2016 Health Insurance Update

A very pink sunrise viewed from bed last Friday.

A very pink sunrise viewed from bed last Friday.

Last year, I wrote a pretty lengthy article on South Dakota health insurance for pre-retirement RVers. You can review that article for the full story but here’s a recap:

Up until 2015 I had a low cost, high deductible plan that would cover me in case of emergency only, everything else I paid out of pocket. My emergency fund was large enough to cover the deductible.

Starting in 2015, the Affordable Care Act (more commonly known as Obamacare) changed the health insurance scene for full-timers dramatically. Everyone over 30 now had to have full insurance – high deductible plans didn’t meet the requirements – or pay a penalty.

Because of my income level I qualified for a subsidy that made the insurance cost similar to what I paid for the catastrophic plan, but I wasn’t able to take advantage of my shiny new “real” insurance, because all of the plans offered on the Marketplace required a person to be within South Dakota for routine or extended care (luckily emergency care was still covered). Not very nomad friendly.

I decided about this time last year when I was signing up for coverage that I’d be moving to Texas this year, since one of the insurance providers in Texas (Blue Cross Blue Shield) still had PPO plans that would cover routine care out of state.

Which brings us up to the present. It was announced this past October that BCBS was going to be pulling their PPO plans in Texas for 2016, a big blow for the full-timing community. I had planned on “moving” to Texas while working at Amazon this peak, but now there’s no reason* to since the health insurance field in Texas is the same as South Dakota. Of the three big full-timing residency states, only Florida still has nomad-friendly health insurance options for 2016, but the RVing community is guessing that in 2017 those will disappear too.

For those of you planning on hitting the road in the near future who are looking into health insurance, I still recommend Kyle’s website over at https://www.rverinsurance.com/ for the latest news and advice. I was in e-mail communication with Kyle last year when all of these changes were taking place and he helped me a lot with the Health Insurance Marketplace and figuring out what my options were.

I talked to several younger full-timers this year who opted to pay the penalty for not being insured and still covered their own costs out of pocket like before – a valid option for those who are in good health. I myself could have saved some money if I’d gone this route but that slim chance of a medical emergency made me pay for a plan. In 2016 though, the penalty for not being insured is going up to $695 a person or 2% of your annual income, whichever is higher, so people who opted out of health insurance this year probably want to think about signing up for 2016. For me personally, my marketplace plan for 2016 is going to come to less than the penalty.

Which brings me to what I signed up for for 2016.

Let me start by saying that signing up through the Marketplace went a lot smoother this year than last year. I still had to do the whole process over the phone since the website does not recognize my mail forwarding address in South Dakota as a real address, but the 26 minute phone call was fairly painless and Avera (same company I had last year) accepted me as a SD resident without any complaints this time so there was no extra phone calls and bickering back and forth (last year, I almost didn’t get the process finished in time for my coverage to start on jan 1st).

Like last year, I opted for a Bronze level plan. Not the cheapest one available, but the second cheapest which has an out-of-pocket cap covered by my emergency fund. There’s just no point in getting something better when I’m not going to be in South Dakota to enjoy the benefits.

That about covers it! Have a good week everyone, I can’t believe it’s only a week until Amazon is done. Receive is still getting 50+ hour work weeks so my paychecks are continuing to be happy. Next week the last day for my shift is the 22nd, so even if overtime would be called on Wednesday us campers were told not to go in for it. I’ll be writing a little more about my plans post-Amazon soon.

*When thinking about it, moving to Texas still might make some sense when it comes to health insurance. If I ever did need to go back to my state of residence for extended care, visiting Texas in the summer, while uncomfortable, would still be easier to do in an RV than staying in South Dakota in the winter. However, I did not want to pay ~$500 to switch the rest of my insurances and registrations over. Just something to think about for those of you getting ready to choose your residency state.

* * *

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At IO I teach people how to ditch the status quo and travel full-time before retirement, and share stories of my adventures (and misadventures) to inspire future nomads and armchair travelers alike. Included at no additional charge: seizing your dreams, living boldly, and making a difference.


  1. Bakerig on August 23, 2016 at 4:55 am

    Hi Becky,

    Thanks for sharing such a great article!! I’m glad to found this post 🙂

    This is a very important topic that I will have to address soon myself. Good to hear that you found an option that you are comfortable with. My family is also considering where to domicile, as I am a native Texan, but we have family in SD and TX. After reading your post, I’m not afraid of insurance premiums.

    Thanks again
    Bakerig recently posted..Why can’t I buy Health Insurance anytime I want?My Profile

    • Becky on August 23, 2016 at 3:31 pm

      You’re very welcome Bakerig and I’m glad you found this helpful! Health Insurance is one of the biggest hassles of full-timing as a young person, but it’s certainly doable. Best of luck to you whatever you decide.

  2. linda Prin on June 20, 2016 at 11:51 am

    I didn’t realize that I had the option of bronze, silver or gold plans in health insurance. I will have to consider this because we often attend urgent care facilities for my son’s allergic reactions. I am glad you were willing to post, it helps me get the most from my health plan. Thanks.

