Author Topic: ACA plan cheap but no coverage outside of my state - please advise!  (Read 1853 times)

ac

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I'm in SC, and a bronze plan post subsidy will only cost me ~$90/mo (family of 5)! 

But...no providers out of state are covered.

I'm a little freaked out about mountain biking in NC or hiking in GA and someone needing to go to the ER and having essentially no insurance.

I'm surprised that the ACA is seen as a god-send to early retirees if this is the case across the nation.  Seems extremely risky to only have health insurance in your state.

I have the option of staying with my employer coverage but paying ~$750/mo.

How should I think about this?

Please only give advice if you really do know what you're talking about :)

geekette

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #1 on: November 01, 2017, 02:13:33 PM »
Check the fine print - plans I've seen do cover for emergencies (not colds, but actual emergencies).

Gin1984

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #2 on: November 01, 2017, 02:21:17 PM »
My husband's employer had one plan that covered out of state and one that did not.  The one that did not was $4000/annually cheaper.  And it did not cover in case of emergency, that apparently depends on the state.

rubybeth

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #3 on: November 01, 2017, 02:39:33 PM »
Would it just be considered "out of network"? Read the fine print. I am guessing it would still help in an ER visit. If you're really concerned, you can buy additional travel medical insurance if you travel a lot.

Bicycle_B

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #4 on: November 01, 2017, 02:55:51 PM »
+1 to checking the cost of travel insurance and comparing the coverage to the fine print in the ACA plan.

IIRC, Arebelspy's family gets that for travel inside the US.  Their case is different because they don't have insurance in a home state, but it seems like coverage would be at least as cheap given that you will have insurance.

I use an ACA plan but a Silver one.  The better benefits are supposed to produce a lower overall cost for most consumers than the lower premiums.  I have saved several hundred dollars this year due to impressive savings on care from the Silver plan.  You may of course have optimized the Bronze vs Silver choice for your family already, just mentioning it in case it's helpful.  I believe the ACA website has some projections that can be used to estimate costs and outcomes for different plan levels.

Fwiw, I don't get any insurance for my rare out of state travel.  But the fine print in my policy clearly states coverage exists, just at a higher price, so I figure my savings will be enough.  I think it was even capped at a certain amount, an amount that I handle.  But of course you need to verify all this for your own case.  Good that you are checking into these things.
« Last Edit: November 01, 2017, 03:07:10 PM by Bicycle_B »

Altons Bobs

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #5 on: November 02, 2017, 12:45:34 AM »
None of the plans sold in the Individual market here have out of state coverage except for emergencies. Some only have coverage in this metroplex only and no coverage outside of this area, except for emergencies. Check the plans and ask about emergency coverage outside of the network and see what they say.

EarthSurfer

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #6 on: November 02, 2017, 04:21:44 AM »
In Colorado, these are referred to as EPO (Eclusive Provider Organization) plans, and there is zero coverage for providers outside the EPO except for emergencies.

I will likely move to an EPO plan for 2018 because the cost savings compared to a standard PPO plan. Non-subsidized the difference was less than $20/m for a 53 y/o male in 2017, but it is over $100/m in 2018 for a 54 y/o male.

At present, I am far more likely to need coverage for a short term medical illness or trauma injury than a long term medical issue. I will be covering my more adventurous out of state exclusions with either medical evacuation insurance or an annual travel policy.

When I have looked at plans in the past as a ski patroller, the costs were generally under $20/m with limited helicopter coverage in the US.

If you are an avid skier in the US on an individual policy, it is unlikely that you policy has air ambulance/ helicopter coverage. While not devastating to a Mustachian saver, a flight from Breckenridge to  level 1 trauma center in Denver was about $25,000 a few years ago.
« Last Edit: November 03, 2017, 05:29:10 AM by EarthSurfer »

jpdx

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #7 on: November 02, 2017, 11:31:02 PM »
Your insurer should have a travel network for emergencies or urgent care.

ac

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Re: ACA plan cheap but no coverage outside of my state - please advise!
« Reply #8 on: November 06, 2017, 09:24:33 AM »
"Out of network" means virtually the same thing as Not Covered for this insurance plan.

My potential statement of benefits says for Out of network:

If you need immediate medical attention:
ER Services:  Facility charges only.  $300 copay, 50% coinsurance
Emergency medical transportation:  Not covered
Urgent Care:  Not covered

So out of state emergency medical needs have a big gap!  I'll look into travel insurance.