Health Insurance Time -> 2018 Considerations For Pre-Medicare RVers
Take a deep breath and get ready my dear blog readers because it’s that time of year again. No I don’t mean Halloween, although this is aaaalmost as scary. No it’s the eve of something much more frightening. Tomorrow is Nov 1st which means Open Enrollment and time to nail down your health care choices for next year. Eeeeeek!
Enrollment Time Is RESTRICTED This Year
This year it’s even more important for RVers to be “on the ball” as we have a super short enrollment period starting Nov 1 and ending Dec 15th (in previous years extended enrollment went 13 weeks). Also the enrollment website, healthcare.gov, will be shut down for maintenance for more than 60 hours during open enrollment, including 12-hour maintenance blackouts on five consecutive Sundays. It’s not much time to work with!
NOTE/ After Dec 15th you will only be able to buy insurance on the ACA if you qualify for a Special Enrollment Period. As an RVer, moving your domicile to a new state qualifies for this.
This Is a Layman’s Guide, Not Insurance Advice
The whole reason I’m writing this guide is simply to (hopefully) help fellow pre-Medicare RVers dig through some of the mess of info out there about 2018 health care. But I’m not an agent! I’m writing this as a layman RVer based purely on what I’ve personally read and understood. It’s not meant to be a definitive guide, nor is it meant to be insurance advice. So, please take note of the following:
- I am not a qualified health insurance agent! Don’t just read this post and take my word for it! Feel feel to peruse the info, but then talk to a qualified insurance agent before you make any final decisions on the right health care choices for YOU.
- I will not talk politics & will delete any comments that mention it. My goal with this post is simply to provide some pointers on 2018 health insurance choices (as I see them) for fellow RVers. How we got here or what might or might not happen in the future is irrelevant & will only lead to heated and pointless arguments that will not help any of us actually sign up for health insurance for next year (= the ONLY thing that matters to me for this post). Please keep all discussion focused on current health choices and how to navigate the current marketplace. No politics, period.
- Prices May Change: All the prices I’ve listed in this post are estimates for Paul & I (late 40’s) as of Oct 31st from Healthsherpa.com. They should be accurate, but some may change once Open Enrollment actually starts tomorrow AM.
- Medicare & Medicaid folks can ignore this post. If you’re lucky enough to be past the magical age of 65 and on Medicare, you do need not worry about anything I’m writing in this post today. The same applies if you have coverage through Medicaid, your job, the VA or other means. Be at healthcare peace and enjoy your day 🙂
There Are Experts Out There To Help You (Not Me)
The other important thing I want to mention before I dig into the nitty gritty is that there are experts who can help you much better than I can.
This post won’t be a comprehensive overview of every choice or every option, but there are other resources which are! In particular I recommend RVer Insurance Exchange (no affiliation) who have written an excellent guide to ALL the possible 2018 health choices HERE. They are fellow RVers who not only understand the RV lifestyle but are also qualified insurance agents, so they can help with both insurance choices and enrollment. I used them to enroll last year, and will likely be using them again to enroll this year. So I suggest you start there and read my very non-expert summary afterwards 🙂
With all that said, let’s get into the details of how I view the marketplace this year….
The ACA Still Exists
No matter what you might read in the news or what policies might change in the future, for this coming year the ACA (commonly called “Obamacare”) still exists and it’s what most of us will be working with for our 2018 health care choices.
Through the ACA online website (or thro’ agents licensed to enroll you with the ACA) you can buy different levels of health insurance (bronze, silver, gold, platinum) that all meet fixed requirements, as defined by ACA law. I’m not going to go into all basics of ACA here since I’ve already covered that in previous posts (plus you can read THIS guide from RVer Insurance) but for RVers the most import details to understand are that all the plans must meet certain basic requirements (such as covering “essential health benefits“) and that no plan can reject you or charge you more for pre-existing conditions.
Plus there’s a FEW more things you need to know….
There Are Very Few Nationwide Plans Left On The Exchanges
The first thing to understand about buying insurance on the ACA exchanges is that there’s nothing in the ACA law about requiring nationwide coverage. In fact MOST plans these days do not, and for fulltime RVers that’s an important consideration.
The two biggest worrying trends on the ACA over the past few years have been providers pulling out of the exchanges (= less choices overall) and the slow, but sure narrowing of provider networks and removal of nationwide plans. I predicted this trend back in 2015 and (unfortunately) I was dead on right. Before 2015 there were multiple choices & decent nationwide plans in all of the the “big 3” RV States (TX, SD, FL). Today however, only a single nationwide choice remains:
- Texas does not have ANY nationwide plans on their Exchange. There is only one provider (BCBS) on offer in the Livingston zip code (Escapees TX domicile) and they only offer HMO plans for 2018.