    • Becky on June 20, 2016 at 1:31 pm

      If you’re applying through the Health Care Marketplace, yes Linda. You’re welcome and I’m glad you found this post helpful.

  3. Greg on December 23, 2015 at 11:05 am

    Was glad to read that you elected to buy insurance vs. paying the penalty and self insuring. One thing people who choose the latter may not consider is the price of a hospital bill and the lengths a hospital can employ to collect. The only escape is bankruptcy. Before ACA, hospitals wrote off the bills of the uninsured, tacking it on to the insured. That was because 30% of the population had no insurance. Nowadays, it’s 9% and dropping, giving collections the ability to collect.

    Not worth the risk for anybody, regardless of health.

    Finally…I’m surprised Washington doesn’t come into play when discussing residency. There are no income taxes in Washington and it’s Exchange offers three PPO plans…two from Blue Cross.

    Also…the residency requirements are not stringent. Here is a copy from their web site…

    Persons are considered residents of this state for sales and use tax purposes if they take actions which indicate that they intend to live in this state on more than a temporary or transient basis. A person may be considered a resident of this state even though the person is a resident of another state.

    The Department of Revenue presumes that a person is a resident of this state if he or she does ANY of the following:

    • Maintains a residence in Washington for personal use;
    • Lives in a motor home or vessel which is not permanently attached to any property if the person previously lived in this state and does not have a permanent residence in any other state;
    • Is registered to vote in this state;
    • Receives benefits under one of Washington’s public assistance programs;
    • Has a state professional or business license in this state;
    • Is attending school in this state and paying tuition as a Washington resident or is a custodial parent with a child attending a public school in this state;
    • Uses a Washington address for federal or state taxes;
    • Has a Washington State driver’s license; or
    • Claims Washington as a residence for obtaining a hunting or fishing license, eligibility to hold public office or for judicial actions.
    Persons may rebut the presumption of residency if they provide other facts which show that they do not intend to reside in this state on either a temporary or permanent basis. A Washington resident who intends to move at a future date, however, will be considered a Washington resident.

    • Becky on December 23, 2015 at 10:09 pm

      Having, or not having, insurance is a kind of gamble. There’s a slim chance you’ll need it in which case you’ll be glad you have it, but more often the insurance company makes out better on the deal which is why they offer the service to begin with. It’s aggravating paying out hundreds of dollars a year for a service I’ve never used, but I personally hold onto it just in case the dice roll up snake eyes to avoid bankruptcy as you said. If I stopped to do the math on how much I’ve paid into health insurance since graduating college (I’ve never needed it) I think I’d be pretty depressed.

      As for Washington State, I really haven’t heard of full-timers using it, except for those who came from Washington originally. Maybe their vehicle licensing is expensive? Maybe it is a good deal and we’ve all been missing out. I won’t have time to look into it until Quartzsite but thanks for giving us another state to think about Greg.

      • Rob on December 23, 2015 at 11:11 pm

        I’m a Washington resident, I was before I hit the road & have not seen a reason to change that. I have needed to give them a “physical address” to register a car & when I got an enhanced drivers license, my mailing address was not good enough for the computer. My mailing address is on the drivers license.
        The local Credit Union computer would not accept my mailing address either when I went to get a second account in just my name but everything is mailed to my mailing address. Odd.
        I suspect the CU is working for the federal law enforcement rather than the state on this one.

        • Becky on December 24, 2015 at 10:33 pm

          Thanks for sharing Rob, that’s good information to know.

  4. Dawn on December 18, 2015 at 8:34 am

    Something I had not considered. Thanks for pointing it out.

    • Becky on December 18, 2015 at 6:41 pm

      You’re welcome Dawn!

  5. pamelab on December 17, 2015 at 6:15 pm

    Hi, Becky –
    Merry Christmas and Happy New Year! I really enjoy your blog with all your good information. Congratulations on the good Amazon job, and that it is almost ended :0)
    Enjoyed seeing how you fixed your hail damage and other areas on Cass.
    Happy Trails.

    • Becky on December 18, 2015 at 6:40 pm

      Heya Pamela,

      Thank you very much! I’m looking forward to Amazon being done for sure. I’ve got hitch itch something fierce.

  6. Reine in Plano on December 17, 2015 at 3:37 pm

    Becky, you might want to plan to be in SD for several days at least once in the next year so you could see a doctor for a general physical. It’s probably covered by your policy and it’s a good idea even for healthy young folks to have a physical every several years as a precaution or to provide a baseline to measure future issues against. There are health issues a physical can catch before they become serious that don’t show any symptoms.

    • Becky on December 18, 2015 at 6:38 pm

      Yeah it’s been in the back of my mind Reine. The problem is the timing. When the weather is favorable for a trip to SD I’m always working a thousand or more miles away.

  7. Steve w. (sdw) on December 17, 2015 at 10:37 am

    By the way, i’m a native Texan. And for those thinking of moving to Texas that didn’t know. Texas has been implementing a new vehicle inspection and registration system starting in 2016. The old way you had two separate stickers on your vehicle one for inspection and one for registration. Now you’ll have to show proof of your vehicle being inspected within 90 days of your registration date. And there will be only one sticker on your windshield. the registration sticker. And it will be the same for RVs.

