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Fulltime RVer healthcare in 2019

The coming new year brings new healthcare legislation with it, the biggest change being that the ACA individual mandate a.k.a. non-insured tax penalty is going away. Because of this, we're making some radical changes in our health insurance for 2019.
One of the biggest frustrations for us about fulltime RV life is our healthcare options. One of the most common questions we get from people who learn we fulltime RV is "What do you do for healthcare?"
For more background, you can read my write-up from 2017 — for 2018, we basically did the same thing. Two worthy updates to the earlier article: 1. We actually did work enough during the year to have to repay all of the tax discount. 2. There's no such thing as a "grandfathered plan" when it comes to healthcare. Our first plan was abruptly discontinued at the end of 2017.
We're still too old for "catastrophic" plans, not very keen on faith-based cost sharing plans, and don't see much value in plans that are capped at maximum $50,000 or less payback.

Our HMO options

What we've previously been effectively forced to choose was an HMO plan that was only usable in our domicile state, Texas. We travel around the U.S. a lot, so the only way we really would have benefited from the HMO was if we paid initial costs of injuries and illnesses ourselves, and then quickly traveled to Texas for further care.
For comparison, our Livingston, Texas based HMO options for a married couple on the ACA marketplace, in a reasonable price range, are

  • HMO 204: $719.38/mo
  • HMO 301: $739.24/mo
  • HMO 305: $744.70/mo (my best candidate)
  • HMO 303: $872.59/mo

All the plans were subtly different and difficult to compare, as one would expect on this level of hell.

Indemnity plans

With the individual mandate gone, we're now more able to shop outside the ACA marketplace. That leaves us with one category that we didn't explore earlier, because the individual mandate no longer exists: indemnity plans. Where the ACA plans are comprehensive plans and aim to cover all of your medical expenses (after deductibles, co-pays, balance billing, and lots of small print that is definitely out to get you), indemnity plans are based on "if you need medical service X, we'll give you $Y to use as you want" (with some limits and annual & lifetime maximums).
So the idea is, you pay the doctor (remember to ask for the cash price) and the plan pays you. There are no deductibles or co-pays, but also no out-of-pocket maximums. For example, every day you stay in a hospital because of an injury you get $6,000, and if you can find the service for cheaper than that, you can actually even make money from being hurt. Note that this means you have to cough up the money up front.
I've tried to look at a bunch of plans, but the health insurance industry is even more unpleasant to deal with than the combination of car insurance and used car sales people, and I have a limit of how many times I'm willing to have the same phone conversation with extremely limited up-front information. To anyone working in the industry, if you want "young" (<50yo) customers, put your stuff on the web, including automated no-contact-info-needed quotes. For now, I'll summarize what I've learned about the plans affiliated with major RVer organizations.

Escapees plans

I looked at the healthcare plan that Escapees/Xscapers is affiliated with (at https://www.escapees.com/​benefits/​escapees-​healthcare-​solutions/), and here are my thoughts:

  • The plans look very affordable.
  • WellMEC preventative care is worth very little to us, we rarely see doctors and can pay out of pocket for that.
  • Axis Healthcare Assist is not very interesting for us, as it will never pay out much (and now we know why the plans looked so affordable).
  • Brightcare Dental covers root canals and such at 50% value on your second year with the plan — that's actually a very short waiting period, compared to some others.

My summary: maybe get this plan if you live paycheck-to-paycheck (working or retired), can't afford much else, and don't have much choice but to go bankrupt if you end up seriously hurt or sick.

FMCA plans

The FMCA plan at https://fmcahealthplan.com/ and https://site.fmca.com/​index.php/​fmca-​healthcare-​plan.html is an indemnity plan with one interesting property: its payout limit is significantly higher than in other plans I've seen. Let's say you end up spending three weeks in a hospital for some reason; this could be the difference between bankruptcy and just a bad year.
There are many plan levels to choose from, but as an example, the mid-tier plan pays you $6,000 per injury-related hospital day (please read the fine print).

  • There's pretty much no information about the plan on the web, you'll need to have an hour-long phone call to get anywhere. The representative is pleasant, but I'd rather read at my own pace, and in general avoid salespeople like the plague.
  • The dental plan only starts really covering root canals on your third year with the plan, and even then at only 50% cost. Pass.
  • The critical illness insurance maxes out at $50,000. Once again, we're really mostly interested in bankruptcy avoidance, and that's too low for it.
  • The plan includes Teladoc, saving us a separate $149/year expense. We haven't used Teladoc much, but it has been great for us.
  • The plan includes Karis360 cost saving concierge services and PHCS network discounts to find affordable healthcare, and ScriptSave prescription discounts.
  • For Texans, there's an extra Enhanced Rider Benefits that doubles your outpatient benefits.

The link to the FAQ is easy to miss, so I'll repeat it here: https://site.fmca.com/​images/​healthcareplan/​FMCA_Health_Plan_FAQ.pdf — for brochures and such, you'll have to contact sales rep.

Not an FMCA member?

If you want to get the FMCA plan, but are not yet an FMCA member,
you can save $10 by joining through this affiliate link: http://join.fmca.com/doga1/

ACA tax penalty grace period

We've established that unless you have sufficient coverage in 2018, you will be hit by a tax penalty. What we didn't know that there's a two-month grace period, and since it's already November you can cancel your ACA plan at any time: https://www.healthcare.gov/​exemptions-​tool/#/results/​2018/​details/​short-gap — make sure to file IRS form 8965 with your 2018 taxes, as explained there.
So, if you want to switch to a non-ACA plan early, you can.

What we chose

We're going with the FMCA plan at the middle Sapphire tier, with a $250,000 calendar year maximum / $5M lifetime max, only 20% of first day hospital payment covered, for a premium of $296.94/month for us as a married couple. We chose not to get a critical illness rider ($10k for $14.44/mo) or the Enhanced Rider Benefits ($84.10/mo). Especially the first day hospital coverage seems to affect the premium radically, and I'm fine trading lower monthly premium for a risk of losing a few thousand dollars later — as I've said repeatedly, I mostly care about not going bankrupt because of major health issues.
At this level, the plan will pay us, for example (based on my understanding of the fine print):

  • $3,000/$6,000 per day for sickness/injury-related hospital stays (only 20% of that for first day in that year)
  • $4,500/$6,000 per day for hospital ICU stays (20 day yearly limit)
  • $80 per doctor visit
  • $350 per MRI, $80 per X-rays
  • $300 per ER visit (limit 1 per year)
  • $125 per urgent care visit (limit 1 per year)
  • $500 per ambulance ride (limit 2 per year)
  • $1,500 per helicopter ride (limit 1 per year)

We might combine that with the Escapees dental plan for Ane for her annual root canal, if we can — we're still figuring that out.
We're not exactly thrilled about the idea of not having a maximum out-of-pocket limit like in the ACA plans, but then again the whole U.S. health insurance industry is covered with so much fine print that we had very little faith in it to begin with. Or, as Ane put it while we were going over our options, "The only way we can feel good about the U.S. healthcare system is that we have a backup plan of moving to Finland" (Tommi is Finnish, and the Finnish healthcare system would never deny care for a resident).

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