Health Insurance Time -> Less PPO’s, Harder Choices for Pre-Medicare Fulltime RVers
Big breath, big breath. It’s that time of year again and it’s not my favorite time either. For those of us out there who are pre-Medicare fulltime RVers we need to think about health insurance. For 2016 the choices have changed, yet again, and the “new” choices are making our filltime nomadic life more difficult. Plus we don’t have a lot of time to dilly dally. The ACA exchange opened up a few days ago and we only have until Dec 15th to make our choices for plans starting Jan 1st, 2016, so it’s time to get cracking!
First things first, for those of you who want to understand more about ACA (aka Obamacare) insurance I suggest you get yourselves over to Kyle’s website at RverInsurance.com. Not only is he a licensed agent and a fulltime RVer himself, but he just wrote an excellent RVer 2016 Guide to Open Enrollment (FREE) which I suggest everyone reads before going further. It’s going to answer most of your questions.
Secondly, I’m not a health insurance agent and none of the advice on this page should be considered qualified insurance advice. These are simply my personal notes and layman opinions, so please direct all final questions to a qualified agent. Yet again I’m going to suggest Kyle’s website because he’s an expert (I’m not), plus I like to support good fulltime RVer businesses (and in case you want to know, I’m not affiliated in any way).
Thirdly, as with my other health care posts I’m going to request that we do not bring politics into this discussion. I’m open to discussing options and how to best navigate the system, but I will not discuss the politics that led us here, no matter which side you’re on. I will delete any comment that has politics in it. Be forewarned 🙂
Phew! With all those disclaimers done, it’s finally time to get onto what I’m going to post about today. I’ve already covered all the details of ACA in previous posts so I won’t go over them again. Also I’m not going to discuss Medicare or Medicaid. What I DO want to talk about is how the landscape has changed in 2016 for pre-Medicare (younger-aged) fulltime RVers and what options we’re looking at today. Here it goes.
A Reminder -> On Versus Off-Exchange Plans
I’m only going to do one reminder and that’s about the difference between on and off-exchange health care plans. There are two main ways you can buy individual “Obamacare” health care plans, either through the official ACA Exchange** or off-exchange**, and there is really only one reason to buy on-exchange -> if you qualify for subsidies (= cost reductions) based on your projected income.
In 2016 the MAGI income limits for subsidies are $11,770-$47,080 as as single, $15,930-$63,720 as a couple (see full table HERE). If your projected 2016 income is within these limits you qualify for a subsidy, and you MUST buy your plan through the ACA exchange in order to get those cost reductions. If your income is more than this you don’t qualify for a subsidy so you DON’T have to buy your plan on the exchange.
The advantage of subsidies is that they significantly lower your health-care costs. As an example if we make more than $63,720 next year the very cheapest plan for Paul and I in SD (Avera HMO) is $573/month. If our MAGI Income is $50,000 next year that cost lowers to $241/month. At $40,000 income level the plan costs are $115/month. It’s huge! You can figure out your own subsidy details using the online calculator provided HERE. The disadvantage of subsidies is that you have far fewer health plan options. There are waaaay more plan options off-exchange. I’ll talk about both types of plans in this post.
** Kyle offers both methods through his website
There Are Less PPO Plans On Exchange in 2016 (And It’s A Trend)
Last year one of the biggest issues we had in South Dakota (where we are currently domiciled) was lack of access to any reasonable nationwide health care plans.
There were zero nationwide plans on the SD ACA exchange which basically meant that if we bought one of those plans we would have ZERO network outside of SD for healthcare. We’d be covered for emergency care out-of-state, but nothing else. There were several nationwide off-exchange options, but they were prohibitively expensive. So what we opted to do instead was take out a Short Term Insurance (STM) plan for the year which covered us out-of-state, but also exposed us to the ACA tax penalty (STM plans are not considered ACA-compliant and thus incur the tax penalty). So, all of this year we’ve paid $265 per month plus the tax penalty.
