Health insurance needed for regular check-ups… what’s the deal with that?

Hey everyone, I’m a bit lost and couldn’t find answers online. My partner says he has to go back to his home state 4 times a year for health check-ups because his insurance requires it to stay valid. He doesn’t have any serious health issues, so it seems strange to me. Has anyone heard of something like this?

Thanks for sharing this! Just a few things to consider:

  • If there’s an emergency, please call 911.

  • For best advice, you might want to add your age, state, and income details, since these often impact insurance advice.

  • An explanation of benefits (EOB) can help you understand your coverage and what’s expected.

  • Make sure to avoid any offers or spam; if you receive any, please report it.

Be kind to everyone here!

This sounds really strange… It could maybe be one of these:

  1. He might be on a narrow-network insurance plan, so if he doesn’t keep going back to that area, they might see it as fraud or cancel the plan.
  2. Or it could be a plan that isn’t ACA-approved for your state, and he’s trying to keep up appearances by going back, so they don’t realize where he lives.

Either of those sound like what could be going on?

@Harlan
Yeah, it could be one of those for sure.

Maybe he actually needs to go every few months for a prescription refill, not for the insurance itself? Some medications require check-ups every three months for a renewal.

If that’s the case, though, he should really switch to insurance and doctors where he’s living now.

@Chen
You know, I didn’t think of that. He did say it was for insurance, but maybe it’s more about needing refills for something small. He also mentioned having a reason to go home because his family is there. It seems like it’s convenient for him in more ways than one.

Like others, I’ve never heard of ACA insurance needing four check-ups a year just to keep the plan active.

If he has insurance from another state, it might be an issue if he’s not actually a resident there. You mentioned it’s ‘affordable,’ which could mean there’s a subsidy, but those usually require you to live in the state where you got the insurance.

@Indigo
That’s exactly what I was thinking! He used to work as a trucker here last year, so I figured they’d know by now. It would make sense to have one preventative check-up a year, but four times? Seems costly, and usually, insurance isn’t keen on covering more visits than necessary.

I think he might be making this up, honestly. Some prescriptions do need regular check-ins, but insurance usually doesn’t care that much.

Vesper said:
I think he might be making this up, honestly. Some prescriptions do need regular check-ins, but insurance usually doesn’t care that much.

As someone who does billing, I’ve never seen health insurance that covers four annual physicals. But for chronic conditions? That’s another story. And, being a trucker, his doctor might want extra check-ups if he’s on medication or has something that needs watching.

Do you know what insurance plan it is? Or who’s providing it? This whole setup sounds unusual.

Paz said:
Do you know what insurance plan it is? Or who’s providing it? This whole setup sounds unusual.

All I know is it’s apparently an ‘affordable’ plan. Just seems like it’d be more expensive to keep flying back and forth so often. I don’t get it.

@Uma
Very strange, right? If it’s legit, there must be more affordable options closer to home. But it’s like there’s something he’s not saying. I’ve got a hunch he might be purposely keeping things vague. Usually, ACA plans will cover one wellness exam per year, not four! If you can, try to get more details about what he’s calling ‘insurance’ here. Might clear some things up.

@Paz
The only thing that comes to mind here is a plan with a max limit of 4 visits, not a minimum. Some non-ACA plans limit how many doctor visits they cover. Can’t imagine an insurance plan that would need 4 visits just to stay active. If anything, insurance wants to pay less, not send you to the doctor unnecessarily.

Maybe not the same, but I knew someone who’d fly back to his hometown just to see his dentist. He had family there and trusted that dentist, so he made a trip of it. Not a common thing, but people do that sometimes for their own reasons.