Where to move to for lowest health care costs (for nomad types)

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clast
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Where to move to for lowest health care costs (for nomad types)

Post by clast »

Inspired by the post "Should I move in order to save on taxes?" (viewtopic.php?f=2&t=204573), I'm posting this to see if anyone has moved or considered moving to another state in order to lower their health insurance or health care costs, or just get better health care.

For example, in Texas there are no more individual PPO plans (they all left). This post probably applies more to people who are self-employed or early retired. People working at a normal, physical employer obviously can't just get up and move.
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dm200
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Re: Where to move to for lowest health care costs (for nomad types)

Post by dm200 »

clast wrote:Inspired by the post "Should I move in order to save on taxes?" (viewtopic.php?f=2&t=204573), I'm posting this to see if anyone has moved or considered moving to another state in order to lower their health insurance or health care costs, or just get better health care.
For example, in Texas there are no more individual PPO plans (they all left). This post probably applies more to people who are self-employed or early retired. People working at a normal, physical employer obviously can't just get up and move.
Perhaps an equally important factor is the availability and quality of health care. Also, some locations may contribute to or encourage good health "Lifestyle" and costs go down because you do not get sick.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by seed4great »

Well, it depends how important health care cost for you. I believe Texas still has one of the lowest healthcare cost in the nation, along with California, Utah and NewMexico - there was a nice article about that: http://www.huffingtonpost.com/gobanking ... 30422.html. But if you are looking for ACA, many insurance companies are leaving this pool because they do not see how to earn money. For example, in California we have UHC left. Kaiser and Blue Cross are still there, but who know for how long?
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Watty
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Watty »

clast wrote:I'm posting this to see if anyone has moved or considered moving to another state in order to lower their health insurance or health care costs, or just get better health care.
Before the affordable care act I looked and there were several states including Hawaii that had health plans where someone in their early 60's could reasonably expect to be able to get health insurance. One of my fallback plans in case I got laid off when I was 60 would have been to move to a state like Hawaii and rent an apartment for a few years until I could get into Medicare and move where-ever I wanted to. (or more realistically move to Massachusetts for Romneycare in January in a blizzard :D )

State ratings would have limited value since in a state like New York the cities of Buffalo, New York City, and a small town in rural New York state would all be so different.

For reasonable costs and good quality health care one option to consider would be a college town with a good medical school and teaching hospital in a low cost of living area.
Last edited by Watty on Wed Dec 07, 2016 11:01 pm, edited 1 time in total.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sperry8 »

Be very careful attempting to move for solely this reason. State laws change. Federal laws change. So you may move to a State only to find out there has been a sea change and the reason you moved is no longer valid.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by protagonist »

I was surprised to find CA #3 best in the nation. Not a bad place to be..... http://www.huffingtonpost.com/gobanking ... 30422.html
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sperry8 »

protagonist wrote:I was surprised to find CA #3 best in the nation. Not a bad place to be..... http://www.huffingtonpost.com/gobanking ... 30422.html
CA is a big state. For those in LA who want a PPO you have one choice. And it's much more expensive than that website shows... and the deductible is 3x what it shows. So be careful when reading these websites and their analysis. If you are thinking of moving best to go type a zip code into a jurisdiction where you want to relocate and see the actual rates for yourself.

But personally I think HC is a moving target and you're not likely to be able to capture savings for more than 2-3 years before it is changed. I'm not sure a move solely for that criteria is worth it. Now if you're also moving to a no income tax State in combo with lower HC costs, that could make sense (for a nomad)
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Mintee »

Getting good information is harder than it seems. We moved to Texas from a midwestern state where most physicians, hospitals and other healthcare providers accepted most insurance plans. Beware, if you are considering Texas, that many providers here will not accept the plans offered in the individual insurance market. The premiums are very high, the deductibles are outrageous--but the biggest challenge is that almost no medical providers in the area will accept any of the individual plans. So, you are paying a lot for nothing and your exposure is huge. Next year, for example, only one hospital (not a good one) in this area (Dallas suburb) will accept the Blue Cross/Shield HMO plan. We are challenged to find a physician who will accept the HMO plan who also has privileges at the only hospital that will take the plan.

