Health Insurance for RVers

This article is being offered here with the permission of its author. If you are an RVer or have any interest in RV's, I recommend you visit their excellent web site. It can be found at

Almost all health insurance plans sold in Florida use an out of state association. It does not mean they are bad companies. It does limit the state's ability to hold their rates in check. They do comply with state insurance laws and you don't have much of a choice. Generally speaking, we like to stay clear of Texas based companies. We have had the most problems with them. Also, do not buy a plan where there the company's name does not include the suffix "Insurance Company". You don't want a health plan, a medical plan or a plan for members of a specific trade. It is all bogus. If you give us a call we can help you navigate your way through the mess. But don't ask us for driving directions. I get lost in my own neighborhood.

Health Insurance Options For RVers
By Jaimie Hall

Originally published in the March/April 2002 Workamper News.

Finding affordable health insurance with good coverage can be a big stumbling block to hitting the road. There is no simple answer. There is no way around doing your own research to see which state and policy is right for you. Your search will be compounded by the fact that each state regulates insurance companies so you’ll find great variance in prices, coverage and consumer protections. Costs will vary too, based on factors like your age, type of coverage, state of your health and any preexisting conditions.

Immediate solutions

If you will be losing coverage with your former employer, you have a few options to consider.

COBRA: You may be eligible for COBRA coverage. You can continue coverage under your current policy for 18-36 months by paying the entire premium, which cannot exceed 102% of the cost of group coverage. Some states mandate continued coverage for a longer period of time. (http://www.dol.gov/dol/pwba - Consumer Infor- Health Plans/Fact sheets or order brochures at 800/998-7582.)
Conversion: Convert your group policy to an individual policy. Some states require health insurance companies to do this without consideration of any preexisting conditions, though the premium may be more expensive or coverage less. In Florida it is not unusal to see rates between $800 and $1000 for a 50 year old couple. Remember that the only person who should elect such an expensive option is someone who has no other choices due to a medical condition.
Medicaid: States provide Medicaid to low-income families who meet income guidelines. Each state sets their own eligibility requirements so it is worth checking into if your income will drop. Florida Medicaid as well as many other states require you to be below the poverty level.
Open enrollment: Check to see if your state has an open enrollment period for HMOs. You must be accepted regardless of preexisting conditions. (Not all states require this.) You will not find this in Florida.

Choose your state

One advantage of full-time RVing is that you can choose your domicile, or legal tax home. Health insurance coverage could be an important factor in this selection. Where you have health insurance coverage should be a state where you plan to spend some time each year and you will get your annual checkups. You would return to this state if you have a condition or illness that needs treatment.

You will need an address in this state. One RV couple had been insured in Oregon. When they began full-timing, the company willingly billed them through their mail forwarding service in another state. Several years later, when filing claims for an illness, the company declined coverage, saying the couple no longer had an Oregon address. The couple was able to rectify this but make sure you have an address you can use. On the other hand, Kaiser, an HMO in California and other states, told Sharon, another RVer, that extensive travel was not issue as long as they came back for checkups and treatment. (Emergency treatment is covered in a non-Kaiser facility.)

There are a number of resources that can assist you in comparing states and seeing what is available.

AARP Web site has a section on health insurance. Health Insurance Options for Midlife Adults can be ordered from them or viewed at the Web site. Here you can find some basic information and definition of terms. http://www.aarp.org
Agency for Healthcare Research and Quality has some excellent articles on choosing a health insurance plan, explains terms and provides questions to ask. http://www.ahcpr.gov/consumer/ Look under Health Plans.
Georgetown University Web site allows consumers to check laws for each state. Consumer guides for each state may be viewed online or printed out. http://www.healthinsurnaceinfo.net
National Committee for Quality Assurance (NCQA) has useful information and accredits and rates health insurance plans by state. You can search by state or zip code for plans, see their rating, and link to that company’s Web site. http://www.healthchoices.org/ or call 1-888-275-7585.
Consumer Health Education Council (CHEC) has helpful articles under Consumer Gateway. http://www.healthchec.org/consumer/consumer.html

To obtain coverage rates, many companies use insurance brokers. Choose an independent broker that does not charge any fees except perhaps a small setup fee when you actually select a policy. A broker can save you some leg work by identifying companies that provide coverage as well as allowing you to compare rates. In Florida there is never a reason to pay a broker a dime. As a matter of fact you should never make out a check to an insurance broker directly. They are paid a commission from the companies they represent.

