RVer Insurance Exchange’s 2018 Guide to Health Plan Options for RVers
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If you are on Medicare, please click here to go to our Medicare Page
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2018 Affordable Care Act Changes
By now most people are familiar with how the Affordable Care Act (ACA) works. So, rather than summarize all aspects of the ACA in this year’s guide we will highlight important ACA changes for 2018 and then focus on 2018 plan options for RVers. Below are the main ACA changes being implemented in 2018 for individuals and families. If you are looking for a more comprehensive overview of the ACA then you can get that by clicking here and also here (great resource at Kaiser Foundation).
- 2018 Open Enrollment is cut in half from 2017 down to only 6 weeks: November 1, 2017 – December 15, 2017. OPEN ENROLLMENT has ended for ACA plans in 2018.
- For 2018, your out-of-pocket maximum can be no more than $7,350 ($6,650 for HSA plans) for an individual plan and $14,700 ($13,300 for HSA plans) for a family plan before marketplace subsidies.
- For 2018, your Maximum deductible is the same as the Out-of-pocket Maximum, just like 2017
- For 2018 HSA plans, the Minimum Deductible required is $1,350/$2,700 Individual/Family
- For 2018 the maximum HSA contribution is $3,450 (+$1,000 for 55+) for individuals and $6,900 (+$1,000 for 55+) for families.
- Cost Sharing Reduction subsidies may go away. This is a very recent change made via Executive Order by President Trump on October 12, 2017 whereby he cut funding to insurance companies for these subsidies. CSR subsidies are not premium-reduction subsidies. CSR applies to Silver plans for certain people with lower incomes (about 57% of ACA enrollees) and reduced deductibles, coinsurance, and copays on these plans. The removal of these subsidies in 2018 will make ACA plans less appealing for many because insurance companies will need to increase premiums in order to make up for this loss of government reimbursement.
- The Individual Shared Responsibility Provision: Even though on January 20, 2017 President Donald Trump issued Executive Order 13765 which seems to indicate that the shared responsibility payment will not be imposed on individuals for not having minimum essential coverage, the mandate to have health insurance is technically still in force for 2018 per the IRS website.
- Technically the IRS could still impose these penalties until these provisions are “changed by the Congress”. Read the executive order as well as the IRS official position on the provision before deciding if you are at risk of having to pay the penalty. It’s still unclear, frankly.
- From the IRS website: “For Tax Year 2018, the IRS will not consider a return complete and accurate if the taxpayer does not report full-year coverage, claim a coverage exemption, or report a shared responsibility payment on the tax return.”
- BOTTOM LINE: Be safe and assume the individual mandate and tax penalty will be a assessed until Congress changes the actual legislation.
- For 2018 Individual Mandate fees (if they are actually enforced) for not having health insurance are the same as 2017 to be adjusted for inflation: 2.5% of household income (up to the total yearly premium of the national average price of a Bronze plan sold through the Marketplace) or $695 per adult ($347.50 per child under 18), whichever is greater. Maximum per person is $2,085. note: using the percentage method, only the part of your household income that’s above the yearly tax filing threshold ($10,150 for individuals, $20,300 for couples) is counted. For more information about the PPACA healthcare law and it’s requirements please visit www.healthcare.gov
- Short Term Medical plans: President Trump’s October 12, 2017 Executive Order also eliminates the April 2017 law that prohibited Short Term Medical plans from being written for more than 90 days. Trump’s Order extends it back to 364 days and allows for renewability of these plans as well. The effective date of this change is unclear at this point, but looks like it will be January 2019.
UPDATE January 2018: We now offer a Short Term Medical plan that can be setup for auto-renew every 90 days up to 4 times, giving you 360 days of coverage! Not available in all states (Yes in TX, FL, No in SD). Click Here.
A Note about ACA Multi-State Plans: “Multi-State Plan” (MSP) (which are identified as-such on the ACA Marketplace) have nothing to do with a plan’s network and are NOT an indicator of multi-state coverage. Here is the official definition of a Multi-State Plan from the federal government: “A MSP is a private health insurance plan sold through the Marketplace under a contract between the U.S. Office of Personnel Management (OPM) and an insurance company. OPM is the federal agency that administers health insurance plans for federal employees, retirees, and their families.” As you can see it has nothing to do with offering multi-state coverage.
2018 ACA Rate Changes
Even though all 2018 ACA plans and rates were filed in June 2017, insurers are likely going to be allowed to make changes to their rates due to Trump’s Executive Order ending CSR subsidies to insurers. We expect Silver plans to be rated up even higher unless another change takes place (which, of course, is possible in this volatile healthcare environment).