I don't know how, prior to our move, we could have determined that we would have these problems, as healthcare access has continued to devolve here. It is a major stressor.

I think the next few years will be ugly for early retirees who don't have employer-provided healthcare. If you are now in a state with reasonable access to healthcare, you may want to consider remaining until a healthcare solution is actually in place.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Rupert »

I think the safest thing you can do is move to a town with a medical school and affiliated hospital. It has been my experience that all providers at such facilities participate in the same networks.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by protagonist »

sperry8 wrote:
protagonist wrote:I was surprised to find CA #3 best in the nation. Not a bad place to be..... http://www.huffingtonpost.com/gobanking ... 30422.html
CA is a big state. For those in LA who want a PPO you have one choice. And it's much more expensive than that website shows... and the deductible is 3x what it shows. So be careful when reading these websites and their analysis. If you are thinking of moving best to go type a zip code into a jurisdiction where you want to relocate and see the actual rates for yourself.

But personally I think HC is a moving target and you're not likely to be able to capture savings for more than 2-3 years before it is changed. I'm not sure a move solely for that criteria is worth it. Now if you're also moving to a no income tax State in combo with lower HC costs, that could make sense (for a nomad)
I agree with all this.
I'm currently happy where I am in MA (#17 out of 50). At least for as long as I escape every winter.
I would think there would be many other criteria that would make one decide where to live that would have much higher priority than health care costs for most people (such as what makes you happy, where you have family and friends, lifestyle, climate, hobbies, etc.)
Just about any state is affordable to most people, though some might require financial or lifestyle compromise. Maybe you can live in a mansion in Oklahoma for the price of an apartment in NYC. Some people would choose the mansion. Others would choose the apartment. Both would very possibly be miserable if they had to trade. Neither is right or wrong.
I also agree that the fate of affordable health insurance in the USA is a real crap shoot now, and making a major life decision based on it is like speculation in investing.
Last edited by protagonist on Thu Dec 08, 2016 11:49 am, edited 4 times in total.
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Orion
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Orion »

With current talk of repealing and/or replacing the affordable health care act, it seems like you could spend a bunch of money moving and then find everything completely different in a year or two anyway. At this time, I would probably only move for health care costs if the move was to another country, as different countries do have dramatically different systems and costs.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Hayden »

seed4great wrote:Well, it depends how important health care cost for you. I believe Texas still has one of the lowest healthcare cost in the nation, along with California, Utah and NewMexico - there was a nice article about that: http://www.huffingtonpost.com/gobanking ... 30422.html. But if you are looking for ACA, many insurance companies are leaving this pool because they do not see how to earn money. For example, in California we have UHC left. Kaiser and Blue Cross are still there, but who know for how long?
That article focuses on cost; I wish there were an analysis focused on networks. Each year I switch my health insurance to the plan that offers the biggest network that year (each year I get a letter telling me they are no longer offering my plan so I have to select a new plan). I guess I'm fortunate in that I can still find a PPO plan to purchase in Washington.

I am basically a nomad, and this is definitely a factor for me in deciding where to live.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by hicabob »

seed4great wrote:Well, it depends how important health care cost for you. I believe Texas still has one of the lowest healthcare cost in the nation, along with California, Utah and NewMexico - there was a nice article about that: http://www.huffingtonpost.com/gobanking ... 30422.html. But if you are looking for ACA, many insurance companies are leaving this pool because they do not see how to earn money. For example, in California we have UHC left. Kaiser and Blue Cross are still there, but who know for how long?

I don't think Kaiser is going anywhere, in fact Kaiser appears to be increasing in California. They just acquired 3 new facilities where I live and will start offering service next Jan 1. Their bronze HSA is currently about 66% of the cost of the BCBS bronze HSA plan so I expect they will be very popular. I was surprised Kaiser seems to non-existent in WA state since that's where I thought they started?
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Re: Where to move to for lowest health care costs (for nomad types)

Post by protagonist »

Hayden wrote:
I am basically a nomad, and this is definitely a factor for me in deciding where to live.
Do nomads decide where to live?

