or proof of a certain number of months spent in-state. It just depends.
In SD, FL and TX however, the domicile requirements are more relaxed. That’s one of the many reasons they’re so popular with fulltime RVers.
Nina
Hmmm,….i wonder if all of the people in Wa. that rent a house, apt., or condo, know that they really aren’t residents of the state?
Let me be more specific. We’re talking about establishing domicile as a fulltime RVer here, not attaining residency as someone who moves to live in a state. These are two very different things.
In order to establish domicile for an RVer in WA you’d have to get a proper street address which either means buying property (e.g. Buying an RV pad or piece of land), or renting something full-time (all year). A mail forwarding address, which is accepted in SD, FL and TX is not sufficient in WA. Locals attain residence simply through extended presence in state, fulltime RVers cannot. Even WA students have to prove they are in WA for “more than educational purposes” to establish their domicile. Either way it comes down to the same issue which is that establishing domicile while you’re on the road can sometimes be tricky, and WA is one if those states where it is.
Here’s more on WA domicile
http://www.washington.edu/students/reg/residency/domicile.html
http://access.wa.gov/topics/living/becomeresident
Nina
Nina, i was born and grew up in Wa. Lived on Maui for 11 years, back to Wa. for a few and then to Az. for a couple of years before we started fulltiming for the last 11 years. Sill residents of Az., understand very well the problems that fulltimers run into with various things…..also know that there are ways to work things out. Sometimes it just takes a while to figure out how to do what you want/need to do. 🙂
Yup, there are always means and ways which is part of the reason I write the blog. I try to present all the options as I see them, and give my readers as many choices as possible.
Nina
Reading all this makes my head swim. One of the few times that I’m glad to be an old geezer with Medicare! I can stay domiciled in SD. So sorry you may have to go through the headache and expense of changing yours. Ugh.
If only we didn’t have to deal with all the other consequences of aging!
I’m interested in hearing your views about getting healthcare for major needs outside the US, for instance in Mexico. I’ve read that other countries have world-class medical services at costs that are a fraction of the costs in the US. So if one had a major accident or illness they could receive the initial care here, and once stabilized move to a facility outside the US for further care.
As for routine healthcare, in our experience if we tell a provider we don’t have insurance they usually deduct about 40% off our bill.
Also, I’ve read that, as of now, one can avoid paying the penalty for not having health insurance by simply claiming a hardship in obtaining the insurance, and no justification or explanation of the hardship is required.
Thank you for your wonderful, helpful site!
Andy
I am all for going out of country to get what you need, if you can find a good provider. We do all our yearly dental appointments in Mexico, for example and I’d do my mole checks there too if I could find a good dermatologist (I haven’t yet). I’ve blogged about Mexico several times before. Also regarding cash pay discounts we regularly do that and I have a blog post covering that exact thing too.
You can see all these blog posts in my “Health Care” section here:
https://www.wheelingit.us/category/health-care-2/
Regarding the hardship exemption, the ACA actually has very specific requirements that you need to meet to claim it, plus you need to fill out an exemption application:
https://www.healthcare.gov/fees-exemptions/hardship-exemptions/
There is a wishy washy clause that says “You experienced another hardship in obtaining health insurance” which I guess could be justified with some effort, but I don’t believe it’s as trivial as just claiming without explanation.
Nina
I’ve found that International Medical Group and Bupa Global offer international health insurance plans that would cover services outside the US. Since healthcare costs are much lower outside the US I would expect the cost of insurance for there would be lower, but I’m not qualified to evaluate the plans to determine if they are a good value or not. This would potentially be for major care to be provided outside instead of inside the US. Perhaps there could be a significant savings.
Yup, we used to carry BUPA when we lived abroad for many years. Great insurance. The problem with international insurance is that it won’t cover US nationals travelling withing the US. So, anything that happens to you in the US won’t be covered. Since most of us young fulltimers are carrying insurance for catastrophic purposes while we RV, this wouldn’t work for us. It’s great if you RV primarily outside the US (say, in Mexico or Canada), but not useful if your main RV circuit is within the US.
Nina
Thanks for educating me about international insurance not covering for anything that happens to you in the US, I wasn’t aware of that. But what about a major illness or medical condition? If, God forbid, one developed one of those it seems that one could go to another country and be covered by the international policy for healthcare for it, as far as you know is that true?