Check the company
Make sure the company is regulated by your state. An out-of-state company may not be. Some RVers join an association to obtain coverage. However, true group coverage where the health insurance plan is guaranteed issue and there are no medical declines, is available only through an employer-employee relationship.

Check the company’s A.M. Best rating. The company should tell you what it is if you ask and the agent probably also has that information. However, double-check at the A.M. Best Web site for any updates. If the rating is A- or better you will see it printed on the companies literature or web site. Anything less is a badge of shame and might not be as prominent.

Check with the state insurance regulatory body. Contact information for each state can be found at the Georgetown Web site.

Is the company covered by state insurance laws? - if the company is "appointed" to do business in that state you are on reasonable safe ground. You cannot expect to find the top insurance companies incorporated in every state.

Once you’ve decided on a state, obtaining affordable individual coverage can be a challenge. It may be difficult to find a company that will sell you a policy, particularly if you have a serious medical problem. You may have to prove you are insurable by getting a medical exam and taking tests that rule out certain conditions the company does not want to pay for. Premiums for individual coverage are generally lower than for group coverage but you may get less overall coverage. Actually, most of you did not pay for all of your group health insurance and the employer covered at least half the bill or more. So, it might seem that individual coverage is more expensive. This will certainly be the case if you are forced to purchase a guaranteed issue plan under the Portability Act. In a non-guaranteed plan, ompanies may exclude treatment and prescription coverage for certain conditions which you have had in the past.

In obtaining coverage, you need to weigh your medical needs against what you can afford to get the best coverage for your money. As you may have discovered, the same coverage in one state can cost more than in another.

The main types of policies are:
Fee-for-service insurance (indemnity insurance): Traditional type of health insurance that pays a portion of each medical service you get, such as doctor’s visits and hospital stays, while you pay the remaining cost. The insurance company does not begin to pay a portion of the costs until you pay the deductible. Plans without any deductible at all are virtually non-existant. Premiums are generally higher than Managed Care.
Managed Care Plans: Also known as HMOs (health maintenance organizations) or PPOs (Preferred provider organization). The health insurance company has contracted with doctors and hospitals to provide services. You pay a monthly premium and then a small amount for each visit or service (usually $10-$15) called a co-pay. Some plans allow you to use doctors and hospitals outside of the plan network but you pay more per visit.

Evaluating coverage
An independent agent or broker can help you compare several companies. Talk to several to find one you are comfortable with and who offers policies from several companies. It is generally a bad idea to buy health insurance from a captive agent. They usually have plans with less than adequate coverage. This does not apply to other types of insurance. Ask questions about each policy and make a comparison chart. An agent can answer many of these questions, but examine the policy itself as well.

- How much of my doctor and hospital bills will this plan pay for?
- What is the monthly premium?
- How much will I have to pay for a hospital stay before the plan begins to pay?
- How much will I have to pay for office visits to the doctor?
- Does the plan pay for preventive health care, such as routine checkups?
- Does this plan have rules for people who already have serious, chronic medical problems? Will this keep me from getting the care I need? A pre-existing condition should be described as a condition "for which you have received treatment, medication, or advice in the past six months" as opposed to having manifested itself for a particular time before the policy began. In the second case, a company could deny coverage of cancer because it might have been growing for more than six months even if you had no knowledge of it.
- If there is a deductible, does it start over each year (preferable) or for each new illness?
- What services are covered by this health insurance? Will it pay for visits to the emergency room or urgent care center? Does it cover routine surgery, hospital stays, doctor visits, skilled nursing facility care, home health care, and medical equipment and supplies?
- Does the plan cover visits to an eye doctor, dentist (rare) or prescription drugs?
- Does the plan pay for catastrophic medical costs?
- Is there a yearly or lifetime limit to how much the plan will pay for medical costs? The lifetime limit should be at least three million dollars.
- Are rate hikes based on individual or pooled claims? (In the case of pooled claims, the company raises the rates of an entire category, not individuals.)
- Are rates based on my age at the time the policy is issued (preferable) or my "attained" age?
- Is the policy Guaranteed Renewable/Non Cancelable (preferable) or is it just Guaranteed Renewable?