(Thinking of a bumper sticker from the 1970s: "Anarchists unite! You have nothing to lose but your decentralized principles.")
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Re: Where to move to for lowest health care costs (for nomad types)

Post by jebmke »

dm200 wrote:Perhaps an equally important factor is the availability and quality of health care.
That is our biggest concern as retirees. Even in a small state like MD there is a lot of variability. The quality is mostly mediocre on the Eastern Shore but when you get to Baltimore, DC suburbs or Annapolis there are many good options.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Levett »

You might comb through the following website.

http://www.well-beingindex.com/

If you are a nomad, it seems obvious to me where you do (and don't) want to go.

But I will say nothing further.

Lev
protagonist
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Re: Where to move to for lowest health care costs (for nomad types)

Post by protagonist »

Levett wrote:You might comb through the following website.

http://www.well-beingindex.com/

Lev
I'm very skeptical of reports like this.

Of course, Hawaii gets the highest score. For one thing, Hawaiian retirees tend to be rich, and many chose to be there. If you have a lot of money and don't have to work, you will probably give any place you choose to live a high score. In part because you chose it, and could afford to choose it.

That said, I am sure Hawaii is a good place to live for many reasons, if you can afford it.

The #4 state on the list is North Dakota. What does North Dakota have in common with Hawaii??? It's probably high on the list among those who want to be able to afford luxuries (large home, nice car, travel, etc) on a more limited budget. I doubt if people go there for the climate, or the beaches. They are vastly different people than Hawaii choosers.

I recall seeing a list of world cities ranked in order of liveability or some such thing. Four of the top five were in Switzerland. Lagos was near the very bottom of the list. I forget what the #1 choice was....let's say Zurich. They interviewed a bunch of people living in Zurich and they were all complaining. They then interviewed a bunch of people living in poor, crime-ridden, dirty Lagos and they seemed happy.

The bottom line is that one man's meat is another's poison. By the time you get to retirement age, hopefully you have a pretty good idea of what you want out of life and where to get it.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Artsdoctor »

Rupert wrote:I think the safest thing you can do is move to a town with a medical school and affiliated hospital. It has been my experience that all providers at such facilities participate in the same networks.
This would make intuitive sense, but reality doesn't always make sense. UCLA shocked nearly everyone several years ago when it terminated all contracts with Blue Shield. And it wasn't for just a month or two to make a point.

A year ago, trying to map out a plan using the current health plan availability was difficult enough. Going forward from here, I would assume that 2017 is going to be a very, very rocky year when it comes to health plans. Insurance companies have to make decisions on what the law is, and they're not betting much on knowing this going forward.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Northern Flicker »

protagonist wrote:I was surprised to find CA #3 best in the nation. Not a bad place to be..... http://www.huffingtonpost.com/gobanking ... 30422.html
This is highly suspect and misleading data. They suggest the cost for an individual without discussion of age as if age doesn't matter, and for at least one of the states they quote premium level after a premium tax credit is applied.

For California to be 3rd cheapest they must be averaging costs for all counties, including, say, towns in the Mojave Desert with coastal communities without weighting the data by population. There is no way health care costs in California coastal cities are 3rd lowest in the nation.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by mouses »

Rupert wrote:I think the safest thing you can do is move to a town with a medical school and affiliated hospital. It has been my experience that all providers at such facilities participate in the same networks.
Thank your lucky stars that you'll eventually get old enough for Medicare (assuming it still exists.) I live semi-near the Boston teaching hospitals and the doctors there all seem to take Medicare. Indeed, even in the nearby state in which I live, Medicare seems to be almost universally accepted, despite the rumors one hears on the web about a lot of doctors not taking it. Medicare and Plan F or whatever the Plan F replacement is and you're good to go.

