December 1, 2022

Upon my retirement at age 59 from the place that I worked at for 42 years, my human resources representative advised me to be certain that I checked the limitations and exclusions on any private health insurance or marketplace (HMO) that I would be purchasing before my Medicare coverage started at age 65. I had been covered by a group health care plan (PPO) with that employer. After having been employed for 46 years, in addition to providing caregiving to both of my parents until their deaths, I was looking forward to traveling, which I have not been able to do in prior years.

In doing my research for private health insurance coverage, I contacted every local agency selling private insurance. I asked each of the agencies, “How does the Virginia HMO private health insurance work when traveling out-of-state lines? What happens if I am injured or get sick while I am traveling outside of the state of Virginia?” Much to my dismay, not one agency was required to disclose this coverage information and most agents were not aware that private health insurance does not provide coverage outside of the state of Virginia. Many states are promoting tourism, yet this unknown, undisclosed, and very important bit of information in regard to health insurance is not provided.

In the state of Virginia, 65% of individuals are on group health insurance (PPO) and 35% are on private health insurance (HMO). I would purchase health insurance for out-of-state travel, but such policies are not offered for sale. The PPO insurance option was removed, and no comparable option is available for purchase. Beware travelers if you are covered by private health insurance plans! If you have a health emergency, you will have a very expensive trip.

If I were traveling out-of-state and were to incur a health emergency due to an accident or was put on life-saving care, medication, etc , I would not be covered and would be 100% responsible for my health cost the moment I was up-graded to stable status. How much do you think the cost would be? How about hundreds of thousands of dollars? Do you know that there were 560,000 bankruptcies last year due to health insurance balance dues? The not-covered out-of-state travel is not discussed during open enrollment and unbelievably most agents are not even aware of this limitation. This is not acceptable! There needs to be a law in place to require this information to be disclosed to anyone that is purchasing private health insurance.

Our elected congressman Ben Cline, needs to be held accountable to act on this vital issue that is so important to his constituents who are not made known of this exclusion upon purchasing their Marketplace insurance.

I would like a law that requires all agencies selling private health insurance to inform their clients verbally — not in small print writing — of this very important limitation of no out-of-state coverage for all policies sold in Virginia. Agents need to be made aware of this limitation in the policies.

I would respectfully provide this information to all reading this article and ask others to join me in holding our elected officials accountable to their jobs of representing their constituents to the best of their ability. This issue must be addressed before another bankruptcy happens to another innocent, unaware traveler.

Do something.

CH Phillips Jr. lives in Lacey Spring.

https://www.dnronline.com/opinion/open_forum/lapses-in-health-insurance-coverage/article_8edbbbc1-9261-5227-ac9a-d09107704e8a.html