ACA health care coverage when out of state- Not covered?

[indie9197]

I have spent the last several hours looking at different plans and I am starting to think there is a big problem for me. I work out of state for 4-6 months per year on the average and also spend a couple of months a year on vacation out of state. It appears that none of the plans I have looked at in the Bronze or even Silver levels cover anything out of state. So if I get injured when I am away from home it appears that I am on my own and there is no limit to my out of pocket expenses. Anyone else in a similar situation?

[flamingdem]

1. I spoke to an agent for Blue Cross / Shield in Colorado

He was in the building where they run Blue Card. Up until he told me it's pretty useless I was considering Blue Shield PPO Silver with the use of their Blue Card when out of state, while they have lousy local coverage just a tad better than Medicaid really due to lack of contracts with the good hospitals, they supposedly have Blue Card.

Be careful because a Blue Shield agent told me I could use their doctors when out of state. The Colorado agent laughed and said yes, only for extreme emergency.

That may be enough for you. The EPO I am going to take from Anthem / Blue Cross here in California doesn't cover anything out of network. I can use an urgent care center I believe and will have to double check this.

This is what is crappy about the new insurance. If you have a "life change" though, like moving, you could change your carrier to that state, every six months I think.

Please let me know what you find out! thanks

[indie9197]

5. Some states offer a multi-state plan, mine doesnt

This link from Healthcare.gov shows a map of those that do and don't

http://www.opm.gov/healthcare-insurance/multi-state-plan-program

[flamingdem]

6. Looks interesting

but very unclear who qualifies etc.

[BlueStreak]

2. In my area, I think there was only one plan that covered out-of-state at a reasonable level

They all covered emergencies while out of state, but you couldn't have normal doctor appointments (unless you pay 100% of that out of pocket). I think there was one policy that covered part of out-of-state visits.

This is just another case of Shock Doctrine. The insurance companies have been pushing for a long time to only pay for services delivered by providers they could knuckle under and force to take the minimum payments. The shock of the ACA exchanges has given them the opportunity to make this basically the standard way of operating from now on. The problem is that if you see a doctor in another state, that doc is going to bill at "full retail", which might be 3 or even 5 times as much as the rate that same doc would receive when seeing patients in network.

In the past, I had a job where I shared time between the Midwest and the West Coast -- 2 weeks each place every month. That would have been OK for me because I could schedule all my appointments while at home. Fortunately I never had an emergency while on the road.

But if a person is out of state for a month at a time, that could be more of a problem.

Yet another reason why single payer would have been so much better. With Single Payer, either the Doc participates in Medicare or he/she doesn't. It wouldn't make any difference where the patient has a permanent residence.

[indie9197]

12. I was able to quickly reach an healthcare.gov rep

on the phone last nite but she was not able to tell me exactly what emergency services are guaranteed by ACA. She said I could enroll ina plan to find out the details and then drop out if I didnt like it.

Afterwards I found this link about emergency services:

http://healthnetpulse.com/broker/2013/04/26/aca-addresses-your-questions-about-emergency-services/

Basically it says what you have said. Out of network providers can charge higher fees to me but my insurance company will only re-imburse at in-network rates. I am responsible for the difference. How much will that be? No telling!

No mention anywhere of the coverage of the ambulance ride.

[KentuckyWoman]

3. mine doesn't but neither did BCBS before ACA

I had BCBS before and switched to one in Kentucky exchange. Coverage is better. Costs less. Oddly I have more choices on the exchange plan.

None of the non-exchange insurance in my area covers anything other than life or limb out of area and neither do plans in the exchange from what I saw.

[indie9197]

4. I never really thought about it, most people don't I guess

It would just suck to get in a car wreck out of state, get transported by ambulance to an ER, spend a couple of nights in a hospital, and end up with a bill for $100K. The whole system is really messed up!

[flamingdem]

7. I think -- but should really check

if it's this kind of emergency it should be covered.

