Many pre-Medicare RVers either can't afford an Affordable Care Act (ACA) health plan or the plan they can get doesn't have a network of providers outside a very limited geographical area.
Therefore, the FMCA RV Club, through RV Insurance Benefits, has recently introduced an alternative - The FMCA Health Plan.
To request a quote from RV Insurance Benefits and/or to be contacted with details to see if this plan is a good fit for you, please complete and submit the form below.
Or to see more of what we have to say about the plan, keep reading.
FMCA Health Plan Details
The plan is a limited-benefit fixed-indemnity plan which means it is NOT an ACA-compliant plan, so it doesn't qualify for Premium Tax Credits (aka subsidies) to help reduce premiums.
However, it is more robust than most indemnity plans and can serve as a stand-alone healthcare plan with lower costs. Most indemnity plans are designed to be a supplement to other health plans, but this one can protect you and provide savings.
AND, with the repeal of the "individual mandate" effective in 2019, there would be no penalty if you decided this plan was to be your primary plan.
Let's look at the Pros & Cons:
1) The premiums are less expensive than an ACA plan with no subsidies.
2) You can choose your level of coverage and all policies have a lifetime maximum of $5,000,000.
3) You don't have to enroll during the limited annual enrollment period (currently November 1 - December 15) or need a special circumstance exemption. You can enroll any time.
4) The benefits renew automatically each year. You do NOT have to re-apply every year.
5) Personal and geographic flexibility. You can choose your service providers anywhere in the country and don't need a primary care physician or referrals.
6) It includes access to the largest PPO network in the nation - PHCS through MultiPlan - and choosing providers in that network will save you a lot on healthcare costs.
7) You don't pay for coverages you don't need. With the ACA plans, many full-time RVers are paying for coverages they will never use and for out-of-pocket limits they will never come close to needing.
8) No deductibles.
9) You have the option to assign claims payments to the healthcare provider or to have the claims payments made directly to you so you can pay the bills.*
10) It includes the TelaDoc plan at no additional cost.
11) It includes Karis360 at no additional charge. Karis360 includes a) the Healthcare Navigator concierge service which can assist in locating a doctor, healthcare facility, lab, or imaging services plus more, b)) the Karis Surgery Saver which shops for the best combination of cost and expertise for non-emergency surgeries in your area, and c) the Karis Bill Negotiator which attempts to negotiate your out-of-pocket costs, if any, after services are performed.
12) It includes the ScriptSave prescription savings card which is accepted at over 62,000 pharmacies.
13) Though it's best if you can qualify through your answers to the underwriting questions, FMCA members with a two-year or longer membership that cannot qualify can get a "guaranteed issue" plan. If you are not an FMCA member, you can join through our FMCA link and get $10 off your membership.
14) Once you are on the plan, it is "guaranteed renewable" up to age 65.
15) The plan can be used either as your primary insurance, or it can supplement other coverage you may have and pay you cash to help cover any out-of-pocket costs.
16) The plan documents are filed with the Department of Insurance for every state where the plan is available. This IS insurance and there are additional consumer protections in place. This is a "pro" when comparing to HealthCare Sharing Ministries plans which are not insurance and are not regulated.
16) Not only is this plan available to FMCA individual members, it is also available to FMCA Commercial members AND their employees. This is a HUGE opportunity for small businesses in areas that have few health insurance choices.
* - Claims Payment Process
1) It's not ACA-compliant, so if you can get an ACA plan with national coverage and you qualify for subsidies that significantly reduce your premiums, you should just do that. This is our current situation; otherwise, we would be signing up for the FMCA Health Plan.
2) It's NOT comprehensive "major medical" insurance (that's why it's less expensive and more flexible), but it does protect you from most financial risks that may arise in the course of obtaining health care ($100,000, $250,000, or $1,000,000 annually per person based on the coverage level you choose, and $5,000,000 lifetime per policy).
3) It's different. It's not what we've become used to in a health insurance plan and you may have to become more involved in managing your healthcare choices. BUT that's where Karis360 comes in to provide assistance in choosing service providers, controlling costs, and negotiating out-of-pocket expenses. I list this as a "con" because we've become somewhat spoiled in the way we obtain healthcare, but it's not necessarily a bad thing to take a more active roll and being more selective in your healthcare providers and the amounts you pay for services.
4) Pre-existing conditions are not covered in the first 12 months. They are handled as follows: "PRE-EXISTING CONDITION means a condition for which medical treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a Covered Person’s Effective Date. A condition shall no longer be considered a Pre-Existing Condition after the date a person has been covered under this policy for 12 consecutive months."
5) ACA plans cannot have annual or lifetime maximums on the minimum essential benefits, while this plan has annual limits (you choose $100,000, $250,000 or $1,000,000 per person) and it has a lifetime maximum of $5,000,000 per policy. (This is how most policies were set up prior to the ACA, and is another factor that makes this plan less expensive than ACA plans - not every risk is covered, but you can see a significant amount of financial risk is covered and that will more than suffice for most of us).
6) By itself it DOES NOT qualify to be used in conjunction with a Health Savings Account (HSA). Personally, none of the other "cons" bother us, but we're big fans of Health Savings Accounts, so this one would bother us a bit. If you don't have an HSA or have never used one, you can ignore this "con".
Who Will Most Benefit From The FMCA Health Plan?
This plan is different than most indemnity plans and it's absolutely worth a look IF:
1) You are an RVer that travels all over the country,
2) You are not yet 65 years old and not eligible for Medicare,
3) You don't have a health plan provided by your employer or former employer,
4) You don't have a military or government health plan,
5) You can't afford the premiums, deductibles, or co-insurance of an ACA plan,
6) You have an ACA plan, but it doesn't have a national network of providers,
7) You are looking for a lower cost option that may not cover every possible healthcare financial risk, but that covers most of them.