Going into 2016 our plan was to switch our domicile to TX which (in 2015) offered a one of the very best nationwide health care plans, Blue Choice PPO. Then came the bomb no-one saw coming, least of all me. A few months ago BCBS suddenly announced it was pulling ALL of its PPO plans from the ACA exchange in Texas for 2016. Boom! Now, all of a sudden there are no nationwide plans on the exchange in Texas for 2016, and all the RVers who switched their domicile to TX for health care reasons last year (and there were many who did) are now faced with going to an HMO-style plan (= no out-of-state network) or buying an off-exchange plan (= very expensive).
In my opinion this is the sign of a general trend in the industry.
I’ve head from folks in several other states who’ve seen PPO plans cancelled or pulled from the individual marketplace for 2016. Insurances are going more “local”, basically because it’s cheaper and my “hunch” is that this trend will continue. So, even if you manage to switch domicile to a state that has great nationwide health insurance this year, there are no guarantees that state will offer that same plan next year. In fact given what we’ve been seeing so far, odds are they won’t. Switching domicile takes time & $$ (sometimes quite a lot of $$) so is it worth it to go through the process just for the chance of a year of decent health insurance?
Last year I really thought it was. This year I don’t think so anymore.
But Florida Still Has Options
Out of the 3 big “fulltime RV” states (FL, TX, SD), Florida is now the only one that is still offering a decent nationwide network on the ACA exchange for 2016.
Assurant pulled out of Florida for 2016, but Florida Blue is still there. Their EPO plans (Blue Select and Blue Options, specifically) although not “technically” PPO actually allow you to use the extended nationwide BCBS network (= Blue Card) outside of Florida, which essentially makes them nationwide. It’s pretty darn close to perfect and if you’re in FL it’s a great plan to get.
Should you switch your domicile to FL to get access to these health care plans?
It depends. If you’re planning to fulltime soon and haven’t yet chosen your domicile, then I think Florida is worth a look. If you’re currently fulltiming with domicile in either SD or TX then you need to look hard at the $$ and details to decide if it’s worth the switch. Remember that domicile choice is not ONLY about health care. There’s car/RV insurance costs, registration costs, business laws (if you have a business), banking, voting, estate laws etc. ALL of these should be considered when you chose your domicile. Add-in the fact that you need to physically go to FL to get your drivers license, and lastly keep in mind that these same health plans may or may not be available in 2017.
Only you can decide if it’s worth it for you. For us it is not.
So, If You’re Domiciled in TX or SD What Are The Options???
There are basically only a select few options left for us Texan & South Dakotan fulltimers:
1/ Buy An HMO-Type Bronze Plan On Exchange
As a fulltime Rver you can still buy health plans on the exchange in both TX and SD, just not nationwide ones. In TX you can get a BCBS HMO. In SD there’s Avera. You’ll need to select a primary care physician and what you’ll get is a plan that’s pretty much local-only and only covers emergency care out-of-state.
Is this good enough?
Well I guess it “could” be. You’re covered for emergency situations out of state, but for post-emergency care, regular doc visits or anything else you have to either pay yourself (out of pocket) or get your butt back to your domicile state for covered medical care. I don’t particularly like it for the same reasons I identified in my post last year, but for some folks it may be within their acceptable risk limits. Only you can decide if it’ll work for you.
2/ Buy An HMO-Type Silver Plan On Exchange
What? Why would you buy a Silver HMO Plan if you won’t buy the cheaper Bronze?? Well, it’s hidden in the plan details:
- In SD, one of the options on the exchange is the Avera Silver PPO Plan (MyPlan 3500). Although it’s still essentially HMO (there are zero in-network docs outside of SD) it actually offers a co-pay-insurance for out-of-network care. There’s a 40% co-insurance, which means you’ll get 60% of your costs covered (after your deductible is met) if you need non-emergency care out-of-state.
- In TX, the Blue Advantage PLUS Silver HMO 102 plan has a similar set-up with 50% co-insurance for out-of-network care. The cheaper BCBS Bronze Plan does not offer anything like this.
