RVer Guide to ACA Enrollment 2016
Open Enrollment (OE) for ACA health insurance ended on February 1, 2016 but the following information is still applicable during the Special Enrollment Period.
Here’s our out-of-the-gate advice…stay calm, grab a ice cold beverage (because we know most of you are somewhere warm already) and read this guide before diving in 🙂 You have 3 months to shop, determine your subsidy, and enroll in a plan. So, there is no need to be hasty in making your plan selection. We are here to help if you have any questions during the process. We can even set up a screen share session with you and walk you through the entire process if you would like. We here at RVer Insurance Exchange are dedicated to making your OE experience as pleasant and seamless as possible!
This guide is not intended to explain the entire Affordable Care Act (Obamacare), but it is intended to give you the highlighted changes and tools we feel will best help you navigate choosing and enrolling in a plan for 2016.
In this guide we will cover the following topics:
- Changes to Health Insurance in 2016
- Choosing an insurance carrier and plan
- Subsidies and Penalties
- ON Exchange vs. OFF Exchange
- Healthcare providers that “Don’t take Obamacare”
- How to Enroll in the shortest and easiest fashion possible
- What to do if you currently are enrolled in Obamacare
- The lack of PPO plans in 2016 and what to do about it
- Multi-State Plans
- Alternatives to Obamacare?
- Medicare Open Enrollment
- 2016 Market assessments in Florida, South Dakota, and Texas (scroll to the bottom for immediate access to this)
Changes in 2016
There are a few important changes that are being implemented in 2016 that you should be aware of:
- Individual Mandate Penalty: The most significant change is that the penalty for not having insurance in 2016 is increasing rather dramatically. The penalty will be the greater of $695 per uninsured adult (50% of that for a child), up to $2,085 per household or 2.5% of household income.
- Higher OOP Maximum: The Maximum Out-of-Pocket (OOP) limit for self-only coverage is $6,850 (up from $6,600 in 2015). For coverage other than self-only (such as family coverage), the maximum out-of-pocket limit is $13,700 (up from $13,200 in 2015).
- Embedded Individual Out-of-Pocket Maximums: In 2016 insurance companies are not allowed to require a family deductible to be met before an individual’s OOP is considered met. The ACA’s annual OOP maximum (rising to $6850) for self-only coverage applies to all individuals—including those enrolled in other-than-self-only [i.e., family plan] coverage. This means that no individual can be required to pay more in annual cost-sharing than the ACA self-only OOP limit ($6850), even though a family unit as a whole may be subject to the higher overall OOP maximum. In essence, the self-only ACA OOP maximum is “embedded” in the other-than-self-only coverage.
- Better Network Transparency: It will be easier to search for providers that take your plan before enrolling in 2016. Quote engines will display provider searches more prominently when shopping for a plan.
- Shorter Open Enrollment: This years’ OE is 3 months long as opposed to last year’s 4 months.
- Fewer Preferred Provider Organizations (PPO): 2016 plan filings showed fewer PPO options in many states, most notably ON Exchange in Texas.
How to Choose the Right Insurance Carrier and Plan
Here is some general advice you should keep in mind when shopping for the right combination of insurance carrier and plan in 2016.
- What you had in 2015 might not be the best choice. There was A LOT of changing, selling, merging, and acquiring that occurred in health insurance over the summer. Insurance companies were bought and sold, plans were discontinued, and come companies even shut their doors completely. You should be prepared to start fresh this OE and re-shop your coverage.
- Choose a PPO where available but don’t assume it is perfect. PPO does not stand for “Perfect Plan Obviously”. PPO (Preferred Provider Organization) plans are changing and their networks are shrinking or disappearing. Although a PPO plan is generally going to give you a broader network and not require referrals to specialists you should not assume that because a plan says it is a PPO that it is going to cover you in all 50 states. Those days are gone for now. This is why you should…
- Inspect the details of any plan you are considering. Read the Summary of Benefits. See what the network looks like. Make sure your doctors are in-network if you are currently undergoing care. Read the policy exclusions. All of these items will be readily available during your shopping experience.
