Greg Hoffman
The first year I lived in my RV full-time, I paid $847 a month for a COBRA plan I didn’t even use because I was terrified of being without coverage and had no idea what my actual options were. That’s nearly $10,000 I handed over to my former employer’s insurance company while parked in state parks and BLM land, perfectly healthy, because nobody told me there was a better way. If you’re about to make that same mistake, or you’re already paying it, this is the article I wish I’d had.
Health insurance for full-time RVers is genuinely complicated, and I’m not going to pretend otherwise. The system wasn’t built for people who don’t stay put. But there are real, workable options, and once you understand how the pieces fit together, you can make a smart choice instead of a panicked one.
The Domicile Problem (And Why It Matters More Than You Think)
Before you can pick a health insurance plan, you need to know where you’re legally domiciled. Your domicile state is where you’re registered to vote, where your rig is registered, where your driver’s license is from. For insurance purposes, it’s the state whose market you shop in, and that matters enormously because health insurance is regulated state by state.
Most full-time RVers domicile in one of three states: South Dakota, Texas, or Florida. No income tax. Straightforward domicile processes for people without a fixed address. Active mail forwarding services set up specifically for travelers. Escapees RV Club in Livingston, Texas and America’s Mailbox in Box Elder, South Dakota are the two you’ll hear about most.
Here’s what most people don’t realize until it’s too late: the health insurance networks in your domicile state may be useless to you if you’re never actually there. A Blue Cross Blue Shield PPO based in South Dakota might have zero in-network providers in Arizona, where you spend your winters. Emergencies are covered anywhere, but routine care gets expensive fast when everything is out-of-network.
So when you’re choosing your domicile state, look at the insurance options available in that state’s ACA marketplace alongside the tax and registration benefits. They’re linked decisions, not separate ones.
The ACA Marketplace: Underused and Underrated
A lot of RVers assume the Affordable Care Act marketplace is just for people who can’t afford regular insurance. Wrong. It’s a federally structured exchange where you buy private insurance, and depending on your income, you may qualify for premium tax credits that make it genuinely affordable.
Here’s how the math can work in your favor: if you’re self-employed, freelancing, or living off savings or investments, you may have more control over your reported income than a W-2 employee does. Subsidies on the ACA marketplace phase in at 100% of the federal poverty level and can be substantial up through 400% FPL (and in some cases, beyond, thanks to the enhanced subsidies from the Inflation Reduction Act, which as of 2024 are still in effect). A single person making around $35,000 a year might qualify for several hundred dollars a month in premium subsidies.
The catch for RVers is the network issue I mentioned. On the marketplace, you’re looking for a plan with either a wide national PPO network or, ideally, a plan with “emergency only” out-of-network coverage you can actually live with. HMOs are generally a disaster for full-timers. You need a primary care physician in-network, referrals for specialists, and everything is geographically tied. I tried one HMO year for about 90 days before I realized I was paying for something I literally couldn’t use.
My honest recommendation for most full-timers shopping the ACA marketplace: look at the major PPO options in your domicile state, call the insurance company directly before you enroll (not the broker, the insurer), and ask specifically whether the plan uses a national network like Aetna’s or Cigna’s broad PPO, or a regional one. That single phone call has saved readers I know from serious headaches.
You enroll through healthcare.gov. Open enrollment runs November 1 through January 15 most years, with coverage starting January 1. A qualifying life event (quitting a job, losing employer coverage, moving states) can trigger a Special Enrollment Period.
The Options Most People Don’t Consider
27 BIG Lessons RVers Learn the Hard Way - Things Every RVer Owner Should Know · HappilyEverHanks on YouTube
| Option | Monthly Cost Range | Network Coverage | Pre-existing Conditions | Best For |
|---|---|---|---|---|
| ACA Marketplace PPO | Varies with subsidies | National or regional PPO | Covered | Most full-timers; income-dependent subsidies available |
| Health Sharing Ministries | $200-$400 | Community-based | Often excluded | Young, healthy individuals comfortable with non-insurance model |
| Short-term Health Plans | Lower than ACA | Limited | Not covered | Temporary coverage gaps only |
| Medicaid | Free (income-based) | State-specific only | Covered | Low-income full-timers (expansion states only; limited utility for travelers) |
| COBRA | High (example: $847/month) | Tied to former employer | Covered | Not recommended for full-timers |
Health sharing ministries are not insurance. Let me be clear about that upfront. Organizations like Liberty HealthShare, Sedera, or Zion HealthShare pool member contributions and pay each other’s medical bills based on community guidelines. They’re often much cheaper ($200-400 a month for a single adult) and some RVers swear by them. I know a couple in their 40s who’ve used Sedera for four years and been fine.