Yes, my understanding of international insurance is that it would cover you internationally for anything that happens. As with all insurances you’d need to look at the details -> out of pocket costs, lifetime caps, exclusions etc. I do know the policy we had when we lived abroad covered us for everything, but I do not recall the cap and exclusion details (e.g. It might have excluded pre-existing conditions).
Nina
Great post and thanks for keeping politics out of it. Just like in the old Dragnet shows (you are too young too remember), Just the facts ma’am!
Quick question….Assurant is in both Florida and SD yet only provides nationwide coverage for RV’ers in Florida. Do you know why that is so???
Thanks, G
Assurant actually offers nationwide coverage in BOTH places. The difference is that Assurant is on the ACA exchange in FL, but is *not* on the ACA exchange in SD. So, in FL, they’re relatively inexpensive plus you can get subsidy help with them. In SD they are outrageously expensive and there is no subsidy help.
To quote specific numbers, in FL we can get Assurant on the ACA exchange for ~$250-$450/mo with subsidy (depending on income level). In SD, we’d be paying over $900/mo for the exact same insurance off-exchange with no possibility for subsidy help.
So, Assurant is definitely a viable choice in SD. It’s just a really expensive one. Sorry if I didn’t make that clear. I’ll update the blog post to make that point clearer.
Nina
you made it perfectly clear but duh me overlooked it on the original post! Thanks for being so patient and answering it again! 🙂
When we went FT over a year and a half ago, we went from NY residents immediately to FL residents. We got out of our high tax situation. As far as insurance goes, We’ve found that the FloridaBlue (BCBS) is the best nationwide plan for us. We do need insurance and can not rely on just catastrophic insurance. We were able to keep all our doctors in NY that know us and every year when we go back we get all our health appts done. The FloridaBlue plan has also been great nationwide as we have needed doctors in a few states. I did look at Assurant and it really did not have the coverage that we needed.
Nice article but the impression that I got was there was only BCBS in Texas and you did not mention them at all in FL, just Assurant. I could have been mistaken, or maybe you were talking about something more specifically, but my husband and I are both under 50 yrs old and the FloridaBlue plan was best for us. I just wanted to let people know that BCBS is also a good choice in Florida.
Thanks for all your info. It was a great article.
Thanks for the info on BCBS. They’re listed as an EPO plan on the FL Exchange which is why I didn’t originally mention them. I have a call in to an insurance agent to learn more. Based on the comments they seem a good choice for RVers in FL.
Nina
So finally…after 4 days and countless hold hours I did get through to a FloridaBlue agent to discuss the various BCBS plans. Looks like there are 2 main types of BCBS plans on the Exchange:
BlueSelect -> This is “officially” their EPO plan which means it has a more restrictive network. The agent told me this would NOT be a good option for folks who travel extensively outside of FL since coverage outside of state is limited.
BlueOptions -> This is their wider PPO-type plan which has coverage cross-nation with the extensive BCBS network. So, this is the one recommended for travellers.
So, bottom line. Looks like the BlueOptions plans on the FL ACA Exchange are a valid RV-friendly choice.
Nina
Yes, that’s what we have. Thanks for all your info and hard work. No one likes dealing with this stuff, let alone writing about it and all the various options. It’s just to difficult to find every little option out there. It always feels good to be validated when someone else looks into it as well and comes out with the same conclusion. Thanks again!
Cool. I’ll update the blog post to add BCBS BlueOptions to the FL portion. It’s good info to know.
Nina
This is what we learned 10 days ago from our South Dakota Health Insurance agent about Avera on the exchange:
“Preventative Medicine, durable medical equipment & maintenance chiropractic treatments will not be covered out of network.”
So you would need to come to South Dakota for an annual checkup, but all care related to emergencies would be covered anywhere.
He also has a very good Wellmark Blue Cross plan if you are off the ACA–apparently better and cheaper than Assurant, and covers you everywhere.
This is what I understand too. However it’s the definition of “emergency care” which is the problem here…and what happens when your situation is no longer deemed “emergency”, for example in the case of a serious accident and subsequent care. That, combined with the fact that Avera has no out of network caps has me worried about using them as a fulltime RVer. Except for emergency care, their coverage outside of SD is non-existent.