Nevertheless, you can use this tool to search for any insurance company’s requested 2018 rate increase (actual increase may be higher or lower based on state approval). Here is a summary of the rate increases requested by 3 popular insurers among RVers (as of 10/20/17):
- South Dakota’s Avera Health: +20.01% (regional PPO plans)
- Texas’ Blue Cross Blue Shield: +23.93% (HMO plans)
- Florida’s Florida Blue: unpublished, but “+33.5%” according to sources at Florida Blue (EPO plans)
Want more 2018 ACA data to make your head spin? Click here and have some fun 🙂
A couple of key ACA definitions to know:
Minimum Essential Coverage (MEC) is the least amount of coverage that is required by Obamacare for an individual to be considered “compliant” and to avoid having to pay the Individual Mandate penalty if it were to be enforced. All ACA Marketplace plans and most major medical health insurance plans are considered MEC. However, since a lot of us RVers have to look at alternatives to these health insurance plans it is important to know if you have MEC or not. The only options below that include MEC are Option #1 (ACA), Option #2 (Elite Series PPO), and Option #5 (AlieraCare). We were going to offer a stand-alone MEC product in 2018 for those simply wanting something to avoid the mandate penalty; but since the penalty is unlikely to be enforced we don’t think it’s necessary.
Minimum Essential Coverage should not be confused with Essential Health Benefits (EHB). EHB is a set of 10 categories of services health insurance plans must cover under the Affordable Care Act in order to be offered on the Marketplace. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. You can view more details about EHB as well as state-specific benchmarks here. In addition to ACA Option #1, Our off-Marketplace Option #2 (Elite Series Plan) below also covers all required EHBs. No other options below offer EHBs.
2018 Healthcare Plan Options
2017 saw more insurance companies pulling out of the Affordable Care Act (ACA) Marketplace and others diminishing their offerings and increasing their rates. ACA nationwide-PPO plans are very hard to find now and even if you do find one it does not necessarily make it a good choice, given the fact that their provider networks are shrinking as well.
Here is an overview of the healthcare plan options available to RVers in 2018:
Option #1 Affordable Care Act (ACA) Coverage
Otherwise known as “Obamacare” this is Major Medical health insurance like you would obtain from Healthcare.gov or your state’s exchange. These, and only these, are subsidy-eligible plans. However, it is getting increasingly difficult to find nationwide PPO coverage options on the Marketplace exchange. But, if you can find one, and you have pre-existing health conditions and/or qualify for a subsidy then this may be the best option for you. There is NO MEDICAL UNDERWRITING with this option.
You must enroll for these plans during the annual Open Enrollment unless you have a special circumstance (like changing state of residency): November 1, 2017 to December 15, 2017 for 2018 coverage.
See if you qualify for a subsidy, get quotes, and enroll in an ACA plan right here. This is our new enrollment platform that is FAST, SECURE, and SIMPLER than going to Healthcare.gov. 2018 Rates may not show up there before November 1, 2017.
Option #2 Elite Series 2
These plans are NEW for 2018 and are major medical comprehensive plans which are ACA-compliant and available only to working RVers. You can not be fully retired and qualify for the Elite Series 2 plans. If, however, you or your spouse/partner work 30+ hours per week then this may be a great option for you.
These plans are available to residents of ALL 50 STATES and provide coverage in all 50 states!
- You need to be healthy to qualify for these plans. Any surgery in the past 6 months or scheduled in the next 12 months will likely disqualify you from this plan. If you are taking expensive medications at the time of application you will likely not qualify. Type I diabetes, high cholesterol, hypertension are okay if there aren’t other additional pre-existing conditions. Email us if you are unsure if you qualify.
- Since this is an association plan, the named primary applicant must be working 30+ hrs per week at the time of application. Work can be through an employer or self-employment of any kind. There are no specific income requirements.
- You can not be fully retired and qualify for Elite Series 2
- Plans are ACA compliant, so no penalty
- Plans are available for individuals and familys
- Plans are not age-rated so they can be a great option for those 50+ yrs olds
- Not subsidy-eligible plans nor HSA-eligible
- Nationwide coverage with large network
- Enrollment is OPEN Year Round! You must apply by the 19th in order to get covered by the 1st of the following month.
Option #3 US HEALTH ADVISORS Nationwide PPO Plan (NOT ACA-compliant)
This is a PPO health insurance plan underwritten by Freedom Life plan that does not qualify for ACA subsidies but provides nationwide coverage via the Cigna PPO network. Available with this plan is the Premier Med Short Term Rider that gives you a $4,000 deductible and then covers all medical at 100% thereafter until the end of the calendar year. In essence, this one-time use rider upgrades an otherwise fixed-indemnity plan (even in the middle of a medical claim) to a $4,000 maximum out of pocket plan. If you want nationwide coverage, are healthy, and aren’t subsidy-eligible then this is a plan worth your consideration.
