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.

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  1. Gee, I am constantly told that we Americans have the best health care system in the world. And it must be true if “best” can be measured by how much we pay for it. Only disloyal people would think of measuring health outcomes to determine which country’s health care system is best.

    I’m over 65. I love my Medicare. Other than beating the alternative, it’s the only good thing about turning 65.

  2. Actually, we’re having the same problems with Medicare Advantage plans when moving to a different state. Some are “free,” but I think that really means you are in charge of a lot more administrative tasks. Six months in, we’re still trying to get a referral to a specialist, and get copies of our medical records…

  3. MEDICARE for everyone!!… It’s such a simple solution to a terribly aggravating problem… I’m on it now but when I was working I would have happily paid a monthly premium for coverage because I had crap insurance that cost a lot of money… But, the problem in this country is and always has been “follow the money”… Money and lobbyists from and for the health care industry buy the votes of politicians to keep the status quo… #%(*&^%$#!!

  4. I’m no expert on blockchain, but one the useful applications of the technology is to eliminate the administrative bloat that you describe. It’s insane that seeing a new doctor or dentist to fill out forms hasn’t changed in my lifetime.

  5. Health insurance is the opposite of health care. Never mind the arguments about distributed risk or shared responsibility; government-administered insurance plans do the same more efficiently and at lower cost. Private health insurance exists only to interrupt caregiver-patient relationships and extract money by controlling access.

    Good luck dealing with the people whose salaries depend on their ability to avoid helping you.

  6. My company’s new benefits provider partners with a company called Health Advocate, whose whole purpose is to advise you about situations like this and call your insurance company on your behalf to help you negotiate medical bills or get procedures approved. I’m glad to have help, but my first reaction on learning about Health Advocate was to feel so angry that such a business has to exist. The way we do healthcare and insurance in this country is so broken.

  7. My condolences! I’ve lived thru this insurance nightmare several times, due to 1) moving to a different state, 2) moving to a different county within the same state or 3) an insurer dropping its participation in Obamacare. (Yes, when I moved only 15 miles in one state, I had to get a new insurer and new PCP, because the first company only insured people in specific counties).

    Looking forward to Medicare.

    Wish that we had Medicare For All (like many “civilized” countries). But, with so many politicians being in the pocket of insurance lobbyists, I often doubt I’ll see universal health care in my lifetime.

  8. Oh yes…. when I hear tails like this I think what we could of had if Ted Kennedy had not shot down Nixon’s Universal Healthcare Program…..

  9. The problem happens intrastate too. I live in a rural area, work in another rural area, and we have trouble with the Arizona state employee insurance. It’s because >80% of the state’s population lives in the Phoenix/Tuscon metro area. We are part of the proud 20%.

    Although the US has the best health care in the world (by far) or maybe because of that fact, I am in favor of a Constitutional amendment to standardize healthcare and provide catastrophic insurance.

    Heck, an honest discussion on health would be most welcome. It seems that none of the sides are interested.