HomeHealth CareHealth Care Snare…

From a health insurance standpoint I am a health care “tween” – no longer on a corporate plan and still too young for Medicare. This can present some difficult to navigate circumstances for those of us under 65’ers that live the nomadic lifestyle.

This is my story of just barely escaping a changing employer retiree health plan that seemed to be a good deal, but ended up being highly restrictive to full time RV nomads and would not deliver on its promises. Thanks to help from the RV community, specifically to Kyle at RVer Health Insurance, I was ultimately able to switch over to an Affordable Care Act Marketplace plan that met my nomadic needs at just about the same premium cost as my corporate subsidized plan.

Motorola, our former employer, has always treated us well and despite fading into oblivion has managed to keep our pension fund healthy, even providing a version of their privately managed health insurance to retirees – that is until this year.

In 2015, the Motorola managed health care plan was to be dropped in favor of plans thru the ACA (Affordable Care Act). The main issue with that was either my  premiums or deductible were probably going to increase significantly. Well, we have always expected this change to happen eventually – I guess I’m not getting old fast enough! On the plus side, a subsidy from Motorola would be provided to offset the cost of whatever plan was chosen. In my case that was $3500/year – that would help keep the premiums reasonable, but the deductible is another matter.

Motorola hired Towers Watson to administer the transfer and I was required to use them or I would not get the subsidy. My old Motorola insurance was set to expire on 3/1/2015, so way back in January I set up a phone appointment with them and began to look at my options. As it turned out, because I was now a FL resident, there were no Marketplace (ACA) plans available to me because of the Motorola subsidy. For reasons I don’t totally comprehend (but probably something to do with the state of FL), this left me with off-Marketplace plans from only one provider, United Health Care, if I wanted to keep the Motorola subsidy (which I thought I did).

I was very clear with my rep at Towers Watson that I needed a plan, like my old Motorola plan, that was very flexible and would accommodate a mobile lifestyle:

  • No requirement for a Primary Care Physician (PCP) or ability to select one without location restrictions and preferably keep my PCP of the last 35 years located in MA.
  • A large and comprehensive network of providers with no significant limits to accessing care providers in any state.
  • No requirement to obtain a referral to see a specialist.

Those criteria ruled out anything except a PPO (Preferred Provider Organization) which by definition theoretically met my requirements. Towers ended up setting me up with a United Health Care plan that they assured me was a PPO and would meet my criteria – it was called Navigate Plus. As it was a non-marketplace employer plan, there was no detailed online info about it. Everything I knew about the plan was information provided to me via Towers Watson. The cost was about $622/mo or $330 after the subsidy. Just a few dollars more than my old Motorola plan but the annual deductible was significantly higher ($6000 vs $500).

At that point I had no reason to doubt what I was told. I even checked the United Health Care  website again and looked up my current primary doctor in MA to make sure he was “In Network” for that plan – yes he was on the list.

So OK, fast forward a few weeks to March 1 and my new plan begins coverage. I didn’t really pay much attention at that time as I had no pressing need for any medical appointments and was well stocked with prescription meds. Finally in late April I set up an online account with UHC and started poking around – didn’t seem to be much I could do online but I did notice UHC had picked a PCP for me (randomly I suppose) in Green Cove Springs, FL. Hmmm, now that’s where our “primary address” is but we don’t actually live there of course. And besides, I wanted to keep my old doctors in MA. Even worse, in the plan description it said that specialist referrals were required! What the hey!

So I called UHC and after a really long winded series of prompts and sitting on hold for a while, I finally got to a real person and explained I wanted to change my PCP to my old one. No can do, I MUST have a PCP in FL only. Even worse I was told my old PCP in MA was NOT in network and I would not be covered if I went to him. Yikes! That is exactly the opposite of what I was told. This was turning into a really crappy situation. How was I going to get med refills or keep appointments I had already made back up in MA for later this year?