Check out the company
Good agents will give you insight into the companies they recommend. Check the financial stability of each company by asking for its A.M. Best rating. It should be an "A" or a "A-." Verify this at the A.M. Best Web site.

Check also with the State Insurance Department or Commission about any company you are considering. Make sure the company you are considering is regulated by your state. If not, the company may hike rates or drop coverage for those who file "excessive" claims. Check to see if there is a history in this state of companies filing for bankruptcy and passing the clients over to a "sister" company, at higher rates, thus eliminating high risk clients. In some states, companies will leave the state or stop issuing individual policies if costs get too high.

Reducing monthly premiums
Companies often offer indemnity policies with differing deductibles. The larger the deductible, the lower the monthly premiums. The percentage the company pays after you have paid out your deductible may be either 50% or 80%. If you are relatively healthy and have money in the bank to cover your deductible if something major happens, you might choose a higher deductible and the lower coverage. Or, set up a medical savings account to cover out-of-pocket expenses (check with your tax preparer on eligibility and how to do this).

Remember that deductibles are per person. A $5000 deductible for a couple will be considerably less expensive than two $2500 deductible plans and about 20% cheaper than having two $5000 deductible plans. Keep in mind that no matter how much you try to get a better deal, the insurance company has already thought of it and closed up the loophole.

You may be eligible for group health insurance at lower rates through a group or association. However, caution is advised. RVer Shaneen obtained association health insurance provided by an out-of-state company. Her premiums were jacked up from $125/month to $1800/month after a bout with breast cancer. She had no recourse because Florida does not regulate out-of-state companies. In some states, association policies fall under different regulations as well. Be sure to check with your state insurance department. In all probablity, Shaneen purchased an ERISA plan which is a formula for trouble. Florida doesn't even allow these plans to be sold anymore and is prosecuting the agents who marketed them. Maker sure the company is an insurance company that is appointed to do business in the state. That way, even if something happens, the state guarantee pools will kick in. If it is too good to be true.. it probably is.

Read and study your policy. Remember, a lower premium may indicate poor coverage, not savings.

Pre-existing conditions
Individuals with pre-existing conditions will have more difficulty finding health insurance coverage. Depending on the state, you may be able to obtain coverage through one of the following ways:

Open enrollment: Managed care companies in some states must have an open enrollment period each year where the company cannot consider any pre-existing conditions. (In Florida this is for valid businesses only. Individuals are not eligible unless they are self-employed).
Health Insurance Portability and Accountability Act (HIPAA): This federal law may help you convert your group or COBRA policy to an individual policy. (If you are over 40 this is expensive. If you are over 50 it is absurdly expensive. If you are over 60 it will kill you just to hear the premium)
State requirements: A dozen or so states require that insurance companies offer health insurance to individuals who have not been able to get health insurance because of their health status even though they don’t want to cover you. The insurance in these states is more expensive if you are healthy but much better than HIPAA if you need the plans.
High-risk pools are available in some states for those who have not been able to get insurance because of a serious medical condition. Most of these pools have been converted to Medicaid.
Temporary coverage: You may be able to get a policy for up to a year that will cover catastrophic expenses such as hospitalization from an accident. They generally exclude existing or pre-existing conditions but give some protection. The underwritting for these plans only looks back three years. So, you might qualify for this plan. However, if you get sick during the year, you are out of luck when it comes time to renew. This is a short-term answer.

Check with the state insurance department to find out if any of these options apply to you.

© 2002 Jaimie Hall


All pages copyright © 2000, 2001, 2002, 2003 Stephanie Bernhagen and/or Jaimie Hall unless otherwise noted.
All rights reserved. No reproduction without written permission from the authors.