- South Dakota also does not have ANY nationwide plans on their Exchange. Avera still offers a PPO, but if you look closely into the network you’ll find it has zero providers out of state (seriously none!) so it’s essentially just a SD HMO (I honestly don’t even know why they call it “PPO”). There are no other PPO’s on offer through the SD Exchange for 2018.
- Florida is the ONLY state that still offers a nationwide plan on their Exchange. There are two types of Florida Blue EPO/PPO plans (Blue Select & Blue Options) which act as EPO in-state, but take advantage of the fabulous & very extensive “Blue Card” network out-of-state (essentially making them PPO out of state). These are the only true nationwide plans left on the ACA exchange in the “big 3” RV states for 2018.
NOTE1/ OTHER STATES: I only discuss the “big 3” RV states here since that’s where most fulltime RVers domicile. There ARE other states who still offer nationwide plans on their exchange so if you have the chance to domicile in one (maybe you have property there?) I recommend looking into it.
NOTE2/ EMERGENCY CARE: A note about emergency care. By law all ACA plans are required to cover emergency care, even if it’s out-of-state and out-of-network. For RVers that means you’ll be covered for emergencies everywhere in the USA, no matter what plan you buy. Networks are still important however not just for follow-up care, but also thanks to a little, strange caveat called “balance billing” (I wrote about that HERE. Also read this article HERE) which can still “get you” after the fact.
Bottom Line -> Sign up for the best network you can.
NOTE3/ MULTI-STATE PLANS: When you browse healthcare.gov you might come across plans called “multi-state” which seem like a promising choice? Unfortunately the name does not mean what you think it means. Multi-State Plans are just a contract between OPM (U.S. Office of Personnel Management) and insurance companies for a specific type of plan that is operated in multiple states. It has nothing (NOTHING) to do with provider coverage networks and does NOT automatically mean the plan can be used across multiple states.
Bottom Line -> When shopping For plans IGNORE the multi-state designation (look at coverage networks, not plan names)!
Base Prices Have Gone UP (esp. For Silver Plans)!
The other big change this year is that plan costs have gone up significantly, yet again. Browsing through Healthsherpa I’ve seen base prices (= non-subsidized premiums) increase anywhere from 8% to 40% over 2017, depending on your plan type, age and location (= domicile zip code).
Out of all the metal levels, Silver Plans have by far seen the biggest increase (this was expected based on the Executive Order that Trump signed last month) whereas Bronze and Gold Plans have seen smaller increases. Also FL remains the cheapest of the “Big 3” RV States. I pulled together the 2017 and 2018 base prices for Paul and I (a couple in our late 40’s) in 5 popular domicile locations so you can see what I mean.
Monthly Base Price (non-subsidized) for cheapest Bronze plans in 5 Domicile Locations:
|Domicile||Zip Code||Plan||2017 Price||2018 Price||Increase|
|TX Escapees||77351||HMO Bronze||$ 841||$ 1,010||20%|
|SD DakotaPost||57104||Avera Bronze 6550||$ 906||$ 1,042||15%|
|FL Escapees||33513||BlueSelect 1452||$ 644||$ 759||18%|
|FL My RV Mail||32536||BlueSelect 1452||$ 695||$ 814||17%|
|FL St Brendans Isle||32043||BlueSelect 1452||$ 729||$ 835||15%|
Monthly Base Price (non-subsidized) for cheapest Silver plans in 5 Domicile Locations:
|Domicile||Zip Code||Plan||2017 Price||2018 Price||Increase|
|TX Escapees||77351||HMO Silver||$ 1,072||$ 1,403||31%|
|SD DakotaPost||57104||Avera Silver 4000||$ 1,082||$ 1,432||32%|
|FL Escapees||33513||BlueSelect Silver 1443||$ 767||$ 1,107||44%|
|FL My RV Mail||32536||BlueSelect Silver 1443||$ 828||$ 1,188||43%|
|FL St Brendans Isle||32043||BlueSelect Silver 1443||$ 868||$ 1,219||40%|
Monthly Base Price (non-subsidized) for cheapest Gold plans in 5 Domicile Locations:
|Domicile||Zip Code||Plan||2017 Price||2018 Price||Increase|
|TX Escapees||77351||HMO Gold||$ 1,344||$ 1,376||2%|
|SD DakotaPost||57104||Avera Gold 1500||$ 1,450||$ 1,583||9%|
|FL Escapees||33513||BlueSelect Gold 1535||$ 1,161||$ 1,292||11%|
|FL My RV Mail||32536||BlueSelect Gold 1535||$ 1,253||$ 1,387||11%|
|FL St Brendans Isle||32043||BlueSelect Gold 1535||$ 1,315||$ 1,423||8%|
But Subsidies Have ALSO Increased (& Make A HUGE Difference)
Although plan prices have ramped quite significantly from last year so have subsidies* which means that if you qualify for one you may even pay less than you did for insurance last year. Perusing through Healthsherpa for 2017/2018 it seems subsidies have increased marginally in SD (only around 3% year on year), but have ramped significantly in both FL & TX. Here’s a specific example:
Monthly Subsidy for Paul & I At Diff Income Levels In Sumter County (Escapees FL)
|MAGI** Income||2017 Subsidy||2018 Subsidy||Increase|
|$ 70,000||$ –||$ –|
|$ 60,000||$ 326||$ 726||123%|
|$ 50,000||$ 407||$ 805||98%|
|$ 40,000||$ 538||$ 938||74%|
|$ 30,000||$ 665||$ 1,063||60%|
If you plug these 2018 subsidies into the plan premiums I listed above you’ll immediately notice what a big difference they make to the final plan price. As an example the BlueSelect 1452 base price is $759/mo in Sumter County (where Escapees FL is located), but at $60,000 income level we’d only pay $33/mo for it. At $50,000 or below we’d pay nothing at all.