WellMark BCBS in SD Require 6-month in-state proof of residency and will not insure fulltime RVers. At least that’s been their corporate policy for years and I’ve not heard differently. We’ve applied to them before and been rejected for the same.
Nina
Great blog,,,, I’m currently looking to retire at 62 and full time but as near as I can figure Health Insurance will be about 1000 dollars a month for my wife and I .I won’t be able to afford that.
There’s got to be something out there that’s around 500 a month for two people in their early 60’s ?
Do you qualify for subsidies? if you make below $62,920 as a couple, you will qualify for a subsidy to help pay the costs. See here:
http://obamacarefacts.com/federal-poverty-level/
The only other alternatives are health share ministries (faith-based. See some of the comments above) or short-term insurance (only suitable for folks with no pre-existing conditions and for short term only).
Nina
Thanks
I’ll check that .
Hi Nina ~ Another great article on the healthcare options available for full-time travelers and RVers. Your article last year helped so much! I’m confused, though, about why you don’t mention BCBS (i.e. Florida Blue) as being a carrier on the exchange in Florida. We chose one of their plans last year as we are full-time travelers (though not RVers) with domicile in Florida, and we plan to go with them again this time around. We actually didn’t use any insurance in 2014 but do plan to go to our doctors in spring of 2015 for preventative checkups. Our docs are in our former state of residence (NC) and in the BCBS network. We don’t anticipate any problems doing this with Florida Blue.
Thanks again for all you do in providing this useful information!
The only reason I didn’t mention BCBS in Florida was because they offer themselves as an EPO which (generally) means a more limited network than PPO. Looking into the FL plans in more detail, however, I see that the Florida Blue plans *seem* to operate on the same network as BCBS PPO plans. In fact they’re listed as EPO/PPO. I have a call into an agent to learn more, but given how many commenters are recommending Florida Blue they look to be a solid choice for RVers.
Once I talk with an agent I’ll report back and update the blog post too. Appreciate the folks that have called this out.
Nina
I managed to speak with an agent today and confirmed that Florida BCBS BlueOptions plans are nationwide PPO-type plans and a good choice for RVers (see my comment to Brenda above). The BlueSelect plans are equivalent to “traditional EPO” plans which means limited networks *not* a good choice for RVers. So, I’ve updated the blog post to match.
Nina
We are pre-Medicare and bought our health insurance through ehealthinsurance.com. It is a high deductible plan with SD Wellmark BC/BS & will cover us throughout the US. It is much more expensive & is going up $150/mo. to a bit more than $1000 each month for 2015 but it does cover us. We would not be eligible for insurance without the ACA because of pre-existing conditions.
I’m glad you guys managed to get in. My experience with Welmark in SD is that they are tricky to get into and generally do not like to cover fulltime RVers. We were rejected back in the day and I’ve known countless other RVers who were rejected and/or asked to produce proof of permanent residence (even recently). They are one of the off-exchange options there and do provide a good insurance packet, albeit pricey.
Nina
One insurance broker in SD told us:
“Wellmark BCBS has never come out directly stating they welcome RVers with open arms, but since this new law went into effect they have not declined, or cancelled anyone with a mail forwarding address, could that change, yes, do I expect it to, no. I would love to tell you there will never be an issue with BCBS, but as this law continues to evolve I don’t think anyone could make that statement.”
He also said “Assurant/Time Ins (not shown for us on ehealthinsurance.com?), would love to have more clients and welcomes all RVers with open arms, but their rates are more expensive.”
Robert
Thanks for the feedback. Always good to have multiple inputs. So, if you manage to get in with Wellmark BCBS in SD it seems they are workable (albeit off-exchange). I’m still not totally comfortable with them especially since I’ve personally known so many RVers who were asked to provide “proof of permanent residence” after the fact (incl. ourselves), but it appears they’ve relaxed the rules somewhat with the new law. So, another possibility for those stuck with SD domicile.
Nina
I applaud you for taking this on with such concise explanations. Also your way with the commenters is to your credit. The SD domicile residency businesses must be freaking out about such an automatic loss in business.