    • Reine in Plano on December 17, 2015 at 3:33 pm

      Just a warning for Texas folks. You probably want to plan to have your vehicle inspected about 30 days before the registration deadline. We’re not full timers but we ran into a problem last summer when it took too long to get a failed inspection corrected and get the computer on the vehicle to register OK on the testing equipment. Apparently after fixing an emission problem you have to do a certain amount of driving before the system resets and shows clear. This took us several days to get done and delayed our departure by a day. Just something to be aware of if you have an older vehicle, especially if your check engine light has been intermittently going on.

      • Becky on December 18, 2015 at 6:37 pm

        Thanks for the info Steve and Reine. I’d heard about the new emission testing law but heard that Escapees was fighting for a way to get an exemption for RVers. Hadn’t heard anything about it recently.

  8. Jodee Gravel on December 17, 2015 at 9:52 am

    Good summary Becky. We’re fortunate to have full coverage in CA even though it too only covers emergency care and urgent care on the road.
    Jodee Gravel recently posted..Back Into Uncharted TerritoryMy Profile

    • Becky on December 18, 2015 at 6:34 pm

      You’re welcome Jodee, glad you’ve got coverage. 🙂

  9. Terri on December 17, 2015 at 5:36 am

    Thank you for mentioning this, Bob! I’m looking to go nomadic like Becky does now, next year, so this is great info to have.
    Terri recently posted..ThankfulMy Profile

    • Becky on December 18, 2015 at 6:34 pm

      Read what I wrote about having to stay in the state for a month before you can get your license plates Terri, the law just changed. Afraid I don’t know all the details, just what I heard from my friend who got her mail forwarding set up there a week or two ago.

  10. Bob Wells on December 16, 2015 at 10:52 pm

    Becky, there is actually a third option for states of Residence and that’s Nevada. It has no income tax and it’s fairly easy to become a resident.

    My thinking is I spend a lot more time closer to it than I do to any other state so after the covered emergency care it will be a lot easier for me to get there than SD or Texas. Where I winter in Arizona (Quartzsite or Yuma) is only a few hours from Nevada so at least 5 months a year it is very easy to get to health providers.

    I got a high deductible Bronze plan and I’m only paying 54 a month for my share, so like you it costs less than the penalty will be next year. Also like you I’ll never probably never use it but why not have it if it saves me money?

    I sure hope to see you this January, I guarantee you’ll be really, really glad if you come to the RTR (Rubber Tramp Rendezvous) in Quartzsite!

    • Becky on December 18, 2015 at 6:32 pm

      Haha, I responded to your RTR post yesterday not realizing you’d already commented on my blog here Bob. We just “missed’ each other, virtually speaking. 😉 (Yes, I’ll be at RTR on the 5th!)

      Funny you should bring Nevada up. A coworker and friend of mine (Nina, she’s a vandweller and attended RTR last year and will be going again this year) got her mail forwarding set up in Nevada only to discover that there’s a new state law where you have to spend a month in a campground/RV park in the state before you can get your license plates there, she was hoping to do the same thing you did and get her plates in Nevada. She was going to tell you about it at RTR.

  11. Jim Schmechel on December 16, 2015 at 2:18 pm

    Thank you for the update Becky. I’m so happy to hear that your work at Amazon is almost done. I hope you take some time to recover from all of your hard work. It is ok to allow your blog to sit still, if you need some time for yourself. But that of course is up to you! 🙂
    Jim Schmechel recently posted..MarriageMy Profile

    • Becky on December 16, 2015 at 6:55 pm

      I’m looking forward to it too JIm! It may sound odd, but writing helps me relax so it’s something I enjoy doing even during a busy week, as long as I can find enough time.

  12. Jim@HiTek on December 16, 2015 at 11:27 am

    Your thoughts about SD in winter are justified. I looked into taking a temp job up there and spent quite a bit of time online trying to find a reasonable way to stay up there and live in my RV in the winter. Even with the ‘Alaska Pak’ mine has, it would have been a nightmare. The living expense would be exorbitant as the oil boom has made prices soar, then you have propane expenses, tank rental, refill charges in the dead of winter, etc., etc..

    I finally gave up on the idea. Much as I like to explore new areas, I had to admit it would just be too difficult and expensive. ND/SD in winter is best left to those not living in an RV. Or those with tons of money who can move into a rental (if you could find one) when it gets really cold.
    Jim@HiTek recently posted..On the way to Mexico…My Profile

    • Becky on December 16, 2015 at 6:54 pm

      I have a Canadian full-time RVer friend who spent several winters up in Saskatchewan in her ’98 Class C motorhome. She said she had to watch the weather like a hawk. At -40 her propane bottle would freeze and her furnace would turn off, bad news. So she had to keep one portable tank inside the RV and switch out the frozen one when the temperatures got cold. It would usually last a couple hours before the new one would freeze but by then the other would be thawed and she could switch them again.

      No thanks