Health Insurance in the Age of Obamacare

We selected Texas as our new state of domicile in large part due to low taxes and RV-friendly legislation.  Escapees, a large organization of mostly fulltime RVers, is headquartered in Livingston, TX and works closely with the Texas legislature to ensure that the needs of full-time RVers are addressed.  By utilizing Escapees as our mail forwarding service, we were able to get both a reliable means of getting our mail forwarded to us but also a physical address that we could use to establish residency in Livingston, TX.

Since we are both quite a few years away from being eligible for Medicare (Jan more than Phil), one of the issues we had to address when we started our full-time RV life was health insurance.  Phil’s employer insurance plan ended in November and, although we could have continued our High Deductible plan under COBRA for another 18 months, the premium for 2016 was going to be over $1,600 per month.

Being now semi-retired, our relatively low income made the Obamacare marketplace seemed like an attractive option.  Through 2015, Blue Cross Blue Shield (BCBS) offered PPO plans through the marketplace that provided insurance coverage throughout the US.  However, prior to the 2016 enrollment period, BCBS announced that it was no longer going to offer PPO plans in the Texas marketplace.

When the time came for us to enroll for insurance for 2016, we learned the good news and bad news of the Obamacare marketplace.  The good news was that we received a large subsidy due to our low income. The bad news was that the only available options in our county were seven HMO plans.  We were tied to a Primary Care Physician (PCP) in Livingston, TX. The only coverage outside of Texas would be for emergency room treatment in the event of a life-threatening medical emergency.  If we needed hospitalization or any other medical treatment outside of Texas, it would all be out-of-pocket.  This would make it very risky for us to travel outside the state, hardly the scenario we were counting on when we decided to RV full-time.

As untenable as this was, our new reality became even worse as we learned more of the details.  Jan needed a prescription filled in early January but, by then, we were five hours away from our assigned PCP.  She called the PCP’s office to see if she could be referred to a local physician from within the HMO network.  Jan was told that the PCP wouldn’t do a referral since he’d never seen her before.  The other option was to switch our PCP to a local physician.  Jan managed to find a local physician in the HMO network that was accepting new patients.  However, she was told by the new doctor’s assistant that they limit the appointments of patients with our kind of insurance.  Initially Jan was told that the first available appointment for patients with our insurance was more than two months out, although there was an outside chance they could get her in earlier.  With few alternatives, we both filled out tons of new patient forms and got BCBS approval to change our PCP to the doctor in Kerrville.  Jan managed to sweet-talk her doctor in Illinois to give her a prescription for another month and the new PCP agreed to see her on February 18th.  At that point, we decided we had no choice but to stay in Kerrville for another month.

Phil decided he should schedule an initial appointment with the PCP so the doctor would have seen him if Phil ever needed to be referred to another doctor in the HMO network in Texas.  He called the PCP’s office on Feb. 5th and was told that the earliest appointment was April 29th.  Since we expect to be in California in April, Phil didn’t schedule the appointment.

We are now faced with a dilemma due to this insurance issue.  We could switch to an insurance plan outside the marketplace but this would require us to lose the Obamacare subsidy as well as incurring a high deductible.  Instead, we’ve decided to roll the dice and hope we can stay healthy for 2016.  We also may need to spend more time in Texas than we would have preferred.  We plan to explore other options in November 2016 when we know what insurance plans will be offered for 2017 and the impact of the elections on the future of Obamacare.

In the meantime, we’re going to try our best to keep safe and healthy.

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