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I love Medicare - I have that and the AARP SUpplement, and it is so easy to use, all the doctors both in NY & FL accept it, and I walk out of the office paying nothing.
HOWEVER - it does not cover a spouse. I have a "child bride" (She'd LOVE to hear this! ), and she HAD a GREAT individual policy. It covered all her doctors, low deductible, etc. They cancelled her plan, and now she is shopping for an individual plan. THe big problem now is that every insurance company has stopped allowing visits to doctors out of state. We are snowbirds, so she spends almost 5 mos every year in FL, but is still a resident on NY. THus she needs a NY Policy. But now she won't be covered if she sees a Dr in FL. THus, if let's say she falls & breaks something, the visit to the ER will be covered, but then any post-ER visits, such a surgery tp repair, PT, follow-up visits, etc., will not be covered. SHe'd have to go back to NY for covered treatment. Now EVEN WORSE, if she had a heart attack, the visit to the ER would be covered, but if she had to be admitted to the hospital, that would not be covered! (Yes - this is what we were told by reps for 2 companies - the ER visit is covered, but if admitted to hospital, not covered) IT'S CRAZY!
I thought one of the things the ACA was supposed to do was to make health insurance more portable. In a case like this, it has the opposite effect. There probably are not an overwhelming number of people affected by this, because most snowbirds probably are on Medicare. (What is needed is some kind of a "Snowbird" policy!)
It makes no sense. NY probably has the highest Dr costs in the COuntry. So having someone pay NY Insurance rates, but get treated in FL would seem to be a Cost-saver for the Ins company. THe companies have told us that they stopped covering Out Of State because ACA mandates no out of state coverage. BULL! It does no such thing.
Without getting into the politics of ACA, what seems to me to have happened is that the Heath Insurance companies are using this law as a means to boost their profits, and making sure that they do not give up their control of the healthcare industry. When reform was first proposed, it could have been a real killer for these companies if something like SIngle-Payer came to be. They weren't about to let that happen. Look at United Health Care for example - record profits! The Ins companies took over the legislative process, and now are still controlling our healthcare.
The Insurance companies really need to be out of the picture.
I have a "child bride" (She'd LOVE to hear this! ), and she HAD a GREAT individual policy.
It covered all her doctors, low deductible, etc. They cancelled her plan, and now she is shopping
for an individual plan. THe big problem now is that...
Is that you two are married and that you actually pay your bills.
Un-married, your income wouldn't count against her ability to get a subsidy.
(I think the snowbirding two sets of docs thing has a get around)
Quote:
Without getting into the politics of ACA, what seems to me to have happened is that
the Heath Insurance companies are using this law as a means to boost their profits...
You noticed huh? Well, any port in a storm.
Quote:
The Insurance companies really need to be out of the picture.
We've jointly spent many hours looking for a "work around", but so far unsuccessful.
(Her family are insurance brokers - but not health - & they can't find anything either).
I have an idea though that I am going to check into.
I wonder if she can get a 5 month policy for when in FL, then cancel & buy a NY policy, then cancel & buy a FL policy, and back & forth. Seems that should be possible now since they can't turn her down.
It would be so nice if medicare allowed spousal coverage.
This doesn't make any sense. NY can't possibly be restricting its residents to only in-state providers.
Call or email your Office of Insurance Commissioner. Also, contact your state representatives - and Chuck Schumer.
In WI, on the exchange, there are carriers which are strictly HMO, and one carrier which offers HMO and PPO. The PPO is higher priced by about 20%, pays 50% out-of-network after deductible up to max oop of $12,700 per person. There are no in-state restrictions on these out-of-network providers, that I know of.
If you're not buying an exchange policy, you should have even more options.
Last edited by Ariadne22; 11-20-2013 at 04:38 PM..
NY is big on HMO's and that makes it hard. What you need to do is go with a Blue Cross/Blue Shield policy and when she is in NY, declare her NY Dr her "primary care doctor" and when you go to FL, submit forms to declare her FL doctor her Primary Care doctor. If you can get a plan through Cigna or Aetna (both national carriers) it would probably be the same. If you can find a PPO through one of these carriers you probably won't have to do the primary care designation.
Call BC/BS of NY tomorrow and see what they say about that but I would try to avoid an HMO if you can in your situation. You won't be able to use companies like MVP, etc. for this though.
As mentioned, an HMO won;t work.
However, FINALLY, after loking at many many policies, we finally found one, a Platinum policy (OUCH - the cost) which will cover drs out of state. Of course, it requires referrals for any specialist, which is something that didn't have to be done under the old policy. A little extra burden, and one that actually cots the Ins companies more money by requiring a visit to the GP even when we know what specialist has to be seen. But doable.
BTW - BCBS does NOT cover Out Of State doctors. It does cover in the Tri-State area, but not beyond.
As mentioned, an HMO won;t work.
However, FINALLY, after loking at many many policies, we finally found one, a Platinum policy (OUCH - the cost) which will cover drs out of state. Of course, it requires referrals for any specialist, which is something that didn't have to be done under the old policy. A little extra burden, and one that actually cots the Ins companies more money by requiring a visit to the GP even when we know what specialist has to be seen. But doable.
BTW - BCBS does NOT cover Out Of State doctors. It does cover in the Tri-State area, but not beyond.
They will usually cover an urgent care center in addition to emergency room. Also currently 37 different states offer a Multi-State policy. It is most likely BCBS. Also, some of the new non profit Co-op that have been set up are affiliated with different groups (as an example the culinary union) and are thus covered in other states.
As mentioned, an HMO won;t work.
However, FINALLY, after loking at many many policies, we finally found one, a Platinum policy (OUCH - the cost) which will cover drs out of state. Of course, it requires referrals for any specialist, which is something that didn't have to be done under the old policy. A little extra burden, and one that actually cots the Ins companies more money by requiring a visit to the GP even when we know what specialist has to be seen. But doable.
BTW - BCBS does NOT cover Out Of State doctors. It does cover in the Tri-State area, but not beyond.
Maybe yes, maybe no. It does prevent people from going to more expensive specialists willy nilly, without a justifiable need and the much lower payment to a GP may well offset the difference when you do have to see both.
Remember, the ins companies use actuaries to figure these things out...they don't just guess.
I won't say they are always right but they aren't in business to lose money.
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), and she HAD a GREAT individual policy. It covered all her doctors, low deductible, etc. They cancelled her plan, and now she is shopping for an individual plan. THe big problem now is that every insurance company has stopped allowing visits to doctors out of state. We are snowbirds, so she spends almost 5 mos every year in FL, but is still a resident on NY. THus she needs a NY Policy. But now she won't be covered if she sees a Dr in FL. THus, if let's say she falls & breaks something, the visit to the ER will be covered, but then any post-ER visits, such a surgery tp repair, PT, follow-up visits, etc., will not be covered. SHe'd have to go back to NY for covered treatment. Now EVEN WORSE, if she had a heart attack, the visit to the ER would be covered, but if she had to be admitted to the hospital, that would not be covered! (Yes - this is what we were told by reps for 2 companies - the ER visit is covered, but if admitted to hospital, not covered) IT'S CRAZY!