If you have any interest in finding out more about this plan, complete and submit the form above. There are many more details and benefits that we can't get into here, and you have nothing to lose by getting a quote or learning more.
Health Insurance is complicated and confusing, and there is a lot of mis-information out there. It's been changing more than ever in recent years.
When we started full-timing, we just selected a plan and stuck with it making slight, easy adjustmets. Now people are having to restructure their health insurance every year.
And the folks at RV Insurance Benefits can help you come up with a plan that works best for you.
They are RVers helping RVers, and even if the FMCA plan isn't a good fit for you, they can do a health insurance assessment with you, and recommend options that best fit your needs and budget.
They are a full service agency with 24 years experience and a decade of assisting RVers. And in addition to the FMCA Health Plan, they can assist with ACA plans, Short Term Plans. Medicare Supplements, Part D and Medicare Advantage Plans.
So, if you don't think the FMCA Health Plan is right for you, you can still request a consultation to discuss your particular needs with experts that care about RVers by completing the form below.
What Do We Have?
2005 to mid-2018
Well, we started out with a domicile in Kentucky in 2005, and we got an Anthem Blue Cross Blue Shield high deductible ($10,000) plan was qualified to use with a Health Savings Account. We had 0% co-insurance if we were to hit our deductible and preventative doctor's visits were covered.
From 2005 to 2014 our premiums were as low as $155/month for the two of us and went up to $263 by 2014. Fortunately, we were on a "grandfathered" plan when the ACA kicked in, but our premiums then started going up more rapidly $332 - 2015, $388 - 2016, $412 - 2017, $523 - 2018.
Still, not bad, so we stayed with our "grandfathered" plan, and we took advantage of the tax benefits of our HSA contributing funds to it and using those funds for any out-of-pocket medical costs.
Those most recent years were good financial years for us, so we didn't qualify for a subsidy, and changing plans to an ACA plan would have doubled our monthly premiums.
Mid-2018 - ?????
But, in 2018 we changed domiciles to Florida and had to change policies giving up our "grandfathered" plan.
Fortunately, or unfortunately, depending on how you look at it, our income dropped below the threshhold for a two-person household and we were eligible for subsidies for an ACA plan.
We chose a Florida Blue BlueSelect Bronze (HSA) 1735 plan with a national network of providers through the Blue Cross/Blue Shield network - pretty much the same as we had in Kentucky.
It is also an HSA-eligible plan, and has a $6,000 per person deductible and a $12,000 family out-of-pocket maximum. We have 0% co-insurance after the deductible is met.
So, it is very much like our prior Kentucky plan but the base premium was $1,160/month over double what we were paying for basically the same thing in Kentucky. However, our subsidy covered the entire amount, and we paid nothing for the last half of 2018 after we changed domicile.
For 2019, the premium is increasing to $1,272/month and our subsidy (based on the same income) will be $1,210/month so we will pay $62/month in 2019.
Of course, if our income goes up, we'll have to pay back some or all of the Premium Tax Credits (aka subsidies).
Here's the bottom line. Because we are domiciled in a state that still has national network coverage and because we are currently eligible for a subsidy, this ACA plan is certainly the way to go for us. And if you have similar circumstances, that's probably the way you want to go.
However, IF our income increases to a level where we're no longer eligible for a subsidy, we can't afford $1,272/month (or higher in future years) and we'll be looking at the FMCA Health Plan.
Or, if we lose national in-network coverage that we need while traveling, we'll be looking at the FMCA Health Plan.
We're just like anyone else. We want the most coverage we can get for a cost we can afford. And our main objective is to indemnify ourselves from healthcare costs that could financially send us into bankruptcy.
But it is far too expensive to try to protect against every potential scenario, so we have to decide how much risk we're willing to take, factor in the odds of the occurrence of a healthcare catastrophe, and determine how much protection we can afford.
Should we earn too much and lose the subsidy, we're just not going to pay $15,000 - $20,000 a year for an ACA plan with more coverage than we need, and the current alternatives are quite limited.
Just for comparison purposes, we got a quote on the middle level (Sapphire) FMCA Health Plan. For the two of us (both born in 1963 and Florida zip code), the monthly premium would be $488 for the following.
**- Resource-Based Relative Value Scale - Developed by Harvard University, this is system used to assign a value to medical procedures adjusted for the locations where the procedures are performed. This is how Medicare payments to doctors are determined.
There is an optional Enhanced Benefit Rider you can purchase that doubles the above Outpatient Benefits (although it's not yet available in all states).
Those are most of the benefits of the Sapphire plan, but certainly not all of them.
Plus there are other riders that you can add to further enhance your coverage if you so desire. And there are Dental, Critical Illness, & Accident products that are available as well.
With the lower tier plan, the Ruby plan, the annual out-of-pocket limit per person is $100,000 and the benefits listed above are, for the most part, cut in half. But the monthly premium will be less, and that may perfect for younger, healthier RVers.
The higher tier plan, the Emerald Plan, has an annual out-of-pocket limit per person of $1,000,000. Though that annual limit is four times the Sapphire plan, the benefits are not even doubled, so it would be hard to justify the additional premium for that plan, in my opinion, especially because the lifetime maximum is still $5,000,000 for all three tiers.
Of course premiums will vary by your age and your zip codes as well as what level of coverage you choose. Again, for a quote on an FMCA Health Plan, complete the form near the top of the page.
Health Insurance has always been a major obstacle for those wanting to become full-time RVers. The FMCA Health Plan attempts to provide coverage to us mobile folks that want a reasonably priced plan with national coverage and more control of our healthcare options.
Again, just like full-timing, it's not for everybody, but RV Insurance Benefits can assist you in determining what might work best for you.