Neither of these plans is ideal, but they give you SOME help with coverage out-of-state which is waaay better than nothing at all IMHO. In addition, if you qualify for cost-sharing the Silver Plans offer even more advantages with lower deductibles and lower out-of-pocket costs. For anyone buying on-exchange I think they are worth a hard look.
3/ Buy A PPO Plan OFF Exchange
There are still very good nationwide network plans available OFF exchange in both TX & SD, but they are not cheap. (remember that there are NO subsidies off-exchange). If you make enough money that you don’t qualify for subsidies, buying off-exchange will offer you many more options with better networks than what you can get on exchange. Amongst other options in SD there is Wellmark, in TX there is Humana One and United Healthcare. Check out further details through Kyle’s website.
4/ Buy A Short-Term Insurance Plan
Short-Term Plans are really targeted at folks who only need a few months of coverage (say, between jobs or before going on Medicare), but they can be bought by us regular folks for up to a full year. Last year we chose this route and it turns out this is still a possibility for this year. If you had a STM plan last year you may be able to renew again this year (check with your plan provider). If you’ve never had one, but just want a solid nationwide plan this is a real, viable option.
The big gotchas? These plans are not considered “ACA compliant” so if you have them for more than 3 months you have to pay the tax penalty (= in 2016 this is $695/person or 2.5% of income, whichever is higher). Plus they will NOT cover pre-existing conditions and there are NO subsidies either. So, if you are already ill or can’t afford the 2016 tax penalty these are not good options for you. However if you’re young and healthy and/or you don’t qualify for subsidies, they could make sense for you.
The short-term plans are typically much cheaper than off-exchange plans and many offer solid nationwide coverage (if you apply thro’ Kyle’s site make sure you chose the STM plans, not the “lite”). Should you decide to go this route price it out and ADD the tax penalty ontop to get your total costs.
5/ Go With A Ministry HealthShare Plan
Let me say up-front this is not for everyone, but it’s an option some of you may want to look at especially if you don’t qualify for subsidies, you don’t want to participate in the ACA and/or you are looking for something more affordable.
The Ministry Healthshare plans are faith-based health-sharing plans. It’s important to understand that these are not regulated insurance plans and provide no guarantee of payment. What they offer is a “sharing” of costs after certain requirements (specific to each ministry) are met. Many exclude pre-existing conditions and/or have eligibility requirements that not everyone might be comfortable with (e.g. need to limit alcohol, or not have sex outside a Christian marriage or be a practicing Christian -> each provider is different, so read plans in details before you decide). However they are typically exempt from the tax penalty and what they offer is a very inexpensive way to get help with health care costs outside of the ACA system.
The top providers are Medi-Share, Christian Healthcare Ministries, Samaritan Ministries and Liberty Healthshare. Of these four, Liberty has the loosest eligibility requirements. You can see a comparison chart for the first three HERE (pdf download). If you’re interested in this avenue look through the details & requirements in the links.
What Are Wheelingit Going To Do?
I’m not 100% sure yet, but I think we’re leaning towards either option #2 (most likely) or renewing #4. We really liked the STM plan we had this year, but the penalty costs are going to start to get painful in 2016. The Silver Avera plan is not ideal since it doesn’t give us a real network outside of SD, but it does cover emergency care out-of-state and if we end up needing non-emergency care it does cover some of those costs too (after deductible). I think it’s a compromise we can live with. We are also considering signing up to Telemedicine which will give us the ability to consult a physician remotely without going into an office. It could cover a bit more of the gap between our insurance and need to access to doctors on the road. We’ll make our final decision soon.
That’s it folks. Feel free to post questions and comments below. Remember no politics please.
Related Posts & Links:
- Health Insurance & SD Domicile -> Are There Any Options Left For Younger Fulltime RVers?? -> My post from last year around this same time. Click HERE
- The ACA And It’s Impact On Fulltime RV Health Insurance -> My original ACA post. Click HERE.
- Self-Medical Care -> My 3-part series on self-care. Click for Part I, Part II and Part III.