Thanks…and yes, I would imagine the domicile agencies in SD are going to be in for a surprise as younger RVers move out of state this coming year. If they haven’t felt the impact yet, they will.
Nina
Excellent information. Our domicile is TX (Livingston-Escapees) which works great and hubby just changed his Medicare supplemental to BCBS which saved him several hundred dollars. One very important piece of this discussion of F/T, “Networks” and “domiciles” is HOW TO YOU GET BACK HOME WHEN SERIOUSLY ILL OR INJURED? Do your research on medical evacuation services. When comparing companies, look for 3 key phrases: 1) “closest appropriate facility” (that means the hospital could be thousands of miles from home); 2) “medical necessity”(this means the insurance company decides if there is a medical need for you to be evacuated, even if you want to get services in-network; 3) “away from home” usually services only start if you are 150 miles from home on vacation-are F/T RVers on vacation? We have SkyMed which posts their complete “member service agreement” on-line so you can read the “fine print” BEFORE you buy. It’s important to plan for medical evacuation as part of your health care insurance!
Good tips all. Reading the details on whatever service you buy is critical. There are all very relevant questions. Thanks for sharing your process.
Nina
I’m puzzled by your comments regarding Avera. Our in-marketplace plan from Avera allows use of the PHCS MultiPlan network. A couple months ago we used a clinic in Billings, Mt, and a doctor in Portland, Or, and all we paid was the doctor office copay. We picked this plan with Kyle when we moved our the domicile to SD. Am I misunderstanding your comments on Avera above?
My understanding is this was true previously, but will not be true in 2015. As of next year the Avera plans do not cover ANY regular care outside of SD….only emergency care. So, you’ll no longer be able to use that great PHCS network except for emergency situations.
I’m not an agent, but this is what I’ve understood from Kyle and others.
Nina
Here is Kyle’s write up of the new Avera policies:
http://rverhealthinsurance.com/south-dakota-rvers-avera-announcement-coming-today/
And the paragraph that counts for coverage:
“Whether you buy ON or OFF the exchange you will not have coverage for routine care outside of the Avera Health network. The PHCS Multiplan network can only be utilized for urgent/emergent care to be considered in-network.”
Nina
The key here is that urgent care is covered. So MultiPlan can’t be used for physicals or cancer screenings, but per Avera customer service it can be used for treatment of strep throat, for example. That’s good enough for me.
Keep it mind it cannot be used for ANY follow-up care. Say, if you have an accident, get out of emergency and then require follow-up or after-emergency care. I personally think this is a risk, but totally understand we all have different risk levels.
Nina
It’s a pain. We just finished moving to SD, and we have 11 months of nonrefundable vehicle registration left. We will hold tight for now, and if SD doesn’t look better for 2016, we will move to Texas.
Once again, you are the calm in the perpetual health insurance storm. We have our domicile in Kansas, with the exception of Lawrence, KS, sucks in just about every conceivable way. I can show my husband Doug this, calm his mind and my guess we will be going with Texas. If they are friendly to full time RVrs we are in. Thanks again! Sally
Yeah I honestly don’t think you can go wrong with TX. Escapees is a great organization, the state is very friendly to RVers and the health care offerings on the exchange there are excellent.
Nina
Having read the exemptions under the ACA, it lists “homeless” as the first hardship exemption, which required no proof submitted (I guess they take your word for it.) My question is, would a full-timer living in a used TT with no real estate interests (having lost my S&B to a bankruptcy several years ago), and of modest means be considered “homeless” and thus exempt from the ACA’s individual mandate?
We’re both 58 now and have insurance coverage through my employer and am considering a SD domicile. However, during the gap (from ages 62-65) I may be unable to afford health insurance, with DW and I living almost entirely off of social security. Even if I could afford a bronze plan with the help of an ACA subsidy, I could not afford the $6,000+/yr each deductible ($12,000 for both), so we couldn’t afford to see a doctor anyway if sick or injured. It would only pay for (in network) routine check-ups and tests if we are not sick or injured (and don’t really need to see a doctor) so wouldn’t do use any good anyway, regardless of what state I declare domicile in. It seems better that for these 3 “gap years”, it might be more advantageous to keep any money that would go to an insurance that I could never use and instead save that to pay for negotiated doctor visits and medicines if and when needed – as long as I don’t have to pay the outrageous ACA penalty, which will be $1,390 for both of us by 2016.