It's seeing a doctor that's discouraged. Another thing is that it's probably better to go to a public rather than private hospital.

[CreekDog]

13. what is this nonsense you are posting now?

the out of pocket maximum and emergency coverages apply.

you went from a reasonable question to outright trolling and lying about ACA.

don't pull this nonsense on us.

[indie9197]

18. Forgive my ignorance on the subject

Up until last year, when i bought an individual plan, I was always covered by an employee plan. I am trying to learn how the system works.

The ACA plans are a step up from my individual plan -I get that. But I am learning that it still has some of the same problems as an individual plan.

So you are saying that when you go out of network in an emergency that the out of pocket maximums still apply? Not from what I have read, but I hope you are correct.

[KentuckyWoman]

19. Employer based plans usually don't cover out of state either.

Most people I know have employee plans that are also limited to the local home area for full coverage of routine medical care.

Out of network for pretty much anything in the marketplace is going to be covered at a lower rate or not covered at all.

Maximum out of pocket would apply

I think you may have misunderstood what your old employer based plans covered..... unless it was a really high end plan that covered everything everywhere.

[Ms. Toad]

20. Typically there are separate out of pocket caps for out-of-network expenses

and separate deductibles. So it is unlikely to be $100,000 - but it could easily increase your overall costs.

[Lex]

8. Wasn't this true BEFORE the ACA?

Or is this ONLY an ACA thing?

[rgbecker]

9. Lex: You didn't get the word? It's all Obama's fault.

[Lex]

11. Every freaking thing that's BEEN WRONG with health insurance is NOW an ACA thing.

What the hell.

[BlueStreak]

15. Not necessarily

Out of state is not the same as out of network. There have always been higher out of network costs. It seems the ACA plans now mostly have a third tier for out of state where they try not to pay ANYTHING except for emergency services.

I don't know that the ACA "caused" this, in the sense of there being a section in the law that requires this behavior. However, what we are seeing is a lot of insurers creating way stripped-down networks where they get the bottom feeding suppliers to join the network and accept the lowest reimbursements. In effect , this is greatly exaggerating the gap between "retail rate" and what the insurers actually pay. And because of this huge gap, the insurers want to stiff-arm anybody who isn't in the network.

It is just another of those games that insurance companies play to maximize their profits at the expense of our health care. ACA didn't "cause" this, but ti certainly permits it, and is providing the fog cover that is allowing insurance companies to move very aggressively here.

[Sgent]

10. Many

BC/BS plans, especially PPO's (vs EPO, POS, HMO, etc.) have very, very broad out of state benefits.

I can use any BC/BS PPO provider just like I was in state. The only thing they cannot do that an in state provider can do is provide tobacco cessation counseling.

In addition, some plans have national networks (United, Humana), but you need to look at the individual plan.

[cbdo2007]

14. So get a gold or platinum plan and don't spend as much time on vacation.

You have a choice you know.

[llmart]

17. LOL

I was going to post something in this same vein. The poster asked if "anyone else had this problem". Yeah, right. Like I can go on a two-month vacation to another state every year. I haven't been on vacation for oh, hell, I don't know, like 10 years??????

If they can afford to go on vacation for two months, then I'm pretty sure they can afford better insurance.

[indie9197]

22. haha. I didnt think about how that sounded,

but for me anytime I am not at my house or away on a job I feel I am on vacation. When I work, I work 72 hours per week so I need a lot of down time. Usually spent in my small camper somewhere by the ocean and not spending much money

[bluestate10]

16. Depends upon the plan that you buy. Most plans cover out of network health-care costs,

up to a specific amount. I have had one out of network event under my health plan, most costs were covered, but I did have to pay the doctors fee. I have a Gold level plan that has zero deductibles in network.

[Ms. Toad]

21. That is one of the limitations of insurance -

Generally only emergencies are covered out of state. (Every insurance plan I've been on for the last umpteen years has had that limitation. Nothing to do with the ACA - everything to do with insurance.)