- Add it all up! Don’t just look at premium. When comparing plans be sure and add it all up: annual premium + annual deductible + out of pocket coinsurance. Example: If you purchase a Bronze plan with a $400/month premium, $6000 deductible, 80% coinsurance, and $6850 out of pocket max then your annual exposure is: ($400 x 12) $4800 + $6000 + $850 = $11,650. This is important if you qualify for a Cost-Sharing Reduction (more on this next), which would reduce your out of pocket costs on Silver Plans Only.
If your household income is under 250% of the Federal Poverty Level then you qualify for reduced deductibles and out of pocket limits on Silver plans. Most people that enrolled in a Marketplace plan qualified for this lesser-known subsidy in 2014 and 2015. If you do, then your total output could be less with a Silver plan than with a Bronze plan since you can not use this subsidy on anything except Silver plans. So be sure and add it all up before assuming that a Bronze plan is the most cost-effective plan for you. You might miss out on this big cost-saving subsidy if you qualify.
Subsidies and Penalties
Subsidies come in the form of Premium Tax Credits (PTC) and Cost-Sharing Reduction (CSR). We discussed the CSR above so let’s go over the PTC now.
PTC is the government advancing you money to pay for your health insurance premiums based on your provided estimated income for the insurable year (2016). You can use any percentage of the PTC that you want to apply to your monthly premiums. If you over-estimate your income you will get a refund at the end of the year when you file your taxes. And if you under-estimate your income, you guessed it, you will be required to pay some or all of that PTC back when you file your 2016 taxes in 2017. So be as accurate as you possibly can when estimating your income.
You are expected to use your Modified Adjusted Gross Income calculation. GO HERE to read how to calculate your MAGI.
Here are two FAST ways to determine your subsidy eligibility:
- Use our Instant Quote page. This is directly linked to the Healthcare.gov calculator and will give you a pretty accurate estimate of your subsidies, including both PTC and CSR. This is the same page you will be able to use starting November 1 to shop and enroll in your Marketplace plan!
- Use this subsidy calculator.
Penalties come in the form of a tax bill when you file your 2016 taxes in 2017. If you do not show proof of insurance for 2016 then you will be required to pay the penalty. As mentioned earlier here there are some significant penalty increases being implemented in 2016. Every individual that is not exempt will have to maintain Minimum Essential Coverage in 2016 in order to avoid paying these penalties. There are numerous exemptions that can preclude you from having to pay this penalty. Oh and by the way, the “homeless” exemption does not automatically qualify an RVer for an exemption 🙂 Our RV is our home.
Minimum Essential Coverage
Minimum Essential Coverage (MEC) includes, but may not be limited to, the following types of health insurance:
*Employer-sponsored coverage (including COBRA coverage and retiree coverage)
*Coverage purchased in the Individual Market, including a qualified health plan offered by the Health Insurance Marketplace (also known as an Affordable Insurance Exchange)
*Medicare Part A coverage and Medicare Advantage plans
*Most Medicaid coverage
*Children’s Health Insurance Program (CHIP) coverage
*Certain types of veterans health coverage administered by the Veterans Administration
*Coverage provided to Peace Corps volunteers
*Coverage under the Non-appropriated Fund Health Benefit Program
*Refugee Medical Assistance supported by the Administration for Children and Families
*Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014
The following types of coverage MAY NOT qualify as MEC:
*Short Term Health Plans
*Fixed Benefit Health Plans
*Some Medicaid covering only certain benefits
*Vision only, Dental only, and limited benefit plans
*Grandfathered Plans (You will avoid the fee, but won’t get the new rights and protections)
ON-Exchange vs. OFF-Exchange
This distinction gets confusing to many people as evidenced by the many questions we get about the difference. So, here it is in simple language:
ON-Exchange means a health insurance plan that is eligible for subsidies. These plans can be found on the Federal Marketplace right here (our site) or Healthcare.gov.