Wouldn’t it be smarter to avoid paying this penalty, if I can be legally considered “homeless,” and instead use this money to pay for my actual medical care instead?
Chip
So, this is a good question. I tried to read a bit around the web this AM, but can’t find a specific definition of “homeless” so I’m not entirely clear to what extent the term covers. Are fulltime RVers considered homeless if they still have a domicile address (which most do)? It does look like the paperwork is minimal, so I guess it’s a possibility. My advice would be to take this to a CPA and discuss it in more detail. If you find out more, do comment back (as will I).
Nina
Hello all,
I just got off of the phone with the folks at RVerHealth. What I was told is that Avera cannot deny anyone coverage if you purchase insurance “on exchange”. “They cannot deny you coverage for being a full time RVer”. Avera will cover Urgent and ER care. They will not cover routine care out of state.
That being said, if you are like I am and buy a Bronze plan then they would not “pay” for “a lot” of routine care until the deductible is hit anyway. I’ve been paying for my yearly routine care for years so this isn’t a big deal to me.
What I need is coverage when we’re on the road and something happens, turn an ankle, come down with strep throat or the like. My understanding is that Avera would cover this sort of thing.
So, I don’t think SD is necessarily out of play if you plan to domicile there and don’t mind paying for most of the routine stuff out of pocket when you’re on the road..
Phil
My worry is the definition of what exactly constitutes “emergency care”…see above in my blog post. That can potentially be a tricky definition and since Avera offers no out of network caps there are no limits to what those $$ amounts could be if they are not covered. I’ve discussed this in detail with the RVerHealth folks and they share some of the same concerns.
It all depends on your comfort level. Some folks may be comfortable with that, but I was personally not.
Nina
I understand your concern. Anytime we deal with insurance companies there is always a possibility that they will try to find a way to wiggle out of paying a claim… it’s the time we live in.
Anyway, the folks at RVerHealth said that Avera would cover “Urgent” as well as “Emergency” care. I asked a hypothetical… “suppose I turn and ankle getting out of the RV and needed to get an x-ray and then get it cared for, would that be covered by Avera?” The person I talked to at RVerHealth said, yes. Of course I suspect that follow up care would not.
Good enough for me… I offer up this information so that anyone considering SD will have it for use in making a decision, not to be confrontational.
On another note, it looks like RV insurance on a Class ‘A’ is twice as expensive in SD as it is in WA state. As of now it looks like I’ll just keep my domicile in WA and not move to SD. Even though sales tax is almost 10% here the difference would be eaten up by RV insurance in a matter of years.
Phil
I understand too which is why I specifically discussed the emergency care clause for Avera and wrote a section titled “isn’t emergency care enough?” in the blog post. For some people this may well be enough for their comfort levels.
If you have domicile currently in WA, I do think it’s worth keeping. The Health Insurance options are significantly better there. We actually looked at establishing domicile in WA, but it wasn’t possible for us to do so without renting or buying property.
Nina
Nina,
Thanks for the feedback.
Washington has become entirely too liberal for me in my old age but it looks like we’re supposed to stay here.
Also, I look forward to looking through your blog and Paul’s too… I find his of particular interest.
Phil
We just completed our move to Texas from SD. In speaking with Kyle we believe that there were not enough safe guards with the “emergency” language. Yes, going to any ER with a bust ankle or leg or hand is one thing and maybe you can hi-tail it back to SD for follow up visits with a in network Dr. But what if it was more serious, maybe a heart attack or something else that would require a lengthy hospital stay….you cannot just get on a car or plane and get back to SD!
The move to Texas was costly but at least now we have BC/BS PPO that is multi-state coverage.
Thank you Nina (and Cherie and Kyle) for the invaluable help and information.
Good to know you made the move successfully. I agree entirely with you about the emergency language, which is why we opted for short term insurance with better (nationwide) coverage. We’ll likely be making the same move you did at the end of this year.
