Best state in the US for Health Insurance

December 26, 2014 8:35 AM

Chronically ill, fixed income US expat. Is it possible to get affordable health insurance in the US? This is pretty much a hypothetical question, but I figure I’d do some research anyway. Snowflakes after the fold:

I am a US citizen that has lived internationally for about 2 decades. Around 5 years ago I developed a chronic illness that has taken me out of work and placed me on LTD payments through my last employer. The policy covers a significant proportion of my last salary through normal retirement age and continues to contribute to Super. I’m moderately financially stable, but unlikely to ever be able to return to meaningful work in my previous professions.

I receive treatment (~monthly IV infusions) for my condition through the public system in combo with private health insurance, hit the PBS safety net annually (for prescription drugs), am required to have monthly blood tests, see a GP and specialist monthly, require additional diagnostic and monitoring imaging periodically, regular physio, etc.

My brother and his family would very much like me to join their household. I’d like that too. They currently live in a single-payor country and have been expats for a couple of decades as well. The twist is they are strongly considering returning to the US sometime in the next year.

There are any number of significant reasons to me why I wouldn’t want to return to the US. One of them used to be the inability to get health insurance with my, very expensive, pre-existing condition. But with the advent of the ACA, it seems that that isn’t the absolute limitation it once was.

Speaking to family this week they said if I joined them, I could choose any state / city in the country I wanted. Aside from the practicality of them finding appropriate employment, housing, schools for the kids, etc, what states have the best health insurance options for someone in my situation and how could I go about figuring out the potential costs?

posted by anonymous to Health & Fitness (10 answers total)

Hard to say, but I'd guess California, Massachusetts or New York, since they already had good Medicaid plans in place before ACA.

Go to Healthcare.gov and check out what's available on the exchange.

I would be tempted to do what you're suggesting, as it sounds like you'd even be eligible for Medicare through Social Security Disability.
posted by Ruthless Bunny at 8:49 AM on December 26, 2014

Your eligibility for free, subsidized, or special plans depends on your exact income. The Kaiser Family Foundation has a good subsidy calculator.

If your income is less than 133% of the federal poverty line, you are eligible for Medicaid but not every state expanded Medicaid.
posted by JackBurden at 8:50 AM on December 26, 2014 [1 favorite]

It depends on your income. Unless you make less than $11,670 / yr, it won't matter too much which state you go to. If you do make less than that, you want a state that is participating in the Medicare expansion, i.e. not a red state, because the ACA deals with people at the bottom most income bracket by expanding Medicade to cover them.

Your best bet is to just go to the federal exchange and complete the application for whatever state is easiest for you. Then you will know. If you decide you want to start over with a different state, you can do a new application.
posted by jeffamaphone at 9:49 AM on December 26, 2014

Medicare is only avaliable to people who have paid taxes to the US and only avaiable after a certan age unless you qualify for SSDI which is a super long process and as an expat I highly doubt you qualify.

A big factor is going to be being in a place where all your medical treatment you need is available.

I'd say a large liberal state would be your best bet in a metropolitan area. Of course housing prices are a big concideration on a fixed income.

From what I've seen the plans on the exchanges try to cater to a location for in network rates. The federal exchange may have more generalized plans but I'm not sure.
posted by AlexiaSky at 10:12 AM on December 26, 2014

But with the advent of the ACA, it seems that that isn’t the absolute limitation it once was.

I would definitely go to healthcare.gov and see what would be available to you. While it's true that the ACA has made basic healthcare insurance more affordable, there are a ton of non-basic things that still seem to be subject to all manner of high copays, coinsurance schedules, etc.
posted by Thorzdad at 10:37 AM on December 26, 2014

Have you looked into whether you are a "qualifying relative"? I am almost certain that a disabled sibling who lives within a household can be added to the family insurance plan, which means that you may not even need to worry about your own coverage.
posted by rada at 10:38 AM on December 26, 2014 [1 favorite]

There will probably have to be some tradeoffs between housing/cost of living and availability of medical care. The states which have expanded their healthcare coverage under the ACA tend to be the more high cost of living ones.

You will also want to check and see if the specialists you need are available in the area(s) you are looking at. You don't want to be in the position of having coverage, but no doctors available near you. If there is any kind of support group or mailing list for your condition, you may want to talk to someone who lives in or near where you want to relocate, to see if the care you need is available there.
posted by Rosie M. Banks at 11:11 AM on December 26, 2014 [2 favorites]

In addition to choosing a state that has expanded Medicare, I would suggest picking a state that is very blue and likely to stay that way. In the next few years the Republicans are going to do everything they can to dismantle and destroy the ACA, and you want to be someplace likely to hang on to the law to the bitter end.
posted by Ursula Hitler at 10:00 PM on December 26, 2014

Consider living in a border town in Canada if that can work.
posted by yclipse at 4:20 AM on December 27, 2014

You could live in Rochester, Minnesota. Minnesota has excellent health insurance regulations that meant we had very high coverage even before ACA. The Mayo Clinic in Rochester is one of the best medical practices in the world, and is also quite affordable. Many, many people with chronic conditions (often older people) live there for that reason.

Rochester has only about 100K people and is surrounded by farmland, but it is pretty unique for a city of that size in that it has a booming downtown with tall buildings, a university campus, its own airport, etc. Houses are cheap, and it has some of the best public schools in the US. The Minneapolis metro area is only an hour away. Of course, finding a job might be a problem if you're not in health care.
posted by miyabo at 9:13 PM on January 13, 2015