by libertatemamo 138 Comments
Pre-Post Notice -> WOW. THANK YOU for the outpouring of love & comments in my last e-mail. I am humbled & amazed!! I am feeling the love today!
It’s finally time for me to talk aboutHealth Insurance{{takes in a deep breath}}. Open Enrollment on the ACA Exchange started 10 days agoand if you want to sign a new plan for next year you need to sign by Dec 15th. When I first wrote about the ACA back in Feb, I foresaw that we’d be running into some serious issues with our SD domicile this year. Sadly I was right and, as it stands today, I would not advise ANY pre-Medicare newbie fulltimer to domicile in SD(NOTE/ Medicare-age RVers are OK & have options in SD. It’s just pre-Medicare that are the issue here & that’s the only group I will address today).
Bottom line is that I seeNO reasonable health care insurance options left for younger, fulltime RVers in SD and those of us who’ve had our domicile there for the past years need to make some serious decisions.
NOTICE#1 -> I am not a qualified insurance agent or doctor or health care provider. These are my purely personal observations&understandings based on agents I’ve talked to and material I’ve read online. I recommend doing your own homework and talking to a qualified agent before you make your own insurance decisions.
NOTICE#2 -> No politics please. This is meant to be a practical report of the optionsavailableto younger RVers.I do not want to talkabout politics, and I will moderate comments the same way.
With that said, thisis going to be another mega-postwithalot of details, so let’s get started:
What Happened In SD?
Prior to ACA we were covered by Coventry with a high-deductible nationwide plan. Not too long afterACA was introduced Coventry announced they would be pulling out of the state and we got confirmation of that earlier this year. When our plan was up in Sept we were notified that they would extend coverage through end of the year (Dec 2014), but then we’d be on our own. Our hope was that there would be other decent options (either on or off-exchange) which would cover the gap, but the sad truth is that there arenone.
NOTE/ For those of you who are new to ACAI recommend reading my initial article on how ACA affects fulltime RVers and what’s important for RVers when choosing a plan (e.g. nationwide coverage, out-of-network caps, friendly to RVers etc.).For those of you who understand all thesedetails, here’s the run-down on the currentsituation in SD:
1/ NO on-exchange nationwide plans in SD -> There are 3 guys on the ACA exchange in SD -> Avera, Sanford and DakotaCare. Sanford & DakotaCare require 6-month proof of in-state residency meaning they will not insure fulltime RVers on the move. Avera wasinitially the same, then (last minute) decided to begrudgingly allow RVers to apply ON exchange, but their plan offerings are terrible. Their PPO plan offers NO out-of-network caps and basically has ZERO network outside of SD (none, nada, zip). It’s essentially just a SD-specific plan. They DOcoveremergency care out of state, but for everything else you are on your own.
2/ Only ONE off-exchange plan in SD -> There is only ONE guy off-exchange who is openly accepting fulltimer RVers and that’s Assurant. They offer a good, solid nationwide plan, but theirpricing is outrageous. For the two of us, the cheapesthigh-deductible plan would cost over $900/mo. Since this is off-exchange there is no chance of subsidies either.
So, current SD residents who need pre-Medicare insurance are basically hosed. You can either buy the Avera plan, which will only offer emergency care out of state, or you can pay 3x for Assurant. I’m not the only one who’s come to this conclusion. Check out this very good write-up from Kyle at RVerHealthInsurance: Kyle’s South Dakota Health Insurance Assessment for 2015
Isn’t Emergency Care Enough?
For younger RVers like us who are really only carrying insurance for catastrophic purposes, why not just go with Avera and rely onthe emergency care clause? Well, this is where it gets tricky since thedefinition of emergency care is wishy washy at best. Here is the infoI got from Kyle for the definition of “emergency care”:
“Under PPACA, a condition with acute symptoms of sufficient severity (including severe pain) that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in—(i) placing the health of the individual (or an unborn child) in serious jeopardy, (ii) serious impairment of bodily functions, or (iii) serious dysfunction of any bodily organ or part.”
What in the world does that mean for coverage????
Well basically the way I readit is that unlessyou’re deemed in “serious”danger, you maynot be covered. So, let’s say you have an accident, get covered for the initial life-threatening stuff and then get transferred out of “emergency” into regular care. Now, you risk hundreds of thousands of dollars of non-covered expenses. Also, given that Avera offers NO out-of-network caps, if you end up in the terrible situation of requiring significant out-of-network care (which basically means ANYnon-emergencycare outside of SD) you will be liable for everything and have absolutely no limits on what you can be charged.
