Pre-Medicare US RVers -> Time To Think About Health Insurance for 2019!
We’re still here in Europe, waiting anxiously for our new RV (we’re days away now, fingers crossed), but in the meantime I haven’t forgotten about my RVing friends back in the USA.
You see it’s that time of year again, open enrollment on the ACA!
For younger (pre-Medicare) RVers this means it’s time to think about health insurance, and you’ve only got around 6 weeks to figure it all out. Open enrollment runs from Nov 1st to Dec 15th, so if you want to sign-up for a plan starting Jan 1st, you’ve got to get on this now!
Official Disclaimer: Before we start this whole thing you need to know that I am not a qualified health insurance broker, nor am I in the medical field. This is simply a layman’s view of health care options, as I see them. Please consult an expert before you buy.
What’s Changed For 2019?
I’ve got lots of older articles on health insurance, including what the ACA is and how it works, so if you want that background take a read HERE. This year the ACA is pretty much exactly the same, except there’s been 2 massive changes in health care law that might affect your choices:
- The elimination of the “individual mandate” penalty – this was the tax penalty you paid if you chose not to get insured or bought a non-ACA-compliant plan. As of Jan 1st, 2019 you’ll no longer have to pay it.
- New rules for short-term health insurance plans which now allows them to be sold up to 364 days at a time, with renewals for up to 36 months. Previously these could only be bought for 3 months at a time.
In addition, early next year new rules expanding access to Association Health Plans (AHPs) are coming into effect. This is super interesting, especially for younger, working RVers and will be a space to watch going forward.
All of this means more possibilities for younger (pre-Medicare) RVers, depending on your income levels, your health (whether you have pre-existing conditions or not), and your personal needs.
Why Am I Even Thinking About All This?
You might wonder why I’m even thinking about all this stuff, now that none of it applies to us anymore. Well, one reason might be that I’m crazy (not far off the truth), but the real reason is that the fab folks over at Xscapers kindly asked me to write an article about it. So I spent several weeks doing my thing, investigating everything in detail and coming up with my “layman’s” view of what the best options are for pre-Medicare, working RVers.
The final article is ~4,500 words and covers everything I can think of from a “top-level” basis, including what is available for the self-employed today and how to decide which option makes the most sense for you. So, instead of writing a long post on here (like I usually do), I hope you’ll check it out the article on Xscapers:
For those wanting to read more there are TONS of other great articles out there on Health Insurance, but for younger, working RVers these are the four I’ve found most useful:
- 2019 RVer Guide To Health Plans – From RVer Insurance Exchange. Good general guidance.
- Health Insurance Time -> 2018 Considerations For Pre-Medicare RVers – Yes, this is my own blog article from LAST year, but it’s got a ton of details about ACA and how insurance costs, options & subsidies vary by state & county. Many details are identical to this year so it’s worth a re-look.
- Tax Reform & Health Insurance: New Options For the Self-Employed and Early Retiree – From physicianonfire.com. Good information about Catastrophic Health plans, in particular.
- 10 Things to Know About Association Health Plans, a Potential Solution to Entrepreneurs’ Healthcare Problem – From entrepreneur.com. Detailed article about AHP’s and how they may well become the go-to plan of the future for younger, self-employed folk.
What Would Wheelingit Be Doing If We Were Still In USA?
This is an interesting thought process and worth a few extra words. What plan would we be buying right now if we were still in the USA?
As those of you who follow the blog know, we changed our domicile from South Dakota to Florida right before we left the USA earlier this year. We did this for a bunch of reasons, mostly related family and our move to France, but as it so happens if we’d stayed RVing in USA, it would have been a great choice for health insurance too!
You see Florida is the only one left of the “big three” RV domicile states (FL, TX, SD) that still offers a health insurance plan with a solid nationwide network on the ACA, through Florida Blue. If you qualify for subsidies (meaning your Modified Adjusted Gross Income falls between 100-400% of the Federal Poverty Level), the rates can be very attractive. Without subsidies it’s expensive, but it’s still a very solid insurance plan. This is honestly the best option out there and would be our #1 choice if we’d stayed in the USA.
Outside of the ACA, the other option we’d be looking into would be Short Term Medical (STM) Health Insurance. We had one of these plans back in 2014 and we also bought one early this year (from Jan-Mar 2018) for the 3 months we were in Florida before we flew to France. Now that these are available to buy on a yearly basis again, they’re a viable possibility for RVers on a longer-term basis. The upside of STM plans is that they are generally cheap (much cheaper than non-subsidized ACA plans!), and can offer really good nationwide networks with very decent coverage. The downside of STM plans is that they do not cover pre-existing conditions and as we found out, this means payment of claims can be a tough process (see below). This would be the #2 option we’d be considering.
Our STM Claims Payment Ordeal: This is classic story about the problem of pre-existing conditions and how they affect the insurance claims process.
While we were in FL in Jan, we used our short-term plan for some minor doc appointments. The plan had a great network, so we had plenty of in-network docs to chose from. However payment was another matter. A few weeks after our visits, our claims were blocked by the insurance company for “pre-existing investigation”. This was basically a check to see if we had any pre-existing conditions (= grounds to deny the claim) and meant we had to give them the names and addresses of ALL doctors who had treated us over the past 5 years. Then they proceeded to contact every single one of these docs for our full medical records!
Since we’d been fulltime RVers, our docs were all over the USA, so many of these requests either got lost or ignored, and the claims process stalled. In the meantime one of our claims went to credit collection services (!) and the insurance company refused to do anything about it. In the end I had to get personally involved and start handling all the calls myself. All in all it took 9 MONTHS of calling, pushing & constant follow-up before I managed to get all the records sent and the insurance company to process our claims. The plan paid-up in the end (just a few weeks ago in fact!), but what a royal pain in the backside!!!
Moral of the story? Be aware what you’re buying into when you buy a plan that does not cover pre-existing conditions. They can be inexpensive & provide really good coverage, but you may well have to fight for MANY months for payment.
That’s It For Health Insurance
Hopefully all this gives all my US RVing friends some ideas for 2019. With any luck (fingers, paws and toes crossed) my next post with be be about our new RV in Europe….wheeeeeeee…..