Travel Lock: ​Explorers Lack Access to Healthcare

The Affordable Care Act made it possible for over 11 million Americans to access health insurance that covers preexisting conditions and essential health benefits. We saw the uninsured rate in the US drop dramatically, and many people were able to leave corporate jobs to start their own businesses because they could buy their own insurance on the Marketplace.

The law didn’t anticipate the exploratory nature of many millennials. The law did create network standards for health insurance plans, called Qualified Health Plans (QHPs), but those standards don’t extend beyond a plan’s service area. All plans must cover emergency care anywhere in the US, but ongoing or less-expensive routine care may be out of network most places. With plan selection based solely on permanent address (which not everyone has), and all plans in Wisconsin being HMOs or EPOs (narrow networks, no out of network coverage), these plans lock people into their immediate area for care. 

For example, only one plan in Wisconsin covers some limited providers out of state, and those providers are located just across the Minnesota border. That plan is only available in select western counties. No plan in all of Wisconsin has a national network. Some have such narrow networks that only one hospital system is available. This leaves travelers access only to emergency care, which can be extremely costly. I just looked at a balance bill from a hospital in Las Vegas for $29,000 after insurance covered at their in-network rate.

Adding to the problem is the fact that once you’re in a fully qualified plan (on or off marketplace), you can’t pause the plan while you’re traveling. Once you stop the plan, you can’t get back in until Open Enrollment (November 1st to December 15th) for the following year.

This leaves traveler types with a tough decision: pay premiums for insurance they can’t really use, or stop their coverage for the rest of the year, even if they are coming back to Wisconsin after their travels. Frankly, this system isn’t set up for our modern world, where more people are working remotely and young people are choosing travel over settling down.

What can be done? Write your representatives about improving the portability of ACA,  and write your insurance company about wanting a travel benefit and better emergency room coverage.