Self-employed and moving to a new state? Good luck with your medical insurance.

The state lines in the US might as well be national borders if you’re trying to change your health insurance.

I recently moved from Massachusetts to Maine, a total distance of 100 miles. I am self-employed and was paying the usual insane amount for my own health insurance in Massachusetts, including coverage for my spouse and a child in college in Massachusetts.

Did you know that Maine used to be part of Massachusetts until 1820? Right about now, I’m wishing it still was.

All I can tell you is, don’t get sick in the middle of transferring your health insurance.

To get health insurance for my wife and me in Maine in the middle of a year, I had to:

• Prove I lived in Maine.
• Prove I had health insurance before (which requires navigating the bureaucracy of the previous insurance company to get a letter certifying proof of insurance).
• Agree to have money deducted from my bank account.

To get separate health insurance for my daughter in Massachusetts in the middle of the year, which was necessary since her doctors are all in Massachusetts, I had to:

• Prove she was a resident with a copy of her driver’s license.
• Prove she lived in Massachusetts with a copy of a lease and proof of lease payments.
• Prove that her current health insurance was in effect before (same letter from the insurance company).
• Prove that her current health insurance was ending, because I was cancelling it. (It takes a week to get this proof after you cancel your insurance.)
• Agree to have money deducted from my bank account.

This is just paperwork. If you do it too soon or too late, you’ll have a gap in your insurance coverage. But the really fun part is if you need actual medical care while doing this.

What happens if you get sick in the middle of changing states?

How hard is it to get a new Primary Care Physician in a new state? All the doctors recommended to me were not taking new patients. Try getting any medical care covered without a PCP. (I ended up solving this problem by getting my old doctor, who happens to teach primary care in a Boston medical school, to twist the arm of one his former students now practicing in Maine to get her to take us on, even though she’s officially not taking new patients. That path certainly isn’t available to most people who are moving.)

I recently had a procedure with a specialist in Massachusetts. Now she wants a followup after I’ve moved. It’s easy enough to drive down there. But I’m sure my Maine insurance won’t pay for that.

More troubling: I had a test result from my doctor in Massachusetts that requires me to see a specialist immediately. It makes no sense to start a relationship with a specialist in Massachusetts when I’ll be living in Maine. But if I see a specialist in Maine before my Maine insurance kicks in, I need a “cross-border referral.” Without the referral, the Maine specialist won’t book the appointment — so I needed to spend hours securing special permission to see a specialist in my new state on my old insurance. Keep in mind that medically, this appointment is supposed to be happening as soon as possible.

Then there’s the question of making my Massachusetts medical records available to my doctors in Maine. I now have two Epic “MyChart” accounts — one in each state. Luckily, there is an option buried deep within MyChart that allows linking the two accounts, so now the doctors in Maine can see the records from Massachusetts.

Of course, all this is happening while I’m in the midst of moving and serving clients.

What a stupid system

Both of my insurance companies — Massachusetts and Maine — are Blue Cross affiliates. Of course, that doesn’t matter. They have nothing to do with each other.

Obamacare is a dumb system. It’s a halfway measure. Without it, I couldn’t get insurance at all — I wouldn’t be covered for pre-existing conditions, of which I have many, and I’d be charged an incredible amount just for being old. Obamacare is way better than nothing. But because it’s a halfway measure, changing states is a potentially life-threatening decision.

I have only positive things to say about the medical professionals I’ve dealt with. They are, to an individual, intelligent, thoughtful, and dedicated to my health. It’s nuts that they have so many staff who must spend their days dealing with insurance craziness. I am pleased with those insurance navigators as well. My problem is that the system requires them to exist.

In my imagination, there is a health care system where insurance is the same regardless of where you live, where all your doctors can easily get access to all your medical records, and where you can see doctors or specialists in any state you want, depending on where you happen to need care, not based on where you are insured. And where the cost of care isn’t inflated based on the people in doctor’s offices and insurance companies whose job is to deal with a system based on something other than the best health for the people it serves.

Of course, that health care system exists. In fact, I’ll have access to it in two short years, when I turn 65. It’s called Medicare.

I’m looking forward to it. And to politicians that are ready to fix the stupid state-based system we are all living with now.