Health insurance for snowbirds?

[bop]

My wife and I spend 8 months of the year in Massachusetts (the Boston area) and 4 winter months in Florida (West Palm Beach).  We have purchased health insurance from the Massachusetts marketplace.  The insurance covers only in-network providers (except for emergency care), so doesn't cover any providers in Florida, where we are now.  For example, my wife's knee is currently bothering her, to the point where she has trouble walking for nontrivial distances.  Tomorrow, she is going to see an orthopedist, who may recommend getting an MRI.  We'll pay out of pocket if we have to, but I'm wondering if we are missing some better solutions.  Is there a good way to purchase health insurance to cover two different states?

More details: our current health insurance is a high-deductible bronze HMO plan in Massachusetts, with a premium of $1196 per month.  I don't believe we qualify for any subsidies.  I am 57 and my wife is 55.  We are essentially retired.  We own a house in Massachusetts and an apartment in Florida.  We consider Massachusetts our primary residence.       

[terran]

I was looking the other day at insurance company participation in the marketplace and saw that much of Florida has Blue Cross/Blue Shield (although, it looks like MA does too), which I think has a pretty good national network, or at least the employer provided version I had in the past did. I don't know if the BC/BS (or any other company) necessarily offers access to their national network, but I would say looking for more national companies would be your best bet. I'd look at BC/BS plans first given the locations you're in.

[MayDay]

My grandpa has this issue. As far as I know he wasn't able to find a solution. If he has a large non emergency issue, he comes home for it (at least in previous years, he could fly home pretty easily).

He originally had much more expensive insurance through his former employer, which he dropped in favor of a cheaper plan with no put of state coverage.... Even though he goes to FL every winter. My mom had warned him and about had a stroke when he did it anywhere. Not making the best decisions in his 80's but he's not incompetent.

[Queen Frugal]

My understanding is that a few years back, something happened (lawsuit? legislative change?) that allowed insurance companies to start limiting their network based on territories. I am not sure if it applies to all states or just some. It certainly applies to mine and it's really ticked me off. I live in a fairly unpopulated state. I have BCBS. BCBS splits the network into the big city with all the best healthcare (where I am not) and the rest of the state (where I am). The result is I don't have access to the best healthcare, a short drive away.  I have seriously considered moving over it. I am so curious if there are states where there are better options as perhaps I will relocate there when I FIRE.

[Sibley]

Blue Cross Blue Shield is actually 30+ companies which coordinate and give each other access to their local networks and it will count as in network. At least outside of the marketplaces. If you have BCBS, then call and ask if this would apply to you. It may not.

Otherwise - go back to Boston early.

[SimpleCycle]

Massachusetts has a BCBS PPO option on the marketplace.  I’d look into that.

[yachi]

I'm just gonna sneak in here,

post this: https://www.mrmoneymustache.com/2013/08/18/reader-case-study-the-black-hole-second-home/

and say this:  Buying a second home is usually a bad financial proposition, because you are instantly creating an average 50% vacancy rate in each house.

But if you want somewhere warm in the wintertime, where you can get medical care cheaply, how about a nice expat area in Mexico?

[pandastache]

We had a similar issue with my son getting an internship for 8 months in another state. We have BCBS. They wouldn't let us purchase a PPO plan because he was already insured under our plan. What we ended up doing is calling BCBS and having them put a letter together in writing as to what they would cover for him while living in another state. Emergencies often mean different things to the insurance providers. We also got him a some sickness/accident protector insurance that will help to cover some emergency costs if needed. That was about 28 monthly for him. It really doesn't cover a lot but we needed a little more piece of mind. We may end up looking at a PPO when it is time to renew for this very reason.

[bop]

Thanks everyone for the advice.  Our current insurance (Tufts Health Premier) is local to Massachusetts.  We will definitely check out Blue Cross Blue Shield during the next enrollment period.  At first glance, the Massachusetts BCBS offers the PPO only to small groups; for individuals, they offer only the HMO.  We will call BCBS before the next renewal to figure out our options and coverage.   

Buying a second home is usually a bad financial proposition, because you are instantly creating an average 50% vacancy rate in each house.

But if you want somewhere warm in the wintertime, where you can get medical care cheaply, how about a nice expat area in Mexico?

Yes, our owning two homes makes little financial sense.  Fortunately, we are well into FI territory.  Mexico sounds nice.  We chose West Palm Beach because my parents live here full time and my father-in-law spends the winter here.  Living a short walk from them has been a blessing.