By the time you’re done reading this post, it’ll probably be pretty clear there’s little love lost on the insurance providers I’ve dealt with.  They don’t get what full-time RVers do, or they get it and don’t like it.  I don’t get anything for my opinions here (if I was, I probably wouldn’t get away with what follows).

WARNING: This series of posts about insurance contains some political commentary, along with both religious concerns and alternative lifestyles. If you’re offended by an approach to managing medicals costs that doesn’t offend someones preferences (religion, diet, or otherwise), this post probably isn’t for you.

Background

First, a little background.  My home state is South Dakota, and I’ve been buying my own insurance for years. For 2015, I enrolled in a plan through the healthcare.gov marketplace from DakotaCARE.  It was fairly inexpensive, but I understood that there was essentially no non-emergency care outside of South Dakota.  It was essentially a catastrophic plan, similar to what I had purchased on my own before the ACA went into effect.

Fast forward to mid-February, and DakotaCARE started asking for additional information:

DAKOTACARE policies are built to provide the best benefit for members who reside in the state of South Dakota. Preventive care services and non-emergent major medical and routine care (unless otherwise preauthorized) MUST be received from a South Dakota participating provider in order for services to be covered.

The address listed on your enrollment was that of a mail forwarding service. Due to the address information received we are asking for the following documentation to verify your eligibility for this policy.

DAKOTACARE requires that Policyholders shall have a permanent address located within the state of South Dakota and must physically live at stated residence.

Please submit the following items for verification of residency:

• Proof of payment of property taxes or copy of rental agreement
• Copy of valid SD Driver’s License
• A recent utility bill for the address noted in the enrollment listing the applicant as the resident

Now, given the extent to which coverage was already severely limited outside of South Dakota, my travels would generally mean a reduced risk to DakotaCARE. But nevertheless, they didn’t want me.  The ACA penalty provisions make all kinds of exceptions, including when the cost of insurance is excessive, but not if no one will write a policy.

It likely wasn’t contemplated because of the guaranteed availability provisions in 45 CFR 147.104.¹  It doesn’t say coverage has to be provided to anyone with a lease or driver’s license, just someone “in the State”–so DakotaCARE is likely violating the law in this regard.

I have to give them credit for being very forthcoming with policy documents, and otherwise professional in their interactions with me.  It just wasn’t going to work the way I had wanted.

Wellmark BCBS Off-Exchange

So on to what I actually succeeded with. My first policy under the ACA was from Wellmark BlueCross and BlueShield.  It was a PPO plan that allowed me to use just about any doctor or pharmacy nationally, qualified as minimum essential coverage and covered the preventive services and essential health benefits talked about last time.  I was generally pretty happy with it, despite its cost.

My plan was purchased off-exchange, direct from an agent in South Dakota.  Pricing was the same as direct from Wellmark or through the marketplace, but my RVer status wasn’t disqualifying.  The (slight) downside is that by not buying from the marketplace, I’d be ineligible for any subsidy even if otherwise qualified.

Many people would struggle with payment terms here. Wellmark BCBS required payment by check, no credit cards, and required payment in advance, 6 months at a time.  The average American doesn’t have that kind of money just sitting around.

Going into the next year, rates were going up.  Not as bad as in many places, but about 50%.  Given the limitations in other plans available, I swallowed hard. The plan still offered good coverage, and there didn’t appear to be any new offerings.

Last fall, however, Wellmark announced discontinuation of all individual plans in the state (after some impressive communication snafus and confusion).  That left me back in the hunt for insurance to start off 2017.

Trying the Marketplace Again

Looking at ACA plans for 2017, I examined what was available in the marketplace again, especially after lots of reading regarding acceptance of full-time RVers.  Avera was the only company that would, and they had a couple of plans that were generally reasonable (or at least not crazy unreasonable), so I picked one and enrolled.  They advertised a national network of PPO providers, which I searched and found a number of past doctors listed in.  Unlike DakotaCARE, there were no provisions listed in their literature requiring preventive and non-emergency care to be rendered in South Dakota.

I had confirmation of enrollment through the marketplace, but January rolled around with no communication from Avera.  I contacted them early in the month (ahead of the cancellation window in the ACA) to make sure they received payment and that the policy was in effect.  Here’s where things started heading south.

I had a routine appointment early in the new year, and wanted to make sure I had all of the necessary information, and to confirm the provider was still going to be in-network for 2017.  She asked who the provider was–they wanted to look it up for me.  I gave them the information, and the agent started explaining that their nationwide PPO network was for emergency use only, and that out-of-network coverages weren’t for routine care (even though the SPD said otherwise).

I’m pretty sure Nancy Pelosi began explaining things at this point.  She told me that if I wanted to see a copy of the policy, I would have to make a payment.  I know they can’t give me a policy number, ID cards, etc. without payment, but given the apparent discrepancy, I didn’t think it was unreasonable to ask for a copy of the policy language.  But I decided to comply.

Like Wellmark before them, they wouldn’t accept payment by credit card.  For a long list of reasons including both security and convenience, this is bad practice.  Charge a convenience fee if you must, but don’t ask for my bank account information.  I reluctantly supplied it, and the agent transferred me again in an attempt to get a copy of policy information, access to their web portal, and the information I’d need for my doctor.

I asked for a copy of either my policy or a sample, so I could look over the provisions myself.  She refused, saying that it would arrive some time later with a welcome packet.  Of course, if the coverage wasn’t satisfactory and I waited until after the enrollment period closed, I wouldn’t be able to select an alternative.  I explained that, and she said the policy wouldn’t explain what she told me in more detail anyways–that I wouldn’t really know what was covered until a claim was processed!?!?!  She insisted that all I needed to know was the information in the plan summary, and that I would have to return to South Dakota for any non-emergency care to be covered.

I was on the phone for well over an hour, before getting to the point that I was frustrated enough to cancel.  So I asked to cancel.  Big surprise: we can’t do that.  We went in circles for a while before I gave up again.  I finished the phone call and I contacted my bank.  Avera didn’t get a nickel from me, and they ultimately cancelled the policy.

Like my failed enrollment in 2015, I continued getting information from healthcare.gov about my successful enrollement–something to keep in mind when you hear reports about the number of people enrolled through the marketplaces.

Is this a Unique Experience?

No.  In most states, there are few–if any–marketplace or ACA-compliant insurance plans that will write policies for full-time RVers.  Those that do generally don’t know what we do, and work via a friend/relative’s address to slip through.

If you want a good overview of some other non-ACA insurance options, check out this overview.  I disagree, however, with their assessment of the Health Care Sharing Ministries, which will be the subject of the next post.

1. “a health insurance issuer that offers health insurance coverage in the individual, small group, or large group market in a State must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products.” https://www.law.cornell.edu/cfr/text/45/147.104