Sue Lani Madsen: Buyer beware, some health insurance isn’t as portable as it may seem

College students on their parents’ health insurance share the same portability problem as retired snowbirds.

“Typically my coverage is great, just not here in Pullman,” remarked one student last week.

Health insurance portability was supposedly addressed in 1996 with the passage of the Health Insurance Portability and Accountability Act, or HIPAA. The fix focused on the problem of employees trapped by a pre-existing condition if they wanted to change jobs. For dependents under 26 year old who are on their parents’ insurance, provider network limitations create lack of portability from home to campus.

Emergencies aren’t the problem. Public and private insurance gatekeepers generally don’t second-guess the need unless the patient has achieved super-utilizer status in the system. System abuse is not the norm, and grounding “frequent fliers” is a complex issue.

For the ordinary student living out of state, the challenge is follow-up care. There is no longer an emergency after a broken bone is stabilized, a tumor is found or a concussion is diagnosed. Local treatment means paying more out of pocket to set the bone, remove the tumor or monitor the concussion. In-network treatment adds the cost of traveling home and missing classes.

Even without an emergency, primary care is an issue. Many chronic conditions like diabetes, asthma and mental health care require ongoing treatment. Portability of care is critical for students, independent contract workers and migrating retirees. Instead of being trapped in a job, people are trapped in a ZIP code.

Staying on parents’ insurance was not uncommon prior to the ACA. Employer-based group plans commonly extended coverage to college students as tax dependents at a reduced rate. Insurance actuaries took notice when the ACA expanded eligibility to any 26-year-old. The result was increased premiums for dependents older than 18, now rated as more expensive adults.

For parents and students enrolling in health insurance this month, it pays to do the numbers. Parents may be better off subsidizing an individual plan based wherever their student is living for most of the year. Students are better off with regular access to primary care without interrupting school or waiting until the next semester break.

It’s not a private insurance problem that goes away with Medicare for All. Even Medicare isn’t completely portable.

Theoretically, original Medicare can be used to access health care anywhere in the United States. Practically, finding a practice that will take a new patient while you’re visiting family for a few months may be a challenge. And coverage for travel outside the United States is nonexistent under original Medicare Part A, which only covers hospitalization anyway. Medicare Part B supplements may cover some primary care while traveling under limited circumstances.

The official recommendation from Medicare.gov is a private option plan sold under Medicare Advantage for anyone planning foreign travel, including Canada and Mexico. Read the fine print if you have plans outside the country.

Tony Kiepe, licensed medicare agent with United Healthcare, confirmed some nationally available Medicare Advantage plans now offer support for travelers. United Healthcare, Kaiser, Molina and others have developed options in response to market demand.

It’s not just a problem for foreign travel. United Healthcare offers the Passport program for access to a reciprocal network of Medicare providers for Spokane snowbirds, but read the fine print. It depends on where they nest for the winter.

California does not take United Healthcare’s Passport. Arizona and Oregon do. And in the 40 or so states providing reciprocal network access, some counties don’t. Spokane residents visiting Seattle can’t use the program to access primary care, although they could go to an emergency department or an urgent care clinic. It’s incredibly complicated.

“Clients call me and I check exactly what county they’re traveling to,” Kiepe said. “I typically give them a few suggestions based on ZIP code.”

And there we are, back to the problem of health insurance and health care tied to ZIP code. Curt Fackler, former candidate for Insurance Commissioner, has been living this dilemma the last year.

“Always appreciated you pointing out the challenge isn’t buying insurance across state line, why not across county lines? That could be fixed at the state level,” said Fackler as we discussed his new snowbird lifestyle. “I don’t understand (Insurance Commissioner Mike) Kreidler saying he’s such a consumer advocate and not fixing that.”

Snowbirds and students would appreciate it.