Maintaining An Out-Of-State Health Insurance Policy

January 29, 2016 7:58 AM

I used to live in CT, where health insurance is cheap and great. A couple of years ago, I moved to NY (state, not city), where coverage is expensive and lousy. So I've maintained my old CT policy (Anthem), using a home address that's actually a mail drop. Am I living dangerously?

Affordable Care Act insurance in NY (at a comparable deductible, i.e. "silver"), is only a bit cheaper than my CT Anthem policy, and the coverage isn't nearly as good (e.g. it seems to favor substance abuse coverage; stuff like that). For one thing, no NY ACA policies allow out-of-network, as my current policy does.

posted by Quisp Lover to Health & Fitness (13 answers total)

Response by poster: Woops, I wasn't clear:

"NY (state, not city), where coverage is expensive and lousy"

There, I was talking about private, "regular" insurance, not affordable care act insurance (which I discussed in the follow-up).
posted by Quisp Lover at 8:00 AM on January 29, 2016

I knew someone whose job it was to find reasons to drop people from their health insurance. So basically the insurance company would just collect premiums (even if they had reason to suspect that something was up) and then if the person got a serious (Read: expensive) thing, they would investigate that person out the wazoo to find an excuse to drop them. It didn't have to be related to the condition or their healthy or anything -- any mistake or lie on the original form, for example, they could call fraud and say you'd bought your insurance fraudulently and just cancel your insurance.

I think the affordable care act made it less easy for insurance companies to just drop people, but if it's at all still possible, I would live under the assumption that if you become seriously ill you will find yourself uninsured immediately.
posted by If only I had a penguin... at 8:06 AM on January 29, 2016 [4 favorites]

I'm sorry, I'm unclear- is the CT coverage through an exchange? Are you filing your taxes at that same CT address? If you buy CT coverage through the exchange and file your taxes at a NY address, I think the CT exchange is going to catch you.
posted by ThePinkSuperhero at 8:22 AM on January 29, 2016

Response by poster: My CT policy is private. I'm exploring NY coverage (expensive/spotty) and NY ACA coverage (only a little cheaper than CT, but much worse coverage).
posted by Quisp Lover at 8:25 AM on January 29, 2016

It's probably not even legal for a CT insurance company to sell to a NY resident (insurance is largely regulated on the state level). Expect your insurance to work right up until you ask them to pay out a significant charge, at which point it will disappear.
posted by ryanrs at 8:30 AM on January 29, 2016 [3 favorites]

It's probably not even legal for a CT insurance company to sell to a NY resident (insurance is largely regulated on the state level).

I'm very skeptical of this claim. I work for a company headquartered in a different state and my insurance is through an insurer which has offices only in that state. They are well aware that I live in a different state and there have been no problems with the insurance. You should probably talk to a lawyer vs random internet people.
posted by enn at 8:36 AM on January 29, 2016

Yeah, I should have said that it's probably illegal to sell a CT policy to a NY resident. Of course you can have multi-state insurance companies, but they'll have different policies tailored to each state's regulations.
posted by ryanrs at 8:43 AM on January 29, 2016 [3 favorites]

I suggest you contact either an insurance broker or anonymously call the New York insurance commissioner and talk to them about it. NAIC.org

New York is a special snowflake and only allows insurance companies to sell insurance there if they incorporate there. So insurance giants who sell coverage in all 50 states wind up having BigCo Insurance plus BigCo New York, headquartered in New York, in order to do business in all states. No other state is like this. You do not wind up with BigCo Alabama or BigCo Wisconsin.

So I think if any state is going to really be an ass about this, it will be New York.

(Source: I used to work for an insurance company.)
posted by Michele in California at 1:17 PM on January 29, 2016

I live in CT and work in the health insurance industry, and my wife works in a doctor's office, so this is not foreign territory for me. I agree with the previous commentators that, yes, you are in a precarious position, especially if you have renewed your policy after moving. But I don't know how great the risk is.

OTOH, I somewhat doubt the premise that NY insurance is not as expensive or not as good. Not saying it's not true, just saying I doubt the difference is really huge. Your comparison to the ACA insurance is probably apples to oranges. The ACA insurance is underwritten (i.e. priced) for a bottom-of-the-barrel class of purchasers, i.e. people who can't get insurance any other way. If you can get covered through an employer, for example, the rates will probably be lower because that group will have lower medical expenses than a group of the unemployed/unemployable.

So, the first thing I would do would be to walk into a regular insurance agency and ask if they can get you a better deal than the ACA. Maybe they can, maybe they can't.

The next thing to do is to sort through all the connections in your life, schools you went to, organizations you belong to, etc and see if any of them offer some sort of group insurance. Professional organizations may do this if the organization has a lot of self-employed members.

Good luck. When I checked out the offerings on the CT Obamacare website, I as appalled at the huge deductible amounts, and you report the same for NY. Find another route to getting insured.
posted by SemiSalt at 1:29 PM on January 29, 2016

Does your CT insurance actually cover non-emergency treatments out of state? I tried to use my CA insurance for a doctors appointment in Boston and they wouldn't cover the visit.
posted by ananci at 1:57 PM on January 29, 2016

This isn't really what you asked, but there is potentially an alternative to insurance that is okay under the ACA, usually when paired with something to cover the pieces it does not. I recently did an FPP about it and here are a couple of articles about direct primary care:

http://www.nytimes.com/2012/05/22/health/direct-primary-care-providers-extend-concierge-services.html?_r=0

http://www.nytimes.com/2014/04/11/us/doctors-shun-insurance-offering-care-for-cash.html
posted by Michele in California at 2:13 PM on January 29, 2016

As a for instance, I just left a job in OR that had group insurance through Blue Cross of MA. When I left, Blue Cross of MA sent me a letter saying that it was not legal for them to sell individual (non-group) policies to non-MA residents.

When you sign the contract to buy the CT insurance, you are saying to the insurer that your home address is in CT. If this is not true you are lying to an insurance company, which is usually enough to void the insurance contract. Here be dragons!
posted by monotreme at 3:40 PM on January 30, 2016 [1 favorite]

Lying to an insurance company is also called the dirty F word by industry insiders: Fraud.

Fraud can not only void the contract, it can have legal repercussions, up to and including jail time, even if you weren't really intending it.

I knew someone once whose so called friends stole his car as a prank. He filed a police report and insurance claim. After he got the check, his so called friends returned the car. He did not promptly return the money. Even though the claim was made in good faith, because he sincerely believed it had been stolen, he did jail time for insurance fraud -- which is really sad because he had a wife and two kids and, really, the asshole friends should have been charged with something, not him.

Please, call someone in the know and get some answers.
posted by Michele in California at 4:11 PM on January 30, 2016