This plan is medically underwritten so you generally have to be healthy to qualify and it does not cover pre-existing conditions.
I recommend reviewing the benefits booklet by clicking here before scheduling an appointment with Portia to discuss this option.
Please go here to request details and/or a quote from Portia Lavigne for a US HEALTH plan only or call Portia directly at (407) 687-1550. Please note that this is the only plan Portia is licensed to assist with, so she will be unable to assist with any other options listed on this page. Her plan is not available in CA, SD, OR, WA.
** You can also schedule an appointment with Portia by clicking here **
Option #4 AlieraCare Health Care Sharing Ministry (HCSM)
Perhaps the most unconventional idea here is to drop health insurance and join a medical cost sharing group instead. These faith-based expense sharing programs are not insurance. Instead members directly share unforeseen medical expenses. Members make a fixed monthly sharing contribution. The groups have set up different systems to either reimburse members for their expenses or directly pay providers for the eligible expenses other members incur. By paying only for actual expenses and non-profit admin fees, the costs of these programs can be very attractive. This was a very popular option for RVers in 2017.
This is our preferred HCSM plan from Aliera Healthcare that combines the 63 Minimum Essential Coverage preventive care benefits plan with a HCSM for hospitalization. It is an ACA exempt plan because it covers preventive care at 100% with no out of pocket expense to the member and includes an ACA-exempt HCSM hospitalization plan (view the letter of approval from CMS). It is not two separate bundled plans but is one plan through Aliera. Rates look good, benefits are nationwide, and the application is simple. The Statement of Beliefs is non-evangelical personal rights/liberty oriented, making it appealing to a broader audience than some of the other HCSMs.
As of August 2017: AlieraCare is NOW AVAILABLE IN South Dakota!
Please go here to learn more about details of the AlieraCare Plan.
This is a Health Care Sharing Ministry + Preventive Care plan. The HCSM portion is through Unity Healthshare (an affiliate of Anabaptist Healthshare). Click here to view the full guidelines of the Unity Healthshare membership. You do not need to purchase Aliera + Unity separately. They are combined upon checkout when you enroll here.
You can email either Kyle with your questions about AlieraCare.
Please NOTE: We DO NOT recommend the Value Plan due to the limited benefits…It is recommended that you choose either the Plus or Premium plans only.
View the provider network here: First Health Network
Short Term Medical Option
There was legislation that became effective April 1, 2017 that made it so that you can only have a Short Term Medical plan for a maximum of 3 months before you have to re-apply to renew. It’s up to each state to decide how many times a STM can be renewed. The government realized that a lot of healthy folks used the STM strategy over the past few years to avoid expensive ACA coverage (or to gain nationwide coverage) so they needed a way to force healthy people back into ACA coverage.
UPDATE 10/12/17: President Trump signed an Executive Order on 10/12/17 allowing individuals to enroll in Short Term Medical plans for up to a year! This eliminates the earlier law (mentioned above) that went into effect in April 2017 that stated you could only have it for 90 days. This may make STM plans a GREAT option for RVers since many of these STM plans offer nationwide coverage. However, the timing of this is currently unclear as there were no concrete dates given in the Order that say when this is to take effect.
Short Term Medical plans are medically underwritten so they will be most suitable for healthy individuals without pre-existing conditions or medications. Keep in mind that when you renew a STM plan you have to medically qualify each renewal term. So, if you have a medical situation occur while enrolled in a STM they can not drop your coverage but they can deny you the option to renew it at the end of your term.
We have new Short Term Medical plans in 2018 that can be written up to 360 days in some states, including TX and FL. New pending legislation will likely make STM plans annually renewable by the end of 2018.
We understand it can be overwhelming when looking at these options and the comparison chart (below) to try and decide what is the BEST option for YOU. But, please understand there is no one-size-fits-all here. You will have to weigh your options carefully before deciding for yourself which option makes the most sense for you and your family.
The first question to ask yourself is, “what’s most important to me?”.
Is it monthly cost? Out of pocket costs (i.e deductibles)? Nationwide coverage? Using a subsidy? Avoiding the penalty? Covering your pre-existing conditions? You will have to consider the importance of each of these categories before deciding which healthcare plan strategy to have in place for 2017.
So let’s look briefly at each of these separately…
If MONTHLY COST is the most important factor to you…
Then you will need to determine if you qualify for a subsidy first. You can do that by running quotes at our ACA enrollment page right here. If you qualify for a subsidy and MONTHLY COST is the most important factor to you then a ACA plan is probably your best option since none of the other options can be used with a subsidy. If you do not qualify for a subsidy, however, you will probably find any of the other options offer a 30-70% lower cost option than an ACA plan.
