Healthcare on the Road -- Part 1 -- If you're under 65
"My doctor gave me six months to live, but when I couldn't pay the bill, he gave me six months more."
~ Walter Matthau
I know, getting healthcare is no laughing matter, so let's get to the facts immediately.
Getting healthcare when you don't really live anywhere in particular can be a little challenging. The biggest problem is finding a plan that won't get you caught up in having to find doctors in your network. If you're old enough to be on Medicare (with or without a supplement plan), things are a lot easier, but if you were old enough to be on Medicare, you probably wouldn't be reading this article.
Since you're not old enough for Medicare
If you go with the Affordable Care Act (also called ACA or ObamaCare), there are some hoops you will have to jump through. The problem of finding doctors can be difficult because in many cases you will have a small network of doctors.
Here are some of the things you need to consider:
- Some companies don't insure RVers. It's written in their policy, so this is a deal killer. Check this first and if you find this restriction, stop and look for another company.
- Next check the details of the plan's network. Will it cover you in all 50 states or just a few? If it's just a few, are these the states that you plan to be in most of the time?
- What about the out of network benefits? Some plans don't cover much when you're out of network except for emergency services. And most plans have a much higher deductible when you're out of network.
- Some plans require you to prove you are a resident of the state by showing a utility bill or other proof -- avoid these plans.
Some plans require you to live in a state for at least six months of each year -- avoid these plans.
- Avoid HMO plans and stick with PPO plans that have a large nationwide network of providers. This is a good idea as a general rule because HMOs restrict you to a small network of providers, but HMOs are a lot less expensive. In one case a fellow RVer told me that a PPO plan was three times as expensive, so he went with an HMO since it would cover emergencies out of network and if he had a serious medical problem, he would travel back to a doctor or hospital in his network. In other words, there are a lot of factors to consider. Do your homework.
- You will need to decide if you want to go with the in exchange (also called Obamacare or ACA) or buy your own insurance out of exchange. Also, if you go with an ACA in exchange plan, you will need to find out if you qualify for a subsidy. Here is a link to a website that has a handy tool to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges created by the Affordable Care Act (ACA). kff.org/interactive/subsidy-calculator.
- The state you select as your domicile will determine which plans are available to you. You may decide that another state (even with higher taxes), would be an overall better choice based on insurance choices and prices. You also may decide that the subsidies you would receive when going with an ACA plan may not be worthwhile because of the limited area of coverage and if that's the case, you may decide that you would be better off with your own individual plan.
Going with your own individual plan is a good option for some people. The annual deductible amounts that you have to pay out of your pocket are usually high ($1,000 to $5,000 or more), but they do cover the major expenses -- surgeries, etc. So if you're reasonably healthy, this may be a good option for you. In other words, you will pay for your visits to a doctor for a sore throat and the insurance will pay for medical expenses after you meet your deductible. Some of the companies that RVers have gone with include Blue Cross Blue Shield, Humana, Aetna, and Assurant. There are others and this is not a complete list.
Look into policies that are eligible for a health savings account (HSA). This allows you to put up to $3,300 (in 2015) into a savings account and then use that money to pay for your out-of-pocket health expenses. In essence, you are paying your part of your health expenses with pre-tax dollars.
- Short-term Insurance -- Another option to consider. If you're reasonably healthy, you might want to consider what is called short-term insurance. It's the only plan that is allowed to be sold outside of ObamaCare (ACA) exchanges.
The premiums run just over $100/month compared to about $270/month for traditional plans. In addition to it's low cost, one of the biggest benefits of short-term insurance for RVers is that you can go to doctors anywhere.
The plan doesn't cover pre-existing conditions and the policy is for one year and renewal is not guaranteed.
If you stay healthy, you can renew the policy each year, but if you get sick and have expensive medical costs, the plan will cover your medical expenses until the end of the one-year period and then you cannot renew your policy.
That's not all bad because you can then buy ACA insurance and insurers can't charge sick people any more than well people. There is one minor problem with short-term insurance and that is that you will have to pay the tax penalty for not having ACA insurance. That's fine. It's only $95 for the whole year in 2015, but it will go up to $695 a year or 2.5% of your income (whichever is greater) in 2016. That's still less than $58 a month.
Summary: If you're making less than $37,000 a year or have a serious pre-existing health problem, you would probably be better off going with ACA insurance, but otherwise consider short-term insurance as long as you're reasonably healthy and then switch to ACAS insurance later if you develop an expensive health problem.
How to buy ACA insurance if you missed signing up during the open enrollment period
If you missed the Open Enrollment period, you may still be able to buy Marketplace coverage by taking advantage of what is called a Special Enrollment Period. If you get married, have a baby or move, you will have 60 days to report what is called a life-changing event and then you'll get a new eligibility notice.
The keyword in the above explanation for RVers is the word, "move." If you change your domicile state, that is considered a move to a different state.
Sources for more health insurance information
Kyle Henson is a licensed insurance agent and a fellow full-time RVer. I'm not associated with him in any way, but his website has a wealth of insurance information for RVers and I've heard a lot of RVers say good things about the services he provides. I recommend that you take a look at the information on his website to help you make your decision concerning what to do about finding affordable health insurance. Here is his website:http://www.RVerHealthInsurance.com
In addition to the above information, below is a website that allows you do comparison shopping of exchange policy plans:
http://www.TheHealthSherpa.com
Just because you have insurance, getting an appointment with a doctor in a city where you have never been to a doctor before could be a problem. Some doctors don't take new patients and some have a waiting list.
Here are three ways some RVers handle the situation of getting to see a doctor
- Some RVers make use of Emergency Medical Clinics (also called a "Doc-in-a-box") or use a service like http://www.Teladoc.com when they have a minor medical problem -- sore throat, etc.
- With Teladoc, you can place a call and a board-certified doctor will call you back (usually within about 15 minutes) and heshe can discuss your symptoms with you and then call in a prescription to a pharmacy near you if necessary or tell you if he thinks you need to see a specialist. You can pay the fee out of your health savings account funds and some insurance policies cover this expense.
- A third option is that CVS and some other pharmacies now have a nurse practitioner on staff part of the time, so that you can walk in and immediately they can examine you and then write a prescription for you for minor health problems if necessary or tell you that you need to see a specialist.
- Some RVers make use of Emergency Medical Clinics (also called a "Doc-in-a-box") or use a service like http://www.Teladoc.com when they have a minor medical problem -- sore throat, etc.