But I’ve also heard from people who got hit with a major medical event and found that certain costs were excluded under the sharing guidelines, or that reimbursements took months. These programs have no legal obligation to pay your claims. They’re not regulated the same way insurance is. If you have a pre-existing condition, many won’t cover costs related to it. If that risk is acceptable to you and you’re relatively young and healthy, health sharing is worth looking at seriously. If it’s not, don’t let the low monthly cost talk you into it.
Short-term health plans are another option people float. Cheaper than ACA plans, but they can deny coverage for pre-existing conditions, they cap benefits, and they don’t count as “minimum essential coverage” under the ACA. I’d only consider one if I was in a genuine coverage gap and needed a bridge for a few months.
Medicaid is worth mentioning because if your income is low enough (generally under 138% of the federal poverty level in expansion states), you may qualify, and it’s essentially free. The problem is that Medicaid is very state-specific. You can only receive care from Medicaid providers in your domicile state, which makes it nearly useless for a full-timer who’s traveling constantly. Emergency services are covered anywhere, but that’s about it.
What I Actually Do (And Why)
I’m domiciled in South Dakota. I use an ACA marketplace plan through Sanford Health that carries a national Aetna network on the back end. My premium after subsidies runs about $210 a month. My deductible is $3,500, which I keep fully funded in a Health Savings Account (HSA) at Fidelity. The HSA contributions are pre-tax, the money grows tax-free, and I can use it for qualified medical expenses anywhere in the country.
Pairing an HSA-eligible high-deductible health plan (HDHP) with a fully funded HSA is, in my opinion, the most financially sound approach for healthy full-timers who want real insurance coverage. You get catastrophic protection, nationwide access, and you’re building a tax-advantaged medical reserve at the same time. To qualify for an HSA in 2024, your plan’s deductible has to be at least $1,600 for an individual ($3,200 for a family), and your out-of-pocket maximum can’t exceed $8,050 individual / $16,100 family.
The total I’m spending right now, including the HSA contributions I’m making to build up that reserve: around $485 a month. That’s down from the $847 COBRA nightmare, and it’s real coverage.
Telehealth: Quietly Becoming the Full-Timer’s Best Friend
One thing that’s changed the RV life health picture significantly in the last few years is the explosion of telehealth. Services like Teladoc, MDLive, and Amazon Clinic mean I can get a prescription for a UTI or a sinus infection from wherever I’m parked, usually within an hour, without finding an urgent care in an unfamiliar town.
Many ACA plans now include telehealth visits at no cost or low cost even before you meet your deductible. If yours doesn’t, a direct-pay telehealth membership like Teladoc’s general medical plan (around $75 a month as a standalone) is worth considering as a complement to high-deductible coverage. I’ve used it from a campsite in the Gila National Forest with LTE signal and it worked fine.
For dental and vision, which health insurance rarely covers adequately anyway, I pay out of pocket for dental and use a discount plan called Careington (about $12 a month) that gets me reduced rates at participating dentists nationwide. It’s not insurance, but when you’re only getting a cleaning twice a year and don’t have a regular dentist, it does the job.
Getting this stuff sorted in your first few months of full-time RV life is genuinely worth the effort. The people I see struggling years in are usually the ones who picked a plan in a panic and never revisited it. Open enrollment every November is your annual reset. Use it.
Photo: Kampus Production via Pexels
Sources
- Kampus Production
- Certified Pet First Aid Kit with Guide Book
- EVERLIT 95-Piece Vet-Approved Pet First Aid Kit
Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.
- Certified Pet First Aid Kit with Guide Book (~$22), Certified pet first aid kit with step-by-step instructions, an essential item for every pet owner.
- EVERLIT 95-Piece Vet-Approved Pet First Aid Kit (~$32), Vet-approved 95-piece kit for dogs and cats, covers cuts, burns, sprains, and emergencies until you can reach a vet.