If you primarily want MAJOR MEDICAL Health Insurance…
Then you will want to select an ACA plan since this is the only option that is considered major medical comprehensive coverage. Without a monthly subsidy the ACA plan will be higher for most people compared to the Elite Series PPO plan.
If you primarily want PREVENTIVE ROUTINE CARE benefits…
Then you will want to consider either an ACA plan or the AlieraCare option since these options include FULL ACA-required preventive care with ZERO out of pocket costs to members. But, we advise against purchasing a plan solely based on this offering since the largest risk of loss with healthcare is not routine preventive care but rather extended hospitalization.
If NATIONWIDE COVERAGE is the most important factor to you…
Then you may want to consider alternatives to ACA coverage like the Elite Series, US HEALTH or AlieraCare. All of these alternatives give you nationwide coverage. There are very few ACA plans that will give you this nationwide coverage. There are NONE in Arizona, South Dakota, or Texas (popular RVer domicile states). Florida Blue* remains a good ACA option for Florida residents that still allows members to use the national Blue Cross Blue Shield network when traveling outside of Florida.
If AVOIDING THE TAX PENALTY is the most important factor to you (it probably shouldn’t be)…
UPDATE 12/22/2018: The federal government has voted to repeal the individual mandate penalty. However, this does not take effect until January 1, 2019. The mandate still applies in 2018.
Don’t lose sight of the reason you are buying healthcare coverage: to protect yourself against a significant financial loss in the event of a major medical situation.
If you are still concerned about the penalty then you will want to choose either an ACA plan, the Elite Series plans or one of the alternatives we offer that allow an exemption from the ACA penalty like AlieraCare.
Keep in mind that there are many other exemptions you may qualify for even if you do not have an exempt or compliant plan. You can check those out right here.
NOTE: One exemption we expect a lot of people will qualify for in 2018 is the Affordability Hardship exemption. This exemption applies if you can not find a ACA plan in your area that costs less than 8.16% of your household (MAGI) income. ACA rates have increased so much this year that many will likely qualify for this exemption. Also keep in mind that it’s based on income only, not savings. Secure the advise of a qualified tax professional before assuming you qualify for any exemption.
If you are unhealthy and have extensive PRE-EXISTING CONDITIONS…
Then the choice is clear: You need an ACA plan. ACA plans are the only option that will cover all pre-existing conditions on day 1 without waiting periods. Same with prescriptions. If you have lots of prescriptions you need coverage for then an ACA plan is your best option. Most alternative healthcare options will give you discounts on prescriptions but will not give you a “copay” structure like ACA plans—although many ACA plans do subject you to your plan deductible first. Some ACA alternatives will cover pre-existing conditions after a 12-24 month waiting period.
We often get asked, “What do YOU have for coverage?”..
We encourage you to not make your choice based on what somebody else has chosen because your situation is unique to you. Case in point: There are 3 health insurance agents here at the RVer Insurance Exchange and each of us has chosen a different option above based on budget, health, lifestyle, risk aversion, and location. We strongly urge you to consider all of your options and make the choice that makes the most sense to you.
Here are 2 additional items we suggest you give consideration to:
- Consider adding an Accident/Critical Illness (ACI) policy to whichever option you choose if you have a high deductible or no nationwide coverage. An ACI plan can help cover first-dollar expenses if you have an accident or specified illness. This is a particularly good idea for ACA plans with high deductibles and/or lacking nationwide coverage. Click Here for details.
- As always we suggest every RVer enroll in our Telemedicine plan so that you can get telephone consultations anywhere in the country. Some of the options in the chart above include a Telemedicine plan but most do not. You can join our very popular Telemedicine program by clicking here. It’s low-cost, convenient, and can save you a lot of time and money if you need to consult with a doctor. It also includes discounts on prescriptions, dental, vision, hearing, and more.
If you currently have an ACA plan…
ACA has automatic re-enrollment in place for 2018. So if you are happy with your ACA plan, it is still available, and your income is not changing from 2017, then you can use the re-enrollment fallback if you want to. However, we suggest re-shopping your plan for 2018 since there may be better plans available to you that were not available in 2017. Additionally, it is very important to report income changes to the Marketplace if you are receiving a subsidy.
Your insurance company will send you a letter if your 2017 plan is not being offered in 2018.
If you enrolled in your 2017 plan through RVer Insurance Exchange the same automatic re-enrollment rules apply.
Comparison Chart of Healthcare Plan Options…
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State Availability Chart
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Sample Only Rate Comparison Chart (Florida, nonsmokers, unsubsidized, $5000-$6000 deductible)
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