Nina
I would love to know which short term plan you decided on as I’m in SD too and in the same boat…
Thanks a TON! 🙂
I got the one offered through RVerhealthinsurance.com. It’s sold by The IHC group. Make sure you look at the STM, not the “lite” version. You want the STM for nationwide coverage. No complaints so far, but of course we haven’t used the insurance so I have no basis to judge it.
Nina
Same here, we bought the one offered by IHC. We did use it once in January and it worked fine. We cancelled it once we signed up for BC/BS of Texas.
Good to know!! Thanks for chiming in.
Nina
Thanks soooooooo much to both of you for your replies! Much appreciated! And, Nina, is that plan “good enough” to avoid the tax penalty (so long as we have suitable coverage the rest of the year), do you know?
Nevermind….i see on Kyle’s site that they aren’t ACA qualified so no need to reply to that question. Thanks 🙂
Nope. You pay the penalty (see details in my blog post above). As I mentioned in the blog you can have a short-term plan for 3 months before you incur the penalty, but after that you pay it. The reason we chose the short-term plan rather than what’s on the ACA website is that there are no nationwide coverage plans on the ACA website in SD (see my blog above). We needed a nationwide plan so we opted for the short-term (and to pay the penalty) until we can switch domicile.
Nina
We also had a short term policy at the beginning of the year after I retired from my full time employer at the end of last year. Since our mail forwarding service in SD was also moving to a new address in Sioux Falls we opted to make the move now otherwise we may have waited thru the end of this year to see how things played out.
Will be interesting to see what happens June with the SCOTUS decision on subsidies and how it will affect Texas and SD.
Just heard about TX for 2016 not going to offer BCBS PPO. Now what do we do? We picked TX after I read your article about health coverage in SD not working for pre-retirement individuals. Now it looks like we might be screwed for TX.
Thanks for all your information. Plan to be full time by the end of Sept. 2015
I just heard about this recently too (a few days ago), but details are not confirmed and I haven’t heard yet whether TX BCBS will still allow use of the Blue Card (= access to extended BCBS network while traveling outside of TX) for the non-PPO plans. Apparently they do this in FL, but I don’t know if they will do the same for TX. If they do allow this, then all should be fine. If they don’t allow this it will be a HUGE impact to all pre-Medicare RVers domiciled in TX, and then I really don’t know what the answer will be. Travel with a plan that offers emergency-only insurance outside of TX? Go outside the exchange (if affordable)? Re-domicile in FL?
Unfortunately it looks like many things are going to change in the health insurance landscape in 2016 (yet again). Some insurers are dropping out of the ACA (e.g. Assurant in FL), others are changing their plans and (likely) many others will raise their rates. I know very little at this point, so I can’t make a recommendation either way (we don’t even know what we’re going to do right now). At this point all we can do is wait and see what offerings are being put on the exchange later this year. I just hope there will be a reasonable solution for all.
Nina
Nina,
Here is a link to an alert from our Texas BCBS…..not looking good at all….
http://www.bcbstx.com/company-info/alerts-announcements/alerts-announcements?lid=icadpkzd
We may opt for Healrhsharing such as Liberty Healthcare
I guess stay tuned is all we can do….
Oh this definitely is not good at all. Thanks for the link. ugh!
Nina
Hello,
We have some friends that recently became full timers with residence in SD. They got health insurance through Wellmark Blue Cross Blue Shield. They did not have to prove 6 month residency. They used an independent insurance agent named Michael Monson in Sioux Falls. In case you are interested in contacting him, his email is mike@bestchoice-ins.com and the phone is 605-782-4642. I currently have BCBS in NC. It’s a policy I bought when I lived there. When we started full timing, they said I could keep it since I was a resident when I first started with Blue Cross. Makes me nervous though so I’ll be investigating the SD option.
I’ve had RV friends who’ve managed to do the same (get into BCBS Wellmark off-exchange in SD), but it’s tricky. Technically BCBS in SD has a 6-month in-state rule. Some folks manage to get signed-on without verification, but what they’re essentially doing is “slipping in” outside of the official system (I’ve had this confirmed by insurance agents). There is a *chance* BCBS can come back and require verification and/or disapprove their expenses because they did not meet the requirement. So, I’m not real comfortable with it. We applied for Wellmark in SD a few years back and we were rejected for lack of proof of 6-month residency.
