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Full-timers buy health insurance in their domicile state and then spend most of the year somewhere else. That is the one situation local HMO and EPO plans were never built for. Here is what works before Medicare.
Full-time RVers buy coverage in their legal domicile state, and most Marketplace plans there are HMOs or EPOs that pay only for emergencies outside the area. Healthy full-timers under 65 should price a private plan on a nationwide PPO network next to full-price Marketplace coverage. Full-timers with health conditions, or with income under the 2027 subsidy line, usually do best on the Marketplace and plan routine care for visits home.
Full-timers have been writing about this for over a decade: a plan that looks fine on paper turns out to have no in-network doctors outside one metro area. The fix is to choose the network first and the premium second.
| Option | Strength on the road | Trade-off |
|---|---|---|
| Private plan on a nationwide PPO network | In-network care across the country | Health questions; possible exclusions; no tax credit |
| Marketplace plan in your domicile state | Guaranteed issue in open enrollment; tax credits if eligible | Often local network only; plan routine care for home visits |
| Health sharing ministry | "Any provider" flexibility | Not insurance; no promise to pay. See our comparison |
Telehealth closes some of the gap on any plan. It does not set a broken wrist.
Many full-timers live on savings, part-time remote work or seasonal workamping, which often puts MAGI under the 2027 subsidy line of $86,560 for a couple. If so, a tax credit can make a Marketplace plan the best value even with a local network. Retirement account withdrawals, Roth conversions and capital gains all count toward MAGI, so plan them with the line in mind. The calculator shows where you land.
At 65 the picture changes. Original Medicare works with providers who accept Medicare anywhere in the country, which suits life on the road. Many Medicare Advantage plans are built on local networks, the same problem in a new form. Plan that decision before your 65th birthday.
Self-employed and 1099 income is counted after expenses. Our free calculator shows which side of the 400% line you land on in about a minute, with results right away and no sign-up.
Under 65, most use a Marketplace plan from their domicile state or, if healthy, a private plan on a nationwide PPO network. Some use health sharing ministries, which are not insurance.
On Marketplace plans, emergency care is covered anywhere. Routine care depends on the network; many Marketplace HMOs and EPOs pay nothing outside their area.
It depends on your income and health. South Dakota expanded Medicaid; Texas and Florida did not. Plan choices and networks differ by state. See our domicile state guide.
Checked October 14, 2026. Rules and dates change; confirm before you act.
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