Montly Cost Of BlueSelect 1452 Plan In Sumter County After Subsidy
|MAGI** Income||Plan Cost|
|$ 70,000||$ 759|
|$ 60,000||$ 33|
|$ 50,000||$ –|
|$ 40,000||$ –|
|$ 30,000||$ –|
The last important thing to understand about subsidies is that they vary by both State AND County. So you’ll get a different subsidy in Clay County FL (for example) than you will in Sumter County FL, and these will both be completely different from any subsidy you might get in SD or TX. So if you’re pricing out insurance make sure you price out for both your expected income level, and where you are or plan to domicile. Here’s what those numbers look like for us in 5 of the more popular Domicile locations for RVers:
Monthly Subsidies For Paul & I Across Different Domiciles & Income Levels
|MAGI** Income||TX (77351)||SD (57104)||FL (33513)||FL (32536)||FL (32043)|
|$ 70,000||$ –||$ –||$ –||$ –||$ –|
|$ 60,000||$ 1,023||$ 681||$ 726||$ 814||$ 706|
|$ 50,000||$ 1,102||$ 761||$ 805||$ 894||$ 786|
|$ 40,000||$ 1,235||$ 893||$ 938||$ 1,026||$ 918|
|$ 30,000||$ 1,360||$ 1,018||$ 1,063||$ 1,151||$ 1,043|
If you plug these back into the base plan prices I published above you’ll see that with subsidies added, SD is now by far the most expensive state for ACA plans, whereas FL is the cheapest. With subsidies the differences are significant!
Subsidized Cost of Silver Plans At $60,000 MAGI Level In Diff Domiciles
|Domicile||Zip Code||Plan||Subsidized Cost|
|TX Escapees||77351||HMO Silver||$ 380|
|SD DakotaPost||57104||Avera Silver 4000||$ 751|
|FL Escapees||33513||BlueSelect Silver 1443||$ 381|
|FL My RV Mail||32536||BlueSelect Silver 1443||$ 374|
|FL St Brendans Isle||32043||BlueSelect Silver 1443||$ 513|
*NOTE5/ Subsidies: f you’re not familiar with subsidies they are advanced tax credits which are applied directly to the cost of your insurance. How much you get is based off your MAGI** income. In SD, TX and FL you’ll qualify if you make between 100-400% of Federal Poverty Level (FPL). This means your MAGI is between $12,060-$48,240 as a single or $16,240-$64,960 as a couple in 2018. Subsidies decrease with income (the more you make, the less you get), but increase with age (the older you are, the more you get).
**NOTE6/ Modified Adjusted Gross Income: MAGI income is related to Adjusted Gross Income (AGI) which you’re used to seeing on your tax returns, but it’s not the same. It’s basically your AGI plus a few excluded items things such as tax-exempt interest, tuition expenses, IRA contributions, taxable social security payments, rental losses and more. You can read more HERE.
If You Don’t Qualify For Subsidies Look Off-Exchange
As you can see from the above tables if your MAGI income is too high to qualify for subsidies (even $1 over disqualifies you completely), then you are looking at significant $$$ increases for your health insurance this year. It’s expensive and it’s not pretty at all!
In this case I wouldn’t limit yourself to the choices on the ACA exchange. By looking outside the exchanges you will not only get more plan choices, but the base prices may actually be cheaper than the “full price” of any plan you can get through the ACA.
As an example RVer Insurance is offering an interesting-looking nationwide ACA-compliant Group Plan (available in all 50 states) that costs $936/mo (for the two of us on the Advantage 5000 PPO plan). Depending on your age and location this may well be a cheaper & more comprehensive option than whatever you can buy without subsidy on-exchange. This particular plan does have some extra requirements (e.g. primary applicant must work 30+ hrs/week to qualify) and it’s just one example. There are likely many more options out there so definitely talk to an agent & shop around.