OFF-Exchange means a health insurance plan that is NOT eligible for subsidies.
Neither option is superior to the other as far as providing Minimum Essential Coverage and Essential Health Benefits. Whether ON or OFF Exchange, all health insurance plans have to comply with Obamacare rules and provide Essential Health Benefits. There may be differences in what plans certain carriers offer ON vs. OFF Exchange so be sure and review the plan details, including the plan’s network. We are seeing a definite trend for carriers to offer more limited-network plan options ON-Exchange in 2016.
Both off and on-exchange health plans in the individual and small group markets must satisfy Essential Health Benefits coverage requirements and utilize one of the metal plan designs for medical out-of-pocket costs.
This leads us to the next item. What to do when a provider tells you…
“We Don’t Take Obamacare Insurance”
If a provider pulls this on you then ask them to explain what they mean when they say that–then watch them scramble for an answer! If a provider is in your plan’s network and sees you have some sort of “emblem” on your health insurance card identifying you as enrolling ON Exchange, and that provider then tells you they do not “take Obamacare”, then they are likely in violation of their contract with that insurance provider.
It is inaccurate for a provider to say they “don’t take Obamacare” because ALL health insurance is now under the “Obamacare” Affordable Care Act law. Essentially all health insurance is “Obamacare” insurance with the exception of the items listed above that do not qualify as Minimum Essential Coverage. Now there are certain providers that may not be in your Obamacare plan’s NETWORK–but that does not mean the provider does not take Obamacare. It only means that provider does not participate in that plan’s network.
The FASTEST way to Shop for and Enroll in a Plan
You can enroll in a plan a number of ways:
- Through an Agent or Broker (ON and OFF Exchange)
- Through the insurance carrier’s website (Usually for OFF Exchange only…they will send you to Healthcare.gov for ON Exchange)
- Print and mail your application (ON and OFF Exchange)
- At Healthcare.gov (ON-Exchange only)
- Your state’s exchange (ON-Exchange only)
No matter which option you choose your insurance premiums are UNAFFECTED by the mode of application.
But what is the FASTEST way to shop, the FASTEST way to get your subsidy, and the FASTEST way to get your application submitted and APPROVED?
Why, option #1 of course!! Enroll with RVer Insurance Exchange in 10 minutes or less whether you are applying ON or OFF Exchange!
If you prefer a more hands-on approach and want free guidance in choosing a plan then we are glad to walk you through the process. Simply contact us.
What to do if you are Currently Enrolled in a Plan
If you already have a plan in 2015, whether On or Off Exchange, here are your options for continuing coverage in 2016:
- Do Nothing and unless you have been notified otherwise by your insurance carrier your coverage will continue as it is in 2016. Your subsidy will also continue based on your 2015 income projections. Important: If you expect to make much more or less income in 2016 or your family dynamics, location, etc. have changed then you should choose option 2…
- Re-Shop plans for 2016 to see if you can find a better plan, better network, better rate, etc.
Generally, we recommend everyone at least shop the plans since there have been many changes over the past 6 months with insurance carriers, networks, etcetera. Remember, what you have in place on January 31, 2016 is what you are stuck with until January 1, 2017 barring a Qualifying Life Event that allows you to make a change outside of Open Enrollment. Shopping plans at our links above will not take much time at all and could save you a lot of headache and money later!
The Lack of PPO plans in 2016 and What to do About it
As many of you know many carriers are dismantling their PPO networks and plans around the country and moving towards more cost-controlling HMO plans. This is not a direct assault on the RV community. In fact, it is extremely doubtful that any single insurance company is even thinking about the nomadic community when filing their plans with the state. Switching to HMO plans is simply a means to stop the bleeding for many of these companies. The alternative to this is to shut their doors completely as some carriers have done this year.
