Health Insurance

Check out Escapee Forums.
Lots of full-timers, frequent discussion there.

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Big Katuna wrote:
We have been self employed and paying for our own healthcare for twenty years.
I recommend finding a reputable independent agent that represents several companies.
Ours helped us immensely.

With the ACA our coverage is the best we have had in years with lower deductibles. It is still quite expensive $1300 mo but better benefits and it did go down the last three years.

Our agent said there were two companies that provide nationwide coverage.
United and Cigna. Fl Blue Cross changes across state lines.

X2. My agent found me a policy that works for me.

Big Katuna wrote:
We have been self employed and paying for our own healthcare for twenty years.
I recommend finding a reputable independent agent that represents several companies.
Ours helped us immensely.

With the ACA our coverage is the best we have had in years with lower deductibles. It is still quite expensive $1300 mo but better benefits and it did go down the last three years.

Our agent said there were two companies that provide nationwide coverage.
United and Cigna. Fl Blue Cross changes across state lines.

Blue Cross changes across state lines but they are all affiliated, so that medical service providers who accept Blue Cross coverage from their own state accept Blue Cross from any state. In other words, any medical service provider that accepts Blue Cross accepts any Blue Cross.

Yes, as long as service provider accepts the Blue Cross company IN THAT STATE then your PPO plan from another state will be in network. For example, my wife had emergency surgery this year in NY state while we were traveling and the hospital accepted Empire NY, the New York BCBS company. All bills were treated as in network and paid promptly by BCBS Arizona. Bills actually gets submitted to the 'in state' BCBS company and then are relayed to your state BCBS company for payment.

BCBS is a combine of something like 39 different agencies. It's hard enough dealing with one.
My independent agent said they were fine if you didn't travel.

There exists a thread about South Dakota and health care for seniors. I have read the thread, not sure if it is this forum family or not but it is alarming, Seems that SD is one of the states fighting the affordable health care act and as a result for those on medicare (Which will soon include you folks) the add-on plans which fill the medi-gap and prescription coverage, choices are limited.

Now that said: Blue Cross is the one card that is known around the world, every state, every city every country knows Blue Cross.. SOME are participating providers (if you have the BC/Bs PPO option) some are not, but they all know how to bill Blue Cross.

Billing BCBS is not the issue. If you want to be billed out of network and be responsible for the 'balance billed' amount go right ahead and use a service provider not affiliated with BCBS in that state. You are then on the hook for the difference between the billed amount and the contracted amount which could be thousands or tens of thousands. In my wife's case it would have been over 15 grand for the appendectomy and one night in the hospital.

There is an excellent ongoing post over at iRV2 full-timing forum on the South Dakota problems. It would be worth your while to monitor that forum. Here is a portion:

Quote:

Originally Posted by Greg Schoenberg

I took a quick look at the Avera plan and I don't see an HSA option. Personally I wouldn't be concerned about that. HSA's are usually chosen by the "healthy and wealthy." Most of us need some sort co-pay for Rx and Dr. visits.

I am concerned about the out of area, no coverage or pre-authorization aspect, especially in regards to a serious, chronic illness. What if one is diagnosed with cancer and thus requires chemo, radiation, etc. It seems you would have to drive from the sun to S.D., to commence treatment. Even if Avera pre-authorized the treatment, you could be subject to balance bill. I have a client who got billed an extra 50k for using a hospital that was out of network.

If it were me, I'd strongly consider changing domiciles. I suspect Texas has many true PPO's with nationwide networks. I know Washington state does. We have no state income taxes.

I'll pipe down for now. Have a ton of work on my desk.

-Greg

Indeed, the out of network limitations do have me worried. I would be fine with nothing but emergency care coverage, but I'm not clear that Avera will give us this in the way we need. I'm still looking into it.

Regarding the HSA compatibility on the 6200 plan it's listed here:
http://www.averahealthplans.com/wp-c...view-Chart.pdf

"2015 Avera MyPlan $6200 HDHP**
**A high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for having a health savings account."
__________________
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http://wheelingit.us

First, check out what your entitlements might be with COBRA.

My experience with pre-medicare insurance at age 60+ was that it was very expensive to pay the whole premium myself, and very difficult to find the coverage I wanted, i.e. no network or geographic restrictions, including emergency care outside the U.S. The best deal I could get was using COBRA to continue on my employer's "Traditional" plan, which had 80% coverage with very high deductibles and out of pockets, for about $3000 a month to cover two of us. We still had to buy trip insurance when we traveled outside the U.S. Even that had a network, going to 50-50 for out of network services.

You can lower the cost, or get more of the medical costs covered, going to PPO or HMO plans, but you may find your coverage geographically limited. There are states where you can find carriers with U.S. wide PPO networks, others where it is hard to get any coverage out of state.

Where you are, trying to pick a domicile, and 5-7 years from Medicare, I would consider the cost, availability, network coverage, and geographic coverage, of medical insurance as my top priorty for establishing a domicile. It is a lot more important than saving a few hundred, or even a few thousand dollars a year on income or sales taxes and vehicle registtration.

At this stage of your life, medical insurance may be the biggest expense in your budget (for us, 6X the mortgage, so you need to do a lot of shopping. We can't begun to suggest carriers without knowing where, yet the where is probably the biggest issue with what you will find available today,

FWIW, while I was paying $3000 a month premiums, when. DW got cancer we were $15k to $30k out of pocket each year for what the insurance didn't pay, and what they did pay was about $800k during the last three years of her life.If you are lucky, nobody gets sick and all you pay will be premiums. If somebody needs medical care, it is going to be a lot more tham insurance.

Big Katuna wrote:
BCBS is a combine of something like 39 different agencies. It's hard enough dealing with one.
My independent agent said they were fine if you didn't travel.

Sounds like your independent agent has found insurers that pay a higer commission than BCBS. Even if the % is the same, if the premium is higher the commission is higher. BCBS is a nonprofit, so they aren't profit motivated, thus lower premiums and lower commissions.

EDIT You don't deal with 39 different agencies. You only have a contract with one. ALL CLAIMS are automatically forwarded to your servicing agency and all statements and correspondence comes from your home BCBS.

EDIT 2 My residence is in Michigan. My BCBS is Illinois, because my previous employer is headquartered there. We have NEVER even seen a doctor in Illinois. The out of state residence is transparent. Michigan doctors and hospitals treat us as if we have BCBS of Michigan. The same is true for doctors and hospitals in Florida.