Get ACA coverage while moving

[Paul der Krake]

I'm planning on my last day to be December 1, 2019, in order to get employer coverage for all of 2019, and then ACA coverage in 2020.

My main problems:
- we will be applying to go from well above the subsidy thresholds to very little income where you not only get premium subsidies but also some fat CSRs
- we will be moving to another state B at some point in January 2020, but in December and January we will be bouncing around with no real address

We don't have family in either A or B that could get our mail in the interim period. We really, really do not want to leave a papertrail in the states where do have family.

So essentially we need to convince everyone in the policy issuance chain that we're suddenly low-income and live somewhere where we haven't really moved to yet. I don't really care about not getting the tax subsidy upfront so long as it gets correctly reconciled during tax season. However, I am quite concerned about the system shitting the bed and flat out refusing to cover us because we're in a floating nomad state for a couple of months, or refusing to give us CSRs. My understanding is that the CSRs do not get reconciled, and with our expected consumption of health services, we're talking about a difference of many thousands of dollars.

I see two possible plays:
1) Leave work on December 1 in state A, apply on healthcare.gov on December 2 (during open enrollment) for coverage in state B starting January 1, and hope it gets issued.
2) Leave work on December 1 in state A, ride the magic COBRA 60 days lookback period in case anything happens, move to state B on January 15, apply for coverage on January 16 as a special enrollment period, and hope they quickly issue the policy to start on February 1.

Play #1 is risky because they may say we're not a resident of state B yet, and may refuse to enroll us.
Play #2 is risky because they may require more documentation and not issue the policy in just two weeks. Also, if we need to trigger the COBRA fallback because I get hit by a bus in January, we're stuck with COBRA for all of 2020.

Has anyone applied for coverage in a new state ahead of their move? Do they require proof of residence or can it be all done electronically? We plan on getting a blue PPO with a nationwide network, but for a bunch of reasons it's vital that the policy gets issued without delay.

[seattlecyclone]

We plan on getting a blue PPO with a nationwide network, but for a bunch of reasons it's vital that the policy gets issued without delay.

Mind sharing what state you're planning to move to that even offers such a thing? I've looked at the plans in Washington and they're all very HMO-ish with coverage generally limited to in-state providers.

[Paul der Krake]

Mind sharing what state you're planning to move to that even offers such a thing? I've looked at the plans in Washington and they're all very HMO-ish with coverage generally limited to in-state providers.

We haven't made the decision yet, but I'm specifically looking at one of these bad boys in Hawaii. There are a handful of other states that offer PPOs, I haven't checked them all but off the top of my head Alaska and Florida also do.

Edit: my understanding that this is a de-facto nationwide PPO is based on the following page:
https://hmsa.com/help-center/finding-a-preferred-or-participating-provider-on-the-us-mainland/

[reeshau]

Just as a brute force answer:  do you know where you will be living when you settle down in State B?  Meaning, at least the city, if not a particular place?  If so, why not start your rent or find a short-term rental there right away in January, or even in December 2019?  You don't need to be physically present, but for the cost of rent and the essential utilities, you would be establishing residency.  While not cheap by any means, it would be both a predictable and closed-ended cost.

Depending on the state, is there a mail service available?  There are several threads on having an address while nomadic.  These services tend to operate in states without income tax--if that describes your destination, this may also be an option.

[Paul der Krake]

Just as a brute force answer:  do you know where you will be living when you settle down in State B?  Meaning, at least the city, if not a particular place?  If so, why not start your rent or find a short-term rental there right away in January, or even in December 2019?  You don't need to be physically present, but for the cost of rent and the essential utilities, you would be establishing residency.  While not cheap by any means, it would be both a predictable and closed-ended cost.

Depending on the state, is there a mail service available?  There are several threads on having an address while nomadic.  These services tend to operate in states without income tax--if that describes your destination, this may also be an option.

I know the county, but that's it. In fact, not knowing exactly where we will ultimately settle is part of the fun: I want to do some a short term rental until we get a better feel for the neighborhoods, and we can't receive mail either during that time. There are mail services available in all states, but it's not clear whether insurers will let me sign up with that address.

I think the cost and logistical complexity of prematurely moving dwarfs the cost of COBRA, even at $1500/month for the two of us. So if I can't find a good solution, I think we'll just eat the cost of COBRA and try to ditch it ASAP.

Now I know it's in theory possible to sign up for the ACA without a fixed address, but this adds another layer of complexity. The last time I interacted with the marketplace (granted, this was the first year), I was not impressed by their ability to make things go smoothly, let alone in a complex situation like this.

[seattlecyclone]

I think you might want to seek out a local "navigator" in the new state and ask their advice. These are folks whose job is to help people get into the right health insurance, who know the right people to call to make the bureaucracy behave appropriately even in unusual circumstances. I've heard @lhamo had great success talking to one in Washington. She could probably speak more about this service.

[CanuckExpat]

You sound very similar to the situation we found our selves in late 2016. It was stressful at the time, and the feedback of information wasn't great, but it worked out mainly without a hitch.

We had wife's work coverage through end of 2016, with COBRA as backup in 2017 in worse case, and were expecting large medical bills for 2017. We were leaving our previous home state, and needed to find coverage with a nationwide plan, we had no fixed address in between. We were dropping from very high income to very low income.

We ended up going with a Florida Blue PPO out of Florida, nationwide network. We used a Florida address from traveling mailbox. We had no problem using the address, nobody asked for proof that we moved. We applied in December, and the "move" also triggered a special enrollment period if we had wanted. We were successfully approved for health coverage for the following year with no need to document our reduced income.

Our only problems with documentation showed up two years later, when we had one year with less income than we originally stated in our ACA application.

[Paul der Krake]

We ended up going with a Florida Blue PPO out of Florida, nationwide network. We used a Florida address from traveling mailbox. We had no problem using the address, nobody asked for proof that we moved. We applied in December, and the "move" also triggered a special enrollment period if we had wanted. We were successfully approved for health coverage for the following year with no need to document our reduced income.

Awesome, this is what I was most worried about.

There are a bunch of equivalent services for HI but their address is either a PO Box (probably a no-no for the ACA marketplace), or a business suite address (also probably a no-no). I haven't yet found a "residential" service for that state.