Either way I could see getting into a major “discussion” (= months of extended battle?) with the insurance about whether what you had was really an “emergency” and what was and wasn’tcovered. I’ve hadmy fair share of insurance “discussions” and they are not pretty. It’s a real risk and these kind of non-covered expenses are exactly the kind of thing that could bankrupt you.
So, What Are Your Options in SD?
As of today, as a pre-Medicare fulltime RVer with SD domicileyou are faced with 4 simple options:
1/ Go Without Insurance – Something I never, everrecommend, specifically because of the big unknowns. It’s not the small stuff that gets you -> all the small stuff, routine care, health-checks, minor operations etc. can easily be handled via cash-pay (which is something we’ve personally done for years. For more see my 3-Part Series on this). It’s the catastrophic stuff, the stuff you can’t plan for that hurts. Major accidents, major illnesses. These will literally bankrupt you if you don’t have insurance and they will do it very fast.
2/ Stay in SD with Either Avera Or Assurant -> If you’re willing to take the risk on an insurance that only offers emergency-care out of state then Avera is a choice. I’m not particularly comfortable with it, especially considering they only begrudgingly accepted RVers (they really didn’twant to insure them), but your risk tolerance might be different. For those taking this option it might make sense to look into an add-oninsurance that would transport you back to SD if you need extended care. It’s not ideal, but it could work. If you have the extra $$ Assurant is a real, viable nationwide option, but it is really pricey.
3/ Switch Domicile -> For the vast majority of younger RVers this is going to be the #1 choice and makes the most sense to do. It’s a hassle to switch domicile but it can be done. FL & TX are the two other “popular” fulltime RV domicile states. Both have a great history of no income tax, reasonable car insurance/registration rates & being friendly to fulltime RVers. Even better, BOTH states offer solidhealth insurance choices on the ACA exchange. See more about this below.
4/ Buy Short-Term Insurance -> For those RVers who are not able to switch domicile right away, or who want to delay their decision there is the option of buying short-term insurance. If you go this route you need to understand that theseplans are meant as interim plans (NOT long-term plans) and they are NOT ACA compliant (which means they don’t accept people with pre-existing conditions, amongst other things, and you end up having to pay the ACA penalty on your taxes). But they ARE nationwide, they DO have solid spending caps and they are very reasonably priced. You can buy 6-month or 364-day plans, enough to cover a gap or delay your domicile switch. This is definitely not a long-term solution but may make sense for some in the short-term.Read more here: Short-Term Medical.
What About TX or FL As Domicile States?
With SD basically out of the running for younger RVers, TX and FL become the prominent choices. Both are excellent RV-friendly options, each having their own pro’s and con’s. Costs are close between the two, depending on what you need. Here’s a few details:
Health Insurance Options -> Both FL & TX currently offer excellent nationwide options on the ACA Exchange for fulltime RVers. Texas offers BCBS which has wonderfulnationwide coverage (on their PPO plans) and very decent out-of-network caps. Florida offers Assurant which also has an excellent network and out-of-network caps (again, on their PPO plan). Dec 2 Update: I’ve now learned that FL also offers BCBS on their ACA Exchange. As long as you selectaBlueOptions plan it is a PPO-type plan withan excellent, extended network.
Health Insurance Costs -> Pricing out health insurance (which you can do HERE) there are a few differences between the two states. Texas offers lower baseinsurance rates, but Florida tends to offer bigger subsidies. For those RVers who qualify forsubsidies, it’s important to look into thissince subsidy levels vary quite significantly from state to state (even by zip code within a state!). Here’s some price examples for us two:
TX Exchange (SKP Livingston zip 77351)
BCBS Bronze PPO 006 ($6000 deductible) $584/mo
Subsidy $60,000 level = $71 ==> $513/mo
Subsidy $50,000 level = $150 ==> $434/mo
Subsidy $40,000 level = $270 ==> $314/moFL Exchange (SKP Bushnell zip 33513)
Assurant Bronze PPO 001 ($6000 deductible) $622/mo
Subsidy $60,000 level = $177 ==> $445/mo
Subsidy $50,000 level = $256 ==> $366/mo
Subsidy $40,000 level = $376 ==> $246/moFL Exchange (St.Brendans Isle zip 32043 Clay County)
Assurant Bronze PPO 001 ($6000 deductible) $634/mo
Subsidy $60,000 level = $221 ==> $413/mo
Subsidy $50,000 level = $300 ==> $334/mo
Subsidy $40,000 level = $420 ==> $214/mo
RV/CarRegistration Costs -> Initial registration fees (first-time fees) in FL are quite a bit higher than TX, but on-going RVregistration is cheaper in FL. For our-sized RV plates cost around $80/year in FL compared to $340/year in TX. The toad costs ~$50/year in bothstates.