I do think it's important to be near a teaching hospital, especially as one gets older. Not only are there experts there, but it seems to raise the quality of healthcare in the general area.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by goaties »

You could do what I've been doing for the past couple weeks: use the healthcare.gov website to see what rates are like for policies in other states. Once the Dec 15 deadline passes, I'm not sure how accessible it will be, but right now is a golden opportunity. Just don't log in! That's likely to make the system think you actually want to apply for a new state!
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Re: Where to move to for lowest health care costs (for nomad types)

Post by misterno »

Mintee wrote:Getting good information is harder than it seems. We moved to Texas from a midwestern state where most physicians, hospitals and other healthcare providers accepted most insurance plans. Beware, if you are considering Texas, that many providers here will not accept the plans offered in the individual insurance market. The premiums are very high, the deductibles are outrageous--but the biggest challenge is that almost no medical providers in the area will accept any of the individual plans. So, you are paying a lot for nothing and your exposure is huge. Next year, for example, only one hospital (not a good one) in this area (Dallas suburb) will accept the Blue Cross/Shield HMO plan. We are challenged to find a physician who will accept the HMO plan who also has privileges at the only hospital that will take the plan.

I don't know how, prior to our move, we could have determined that we would have these problems, as healthcare access has continued to devolve here. It is a major stressor.

I think the next few years will be ugly for early retirees who don't have employer-provided healthcare. If you are now in a state with reasonable access to healthcare, you may want to consider remaining until a healthcare solution is actually in place.
Just curious
why wouldn't the facilities do not accept the individual plans? Is that because maybe you enrolled to a very cheap plan? Or they are refusing to accept no matter what kind of individual plan you have? even the expensive ones?

What can be the reason for this? I keep hearing the same thing from other people also
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Re: Where to move to for lowest health care costs (for nomad types)

Post by ncbill »

If you want truly low-cost medical care it's available, just south of Texas.

Many expats there choose to buy into the national health care system (IMSS) for catastrophic (e.g. heart attack or hit-by-a-bus) care.

It's priced by what decade you've reached.

Given my age, I'd pay less than $200/year.

Of course, most expats pay privately for routine care, though private insurance plans are available.

If they can't handle it down there, well, just moving back to the U.S. is a qualifying event to signup for an ACA plan.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sawhorse »

Healthcare costs in Massachusetts are low, but most everything else is expensive, so overall you still pay more to live there.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Watty »

misterno wrote: Just curious
why wouldn't the facilities do not accept the individual plans? Is that because maybe you enrolled to a very cheap plan? Or they are refusing to accept no matter what kind of individual plan you have? even the expensive ones?

What can be the reason for this? I keep hearing the same thing from other people also
If they provide any coverage for out of network doctors the insurance might pay 50% of what they think a procedure should cost and the patient would need to pay the rest. For example a doctor might charge $100 for something, the insurance company might say it should have cost $60 and only pay $30. The doctors office would then need to try to collect the other $70 from the patient. Many insurance companies are also very hard to deal with. If the doctors is already busy then there is no need to go through that.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by protagonist »

sawhorse wrote:Healthcare costs in Massachusetts are low, but most everything else is expensive, so overall you still pay more to live there.
I know that Bogleheads are, in general, very frugal types, but it also seems to me that most of the frequent posters on this forum are financially quite secure and comfortable.

IMHO, I think many (certainly not all) give TOO MUCH priority to frugality, when it comes to the most important decisions- eg. where to live, not what cell phone service to use.

Yes, certainly MA is more expensive than, I would guess, ND for example. But low health care costs and low cost of living do not equal happiness. It is no surprise that Hawaii has the highest COL in the country and is also listed as the best place to retire- natural beauty, climate, beaches, recreational opportunities, etc.

I can afford to live in MA, given my lifestyle, and live there happily. I like it here. Others may not, and that is certainly understandable.

And where I live isn't really all THAT expensive. I live in a very cool, beautiful college town with lots of cultural and recreational opportunities as well as easy access to NYC, Boston, Montreal, beaches, mountains, history, etc. I own my home and my taxes are reasonable. I have saved money on health insurance via Romneycare since I retired in 2008, and despite having some of the best medical facilities and academic centers in the country, our health care costs are relatively low here. I can afford to travel and escape the winters. I can live very well here on $50000/year and do anything I want to do, and when I turn 70 I should be getting about $35K/year from social security. I would not get much pleasure out of living in a mansion or driving a Tesla.

So given that, why would I want to move, just to save money on housing and health care? He who dies with the most toys does NOT win. When (and if) I turn 80 or 90 or so, maybe I will move into a simple apartment and save money and hassle. Or maybe not.