Nina
I do have kind of a related question. Have you talked about seeing a doctor when you are on the road and away from your established doctors? If you have I’m sorry I have missed it, I did a search on your website and read some articles. In most cases if you are sick you can go to a walk-in clinic or an emergency room. What if you feel like you are somewhere in between? A little more than a walk in clinic can take care of, but not quite emergency room either. Do you ever call a random doctors offices and make an appointment? Just a little back ground we are 40ish, work from the road and have good insurance … so that is not an issue. Any thoughts would be helpful and appreciated.
We tend to do urgent care most of the time, and if we feel it’s anything more we go to the ER. However it is possible to have an online consultation if you sign up to a service that offers it. We haven’t gone this route, but I know other RVers who have and like it a lot. These docs can’t treat you over the phone, but can provide consultation, help with diagnosis, recommend treatment plans and write limited prescriptions. Teledoc and eDoc are examples of companies offering this. Read more here:
https://www.rverinsurance.com/telemedicine-2/
Hold that helps!
Nina
We use local doctors for our yearly physicals and for chiropractic care. So far we have not run into any issues. I try to get a referral from a local yokel so we aren’t just throwing darts and hoping to get a good doctor. In small towns, it’s generally very easy to get appointments even the same day.
Hi Nina, just wondered what you decided in terms of domicile and insurance for 2016?
No firm decisions yet. Healthcare.gov just opened price and plan views for 2016 (preview only) so I’m just starting to wade through all the options now. I’ll write about it when I’ve had a chance to delve into the details a bit more. One thing I can tell you right now though -> SD choices are just as poor as they were last year (no improvements) and TX choices have worsened. I’ll write more soon.
Nina
Nina,
Thanks again for your insights. As you pointed out Texas just got worse. We moved our domicile this past April to be able to enroll in the BCBS PPO and now low and behold they along with many other BCBS plans are getting out of the PPO market.
After much thought we look like we are going the route of Liberty Healthshare as they offer the only reasonable alternative without getting penalized almost $700/ person in 2016 for not having an ACA compliant plan.
We spoke with them and here are a few notes from that conversation :
1) There most comprehensive plan is just under $400/ mth.
2) They pay within 30 days of receiving the bills from the doctors or hospitals.
3) All bills go to them and they negotiate all bills with the providers.
4) They pay 50% more than Medicare/ Medicaid so they usually get no push back from any healthcare providers.
We are seriously considering them since we are not moving our domicile again and even if we wanted to there does not look like there will be any PPO type plans offered for FT RVers in any of the usual suspect states, TX, FL or SD.
We are also awaiting Kyle Henson’s analysis if the whole issue so we can finalize our decision.
Thanks for your insights Les. The Healthshare Plans are becoming a more viable-looking option for many. It won’t work for us since we are not religious-affiliated, but it may be a decent option for those who are.
Sadly I do believe the trend of plans pulling PPO options on the individual marketplace will continue. This year It’s happened in TX and several other states too. It’s cheaper for the insurers and it seems to be the future. This definitely makes it tougher for us fulltime travelers.
Also still not sure what we’re going to do yet. We took a short-term insurance plan (in SD) and paid the penalty in 2015, but the penalty fee is increasing significantly in 2016, so the $$ are becoming significant.
I’m also waiting for Kyle’s analysis and will do more digging too. Once I have a better overview of our options I’ll do a write up on the blog.
Nina
For everyone who’s following this thread. Kyle just released his 2016 guide. He’s pretty much covered it all for next year. I’ll be writing a more extensive blog post soon:
https://www.rverinsurance.com/uncategorized/rver-guide-to-2016-aca-open-enrollment/
Nina
Here’s a good alternative, especially if you’re in good health. This is a valid option in all 50 states.
http://samaritanministries.org/healthreform/
Yes, it’s a ministry healthshare which offers a viable non-ACA alternative, but also has some limitations. I listed this in my most recent healthcare post here:
https://www.wheelingit.us/2015/11/04/health-insurance-time-less-ppos-harder-choices-for-pre-medicare-fulltimers/
Nina
Hi Nina,
Thank you so much for your thorough coverage of the situation. Looks like we will have to change our domicile from SD…in the meantime- what ST plan did you get in SD?
Thanks!
Bettina