Short-Term Plans *May* Become An Option Again in 2018
Back in 2015 we ended up buying a short-term (STM) health insurance plan for the entire year. Costs were much better than anything we could get on the ACA, even with the Tax Penalty*** added on top. Plus it provided nationwide care with minimal deductibles. It was available to us as long as we didn’t have any pre-existing conditions (which we still don’t) and served us well that year.
The last few years however STM’s were limited to 3-mo max so they were no longer an option for us, but this may be changing again for 2018. Trumps recent Executive Order allows extension of STMs beyond 3 months which makes them (yet again) a potential option. This is all still an evolving story so I’m not sure we can count on it before Open Enrollment closes. Also we’d have to look at the plans & see what extra $$ the Tax Penalty would add to them before we could make a final decision.
Either way we’ll be keeping an eye on RVer Insurance Exchange news to see what they announce
***NOTE7/ Tax Penalty In 2018 – YES the tax penalty for not having insurance (or for having non-ACA compliant insurance such as an STM) still exists! Many folks believe it was repealed by Trump’s recent Executive Order, but that is simply not the case. The IRS have confirmed they are still imposing the penalty, and until Congress enacts the change it is not law. So, unless you are exempt, you will still owe it. Bottom Line -> you won’t be absolved of paying the penalty until law actually changes.
Health Share Ministries Are Popular (But They’re Not For Us)
I have to add a note on Health Share Ministries because I know they’ll come up in the comments as a viable alternative. Many of you won’t like my opinion on this, so I apologize in advance for that.
With ACA plan prices ever increasing many of our RV friends, especially those that don’t qualify for subsidies, have chosen to go non-conventional and get coverage through Health Share Ministries. For those of you not familiar with Health Shares, these are faith-based organizations that share health care costs amongst their members. Basically your money goes into a central pool that is paid out to other members (as needed, and as approved by the ministry) for their health care.
Their biggest advantages are that they avoid the Tax Penalty (through religious exemption) and their costs are SUPER attractive. As an example this is what Paul & I would pay if we signed-up for the most basic share level at each of the big Health Shares:
|Health Share Ministry||Plan Share Cost|
|Liberty Health Share||$ 299|
Pretty compelling right? So why are we not members??
Most of the Ministries have limitations on pre-existing conditions and require some kind of faith statement, but that’s not really the issue for us. What scares me and the main reason we are not members is this:
Health Shares are not insurance. In fact they are not even regulated!
They are religious organizations that are not subject to review, standards or any other requirements. This means they can chose to drop you, they can choose to deny payment for any reason (even moral!) and if they do not pay, you have literally zero legal grounds to go after them. In addition this also means they are not required to publish financials, so you can’t even check if they’re financially healthy or what their pay-in or pay-out rates are. Lastly words like “trust” and “faith” are used liberally in their marketing pages, and legal notices such as this one (from Liberty Health Share) are standard:
“This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such this program should never be considered as a substitute for an insurance policy” (emphasis mine)
Payment is voluntary?!! Although I realize folks may argue passionately about this, that is a huge risk and I personally can’t live with those insecurities. This is especially true if I’m in the midst of a serious health issue that might potentially bankrupt me (= the main reason we carry health insurance!). I understand why people go this route, but it is not and will never be for us. Do what’s right for you, but just be fully aware of what you’re getting into if you sign-up to one of these.
So What Are The Key Takeaways For 2018?
Basically I have three takeaways from all this:
What Are WheelingIt Going To Do?
We’re still domiciled in SD which has zero nationwide plans on the exchange for 2018. This past year we had the Avera Silver 4000 Plan which gave us a “bit” of coverage out-of-state by offering 40% coinsurance (after deductible) for out-of-network care. However in 2018 the price for that plan will ramp significantly and the subsidies in SD have not increased to match (ugh!)
We’re Considering Gold: If we stick with ACA we will likely dump the Silver Plan and switch to the Avera Gold 1500 (still no network out of state, but that same 40% co-insurance deal). It’s not HSA-compatible (a negative), but it would get us much lower deductibles for only a small increase in cost.
We’re Considering STM Or Off-Exchange: If it becomes a real possibility we might consider buying an STM again (I’ll have to crunch the numbers to see if it makes sense). We’re ALSO seriously looking at the off-exchange plan that I mentioned above. It’s some extra $$, but it would provide us a much better plan than what we have now.
We’ll likely go with one of these three options.
PHEW!!! That’s it folks. I know this was long, but I hope it was somewhat helpful. Feel free to comment and ask questions below (I’ll do my best to answer). We’ll get back to our regularly scheduled travel blogs next…