We wish we could tell you we had the secret to turning any health insurance plan into a RVer’s dream policy that goes with them to all the corners of the country–but of course we can’t. If you are in an area where there are only HMO options available then we can offer this advice to you…
- Apply early and pick your primary care physician early before they are all taken. Especially in Texas, we foresee a shortage of doctors as all of those PPO members rush to find a primary care physician (which will be a requirement under the HMO plans). If you do not pick one, one will be assigned to you by your carrier.
- Get your preventive care done in-network. Otherwise it may not be covered at all.
- Stay close to your plan’s network if you have extensive pre-existing health conditions that will require you to seek regular medical care.
- Enroll in a Telemedicine plan. If you don’t know what this is then where have you been? Just kidding — We strongly urge you to check out our page on this. We have negotiated very low rates on these plans for the RV community and our plan utilizes the largest provider of telemedicine services in the country, Teladoc. See why prominent RV bloggers are saying things like this after using this service, “It still blows me away. If there is one thing I would recommend every traveler to have, it is Telehealth.”
- Consider a Metal Gap plan. These plans have NO NETWORK and can be used to fill in your pre-deductible gaps in coverage. GO HERE to learn more.
- Consider Short Term Medical insurance. These plans do not meet the MEC requirement but they are generally less expensive than regular health insurance and most offer nationwide networks. GO HERE to learn more.
- Consider a Direct Primary Care membership (a/k/a Concierge Medicine). This can give you 24/7 access to your primary care physician and many of them will work with your insurance company as well. We are building a relationship with one provider of these services called MDVIP, Inc.. We are particularly fond of this organization because they have a nationwide network of healthcare providers that are affiliated with them and to whom you can be referred while traveling. They are agreeing to offer a 5% discount to anyone enrolling through RVer Insurance Exchange. We will not be “selling” this and will not make a commission from any enrollments. We simply feel this is a great service that many in the RV community will want to take advantage of. To be notified when the enrollment site is up and running please subscribe to our newsletter. We expect to be able to offer enrollments here sometime in November, 2015.
Should you change your domicile to a state that offers better options in 2016?
That’s a question only you can answer since there are many factors to consider besides health insurance. Many people switched from South Dakota to Texas last year because of the poor options for health insurance in South Dakota only to have the largest PPO provider in Texas announce they are discontinuing their PPO options in 2016. Health insurance is changing often and changing fast. No doubt this will continue to be the case at least through the next presidential election cycle. We generally recommend riding things out and not making drastic changes unless absolutely necessary to your healthcare.
Important Note: You can not simply get an address in another state and purchase your coverage there. You have to be a legal resident of that state. That is an ACA requirement!
What about Multi-State Plans? Aren’t they ideal for RVers?
In short: NO. Multi-State Plans have little to do with a plan’s network and are NOT an indicator of network availability. Here is the official definition of a Multi-State Plan from the federal government:
A Multi–State Plan 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.
Yeah, that’s about it. Pretty boring, huh? Notice it says nothing about coverage across state lines. Our advice is to ignore that identifier on any plan and focus on the plan’s actual benefits and network (PPO vs HMO vs EPO) instead.
Alternatives to Obamacare
We realize we have not painted a glorious picture of health insurance for RVers in 2016. But it’s important to us (and you) that we give you the facts. Being “outside the box” kind of people, we RVers are able to look at alternative options to the ones that don’t seem to be increasing our access to healthcare on the road. Here are a few options available to you…
- Go Uninsured? Hey, you still have this option. For most people it’s not going to be the wisest path. Not only is the tax penalty for going uninsured going to be higher in 2016 but being uninsured exposes you to the possibility of medical claims bankruptcy. We do not recommend this route!
- Purchase Short Term Medical. If you are healthy, exempt from the penalty or don’t mind paying it in addition to short term medical premiums (which can be significantly lower than Obamacare plans), don’t qualify for a subsidy, and want nationwide coverage, then this can be a very attractive option. Just make sure you understand the facts, which you can read about here.
- Health Care Sharing Ministries. What?! An insurance broker mentioning Ministry Sharing Programs!? The reality is that many people are perfectly okay with this option. Besides, members of some (but not all!) of these programs are exempt from paying the ACA tax penalty. It’s NOT insurance, however. There is NO GUARANTEE of claims payment under these memberships. So there are inherent risks involved if you choose one of these. But, they are becoming more and more popular because of the apparent freedom to choose your doctors and to stay out of the “Obamacare” system. Update 4/19/16: RVer Insurance Exchange now offers a Health Care Sharing program! Click here for details.
Medicare Open Enrollment
So as not to confuse, we thought we should include a section about Medicare here since the federal government thought it would be wise to make the ACA Open Enrollment a little more interesting for folks by coinciding it with the Medicare Open Enrollment period 🙂
Technically, for Medicare enrollees October 15-December 7 is the Annual Enrollment Period (AEP), not “Open Enrollment” as many people refer to it.
During this Annual Enrollment Period (AEP) you can make changes to various aspects of your coverage:
- You can switch from Original Medicare to Medicare Advantage, or vice versa.
- You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
- And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.
If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria…
- You must be enrolled in Medicare Part A and B.
- You must live in the plan’s service area.
- You cannot have End-Stage Renal Disease (some exceptions apply).
Notice there was no mention of Medicare Supplement insurance above. That is because there is no AEP for Medicare Supplement insurance. If you have Original Medicare then you can apply for Medicare Supplement insurance any time of year!
We recommend shopping your Medicare supplement coverage once a year to make sure you are getting the best coverage and best rate available.
Assessment of 2016 ACA Plans in Florida, South Dakota, and Texas
We suspect this is the section many people (ourselves included) have been most apprehensive about–what will the insurance companies offer in the “BIG 3” RVing states of FL, SD, and TX? Nothing like carriers announcing at the last minute, eh? Below is a simple outline of the availability of plans in areas where RVers tend to domicile the most. We encourage anyone to contact us directly if you want to talk specifics. As insurance brokers we have to be very careful about the language we use here so as not to seem to recommend one carrier or plan over another to all people. Each person enrolling will have certain specifics that need to be evaluated before we can make specific recommendations. We trust our RVing friends will understand that and that this guide has been most helpful to you even without specific plan recommendations en masse.
Florida 2016 Plans
In Florida you will have different options available depending on your resident county.
ON Exchange most counties will have Florida Blue (not Florida Blue HMO–that’s a different company) as an option. Florida Blue has Blue Options (PPO/EPO), Blue Care (HMO), and Blue Select (PPO/EPO). Each of these plans utilizes different networks inside Florida but with the Blue Options and Blue Select, when traveling outside of Florida you can utilize the Blue Card program. This program allows you to see doctors in the national and worldwide networks.
UnitedHealthcare will also be available in some counties (including Sumter County/Escapees) ON Exchange but these will be their HMO (Compass) plans only, not their Choice plans. Same with Coventry–ON Exchange will be mostly HMO where available.
OFF Exchange in Florida many counties will offer Ambetter, Coventry, HumanaOne (PPO), United Healthcare EPO (Choice) and HMO (Compass), and Florida Blue EPO/PPO plans. United Healthcare EPO (Choice) may be a good choice if it’s available to you, as well as HumanaOne’s POS offerings.
Cigna will have limited options available in Florida for RVers. Their Cigna Advantage (HMO) plans will be available in Sumter County, Osceola County, and Pinellas County but these are local networks with no out of state coverage. Cigna’s Open Access plans won’t be available in most counties, including the aforementioned counties popular with RVers.
I suggest the Florida Blue plans (NOT the HMO ones, but the EPO plans only) as these plans will give you a good provider network both inside Florida and while traveling outside of Florida.