To those for whom cost is their #1 priority, and who are not seriously financially compromised, I would humbly suggest that you might consider other factors than cost of living to a greater extent when planning where you will be happiest for the rest of your life.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by cannondale »

Go to the cheapest Kaiser place and buy it. You can use Kaiser insurance at all Kaiser facilities where they operate....with certain like scheduling with your primary physicians.

Kaiser bought out group health in Seattle. Now, they have pretty good coverage in Washington state.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sperry8 »

sawhorse wrote:Healthcare costs in Massachusetts are low, but most everything else is expensive, so overall you still pay more to live there.
The OP stated he was/is a nomad - and will not be "living" there (thus not incurring the cost of living).
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Volkdancer »

Protagonist, could you share the name of that college town? I am considering a move to MA and as you describe your location, it sounds like a reasonable compromise between Boston and Pittsfield, Karl V
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Re: Where to move to for lowest health care costs (for nomad types)

Post by btenny »

Go to northern California and sign up for Kaiser. It is a good health care setup. It is in expensive. They have good networks with lots of good doctors in their plans. Most of the people who live in and around Sacramento and the Bay area really like them. This of course assumes you can be true nomad and only go there once year to get your health check ups and annual tests. Otherwise if you become a California resident and make any money you will owe state income taxes. So income taxes will cost you and may offset any health care costs savings. But NorCal is very nice place to live and retire. So there are trade offs.

Good Luck
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Hayden »

cannondale wrote:Go to the cheapest Kaiser place and buy it. You can use Kaiser insurance at all Kaiser facilities where they operate....with certain like scheduling with your primary physicians.

Kaiser bought out group health in Seattle. Now, they have pretty good coverage in Washington state.

Thanks for this info. I'm in WA, looking for the plan with the best coverage.
How does Kaiser work for a nomad lifestyle? Do they provide coverage out of state?
Does Kaiser cover doctors at the major WA hospitals? Or only at their facilities?
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sperry8 »

btenny wrote:Go to northern California and sign up for Kaiser. It is a good health care setup. It is in expensive. They have good networks with lots of good doctors in their plans. Most of the people who live in and around Sacramento and the Bay area really like them. This of course assumes you can be true nomad and only go there once year to get your health check ups and annual tests. Otherwise if you become a California resident and make any money you will owe state income taxes. So income taxes will cost you and may offset any health care costs savings. But NorCal is very nice place to live and retire. So there are trade offs.

Good Luck
If you get your healthcare from California you will be considered a CA resident for tax purposes. Will wipe out any savings.

If you're a true nomad then pick among the no-income tax states. I think you need to pick a PPO so you can see doctors wherever you are. If you're abroad it won't matter since any medical needs you have will be an emergency and not covered until you hit your deductible anyway. LIkely you'll need to come back to the States if you have an issue and need a procedure rather than checkup.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by Mintee »

Regarding the Texas individual plans: The plans available on the individual market are HMOs. As I mentioned, very few physicians and only one hospital in our area will accept the Blue Cross/Blue Shield HMO (plans offered by other insurers have even less accessibility). HMOs are a hassle for a physician, and I'm sure they are for hospitals, too. Because even fewer providers accept the plan this year than last, I'm guessing that Blue Cross of Texas hasn't paid claims or has made the process difficult (they have certainly made it difficult for me).

Interestingly, my husband has to go to another town to find a physician who will accept Medicare. We are about a mile away from a good hospital with good physicians and specialists next door, but none will take my Blue Cross HMO and no physicians will accept Medicare.

We viewed the ACA rates before we moved here, so we knew how much insurance would cost, but we didn't know that we wouldn't be able to use the insurance. And we couldn't have predicted the huge increase in rates.

Thus, the caution.
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Re: Where to move to for lowest health care costs (for nomad types)

Post by sperry8 »

Mintee wrote:
We viewed the ACA rates before we moved here, so we knew how much insurance would cost, but we didn't know that we wouldn't be able to use the insurance. And we couldn't have predicted the huge increase in rates.

Thus, the caution.
Exactly. So OP as a Nomad, I strongly suggest a PPO so you can go out of network and just pick the State with the lowest healthcare PPO cost and lowest deductible from the 6-7 tax income-free States.
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