At first I resigned myself to the fact that I would just have to find a FL based PCP and hope he would work with me remotely to provide scripts for my meds, then suffer out the rest of the year until I could re-enroll in something more appropriate. Then I realized Towers Watson, probably unknowingly, had sold me a false bill of goods, so I called them. They were all apologetic and I do think they were misled too by the PPO designation of the Navigate Plus plan. I never did find any documentation that described this plan as a PPO, but even if it was, the lesson is that apparently not all PPO’s are created equal if they are off the ACA marketplace! Towers even told me many other Motorolan’s had run into the same issue and had just given up the subsidy and gone with ACA Marketplace plans instead. So it looked like that’s what I should have done.

But by this point its too late for me, right? Actually no! As Towers explained, my Motorola plan ended 3/01 so by law I had 60 days, or until 4/30 to find a new plan. Really!

So this is where the RV community steps in. One of our favorite bloggers WheelingIt has written extensively about health care for nomads and I remember them being very impressed with a full time RV’er that runs a fully licensed health care insurance agency. So I contacted RVer Health Insurance, after all I figured as full time RV’ers themselves they will most certainly understand my situation.

And yes they did! Within minutes Kyle had responded to my email and explained that there were only three choices for me in FL – Assurant, Florida Blue and United Health. He went on to say that even with ACA Marketplace plans, United Health was the worst choice and Florida Blue was only slightly better. Assurant was much more flexible and not only going to meet my criteria but it was going to be cheaper to boot. And even better, based on our income for 2014, I would be eligible for an ACA government subsidy (but I would lose the Motorola subsidy). Wow!

I ended up picking an Assurant Bronze (low premium high deductible) PPO plan that had a regular premium of $588/mo but after the government subsidy would be $340/mo, just $10 more than the Motorola plan after the Motorola subsidy. Note that the government subsidy is tied to income and could be increased or decreased come tax return completion.

The process of signing up was fairly painless. Despite all the bruhaha last year about healthcare.gov, I found it to be a really well done web site. Even better though, RVer Health Insurance has a streamlined form that will sign you up on healthcare.gov in one tenth the time. After that, you use healthcare.gov to administer your plan, you can check status and even upload the required proof of income documents right online. In regard to the subsidy, healthcare.gov takes it off the top of your premium so there is no reimbursement rigamarole to navigate, you pay your insurer the subsidized amount only. Simple.

Coming to find out, because of agent commission changes made by Assurant, RVer Health Insurance made the recommendation for Assurant, even though they would not get a commission if I signed up thru them (I did anyway). Note that RVer Health Insurance plan prices are exactly the same as you will get if you go directly to healthcare.gov but you don’t get the streamlined application, RV’er specific knowledge and great advice provided by these folks.

Kyle also suggested looking into an HSA (Health Savings Account) as that can buffer a high deductible in the event of a serious condition. Even better, contributions to an HSA lower your income and therefore will increase the government subsidy effectively lowering your premium. I will need to ponder the possibilities there…

We very highly recommend checking out RVer Health Insurance, particularly if you are a nomadic RV’er. Note that they can provide expert advice to those already on medicare as well as pre-medicare tweens like me.

So is the Assurant Plan ideal? Heck no, but it will be fine as long as I don’t get sick. And if I do, I know exactly what my exposure is. I am on the hook for all costs until I meet the $6000 deductible. Except for 4 annual “Wellness” visits required by the ACA, I will have to pay full freight on any doctor visits, all my meds, etc. I would have had the same exposure with the United Health Care Plan but would have trouble seeing any doctor outside of Florida. At least with Assurant I know my potential $6000 expenditure buys me the peace of mind knowing I can go to anyone I want to wherever they may be.

This is pretty much what all unemployed nomads under 65 will be facing if they don’t have a corporate retiree health plan, but at least with the ACA Marketplace they can get a plan at a reasonable cost that meets some minimum requirements.

As this is a complex subject that will vary dramatically from person to person and state to state, heads up to do your research if you are a pre-medicare tween planning to go nomadic. For example, be very careful what domicile state you choose. South Dakota has always been a popular choice but will not be a good option for a pre-medicare tween!

Here are a few more links to check out:

 

 


Comments

Health Care Snare… — 1 Comment

  1. As usual, easy to understand what you said. Second, we Americans shouldn’t have to go through this medical web to find out which one is best for us. And, we can’t even compare apples to apples.

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