Any of the Florida Blue Select or Blue Options plans are good choices for frequent travelers.
The Blue Select Network is a 13,000 provider network inside Florida. Search this network here: https://providersearch.floridablue.com/providersearch/pub/index.htm
The Blue Options Network is a 39,000 provider network inside Florida. Search this network here: https://providersearch.floridablue.com/providersearch/pub/index.htm
When traveling outside of Florida with either the Blue Select or Blue Options plans you will be able to use the Blue Card national BCBS Association network. You can search that network by going here: http://provider.bcbs.com/Landing and choosing the Blue Card PPO/EPO network.
South Dakota 2016 Plans
ON Exchange not much has changed from 2015. Avera Health is the only PPO offering ON Exchange. You must read your plan carefully though as there are restrictions on using their PHCS (multiplan.com) network when traveling outside of SD. With Avera Health you may be limited to urgent care and emergency care when traveling outside of SD–even though it is a PPO.
11/3/15 UPDATE: With Avera Health, if you go with a plan (like the Avera MyPlan $3500) that has Out of Network benefits (read the Summary of Benefits!) then you will be able to use it outside of SD (even for non-emergency situations). Benefits would be paid at the Out of Network level of course. Be aware that you may not have an Out of Pocket maximum for those services and your Out of Network deductible would apply. Emergencies may still be paid at the In-network benefit level.
Be advised that Sanford HMO has been known to cancel members who have a mail-forwarding address in SD. We do not recommend enrolling with them.
OFF Exchange PPO options are limited to Wellmark BCBS and Avera Health. Wellmark is implementing a hefty 48% rate increase on many of their plans in 2016 and their standing policy is to not insure RVers with mail-forwarding addresses in SD.
Texas 2016 Plans
ON Exchange in most counties in TX (including Polk County where Escapees is) Blue Cross Blue Shield will be the only offering available. Unfortunately their offerings are all HMO in 2016. There will be two types of HMO plans available through BCBS: Blue Advantage and Blue Advantage PLUS. Examine each plan closely by reading the out of network benefits. Many of these plans have ZERO coverage out of network other than for an emergency.
There may be other options scattered around some Texas counties, such as Scott & White, Oscar, Aetna, and Ambetter both ON and OFF Exchange.
Blue Cross Blue Shield of Texas
Blue Cross Blue Shield of Texas plans all operate within the Blue Advantage HMO network starting in 2016.
I suggest choosing one of the following plans in order to have at least some out of network benefits while traveling outside of Texas: Blue Advantage Silver Plus 102 or Blue Advantage Silver Multi State Plan 102 (this one is only available on exchange). These two plans will allow you to see providers outside of the Texas network and will cover you at 50% after your out of network deductible. Not exactly ideal but it is important to note that all of the other plans have no coverage at all if you go out of the network—unless you have a medical emergency.
It is very important to read the Summary of Benefits in any plan you choose.
To search the BCBS of TX provider network you can GO HERE. You will need to choose the Blue Advantage (BAV) network.
Note: We are getting asked a lot about the Blue Cross Blue Shield Blue Card Program and the Away From Home Care Program. Unfortunately, The Blue Card Program (generally for PPO/EPO plans only) and the Away From Home Program (designed for traveling HMO members and students) are not available to BCBS of TX Blue Advantage HMO members in 2016.
Read the print at the bottom of this link. It states the following:
* The BlueCard Program is not available for Medicaid, Medicare Advantage or Medicare Part D plan members. HMO plan members can use the BlueCard Program only for emergency or urgent care when traveling or away from home for less than 90 days. Also, the Away From Home Care Program is not available for Medicaid plan members or for HMO plan members on the Blue Advantage network.
All BCBSTX plans in 2016 will use the Blue Advantage network.
Safe and Happy Travels,
Kyle Henson, Founder and fellow RVer
Don’t forget we can also help you find the best Auto/RV coverage! CLICK HERE for a Quote TODAY!