RV/Car Insurance Costs -> I priced out insurance costs with 3 different agents for both TX & FL and found very, very little difference. Both states cost around $1,200-$1,400/year for the RV and only a few hundred less for our car, which is about twice what we currently pay in SD.
RV Registration Requirements -> For our-sized rig TX requires a special Class B non-commercial driving licence (test), plus TX does require inspections on your rig when you pass into state. In FL there are no such tests or requirements.
Mail Forwarding/Domcile Services -> TX offers the most excellent Escapees organization. In FL there are several options includinga brand new Escapees home base location, St.Brendan’s Isle, Good Sam’s, andMyRVMail. Escapees is undoubtedly the cheapest service, but doesn’t (yet) offer cool features like mail scanning and online mail viewing. Many younger RVers preferthe snazzy online services offered by the otherFL guys.
Legality -> Escapees in TX (specifically) has fought in court to establish themselves as a legal domicile address for RVers, and do alot of advocacy work for RVers in general. Many, many RVers use FL too, but none of the services therehavegone to court the way Escapees has. This may not matter to you, or it might matter alot.
This covers the basics, but there’s much more to domicile choice, especially if you own a business or have other things going on in your life. I really recommend the following articles for those who are choosing domicile right now:
- Technomadia -> Picking a Domicile State, Getting Mail & Voting as a Nomad
- Technomadia -> Setting up Domicile in Florida as a Full Time RVer
- Escapees -> How To Become A Real Texan (pdf download)
What Are WheelingIt Going To Do???
Oh goodness, this is where the rubber hits the road, so to speak. We’ve been going back and forth on our options for weeks and months. For various logistical and cost reasons ourcurrent leaning is to delay our domicile switchby signinga short-term insurance plan in SD. Since we have no pre-exsiting conditions this is a real, viable choice for us and the costs are reasonable ($265/mo for both of us combined on a 364-day STM 5,000/10,000 plan. The ACA Penalty would add around $80/mo** ontop of that).
Long-term, unless something significant changes in SD, we will need to switch domicile. Both TX & FL look good and it’s about a wash between the two. Overall costs are actually lower in FL, especially with health subsidies included, plus Paul has family there (which does tie us to the state), but I also really like the Escapees organization (in general). We will likelydecide to switch domicile towards the middle or end of next year, and since moving is considered a “Qualifying Life Event” according to the ACA we will be able to sign new insuranceright away when we do.
We’re getting all our insurance info & signing our plans with KyleRVerHealthInsurance.com. He’s a qualified broker and a fulltime RVer himself and I’ve used his website & expertise as ourgo-to source for info since ACA started. I definitely recommend him (Dec 11th Update: Kyle has announced he will focus on Medicare-age RVers going forward and is bringing on a new insurance agent to help with non-Medicare RVers. So, RVHI will now be a team of two!)
**NOTE/ You can sign ashort-term insurance plan for up to 3 months before you incurthe ACA penalty. Click HEREfor more info.
PHEW!! Hopefully that gives you all the details of what’s going on in SD, what options you have if you are currently domiciled there, and what the options look like today in FL & TX. If you’re a younger RVer who’s about to go fulltimeRVing within the next year and you need health insurance (i.e. you’re not bringing it from your job) I would recommend you AVOID SD at all costs. For current RVers domiciled in SDI would recommend looking at switching domicile over the long term, even if you don’t do it right away.
How About A Video On Health Care???
Well, funny you should ask, but this is exactly whatTechnomadia arrangedwhile we were boondocking in Trona last week. Cherie & I had a casual chat about health careoptions for younger fulltime RVers, what concerns you should look at, self-care options and so forth. If you prefer to see my mug in all it’s live streaming glory, click here to view the archived version:
Related Posts & Links:
- The ACA And It’s Impact On Fulltime RV Health Insurance -> Click HERE.
- Self-Medical Care -> My 3-part series on self-care. Click forPart I, Part II and Part III.
- RVerHealthInsurance -> My go-to source for RV Health Insurance in SD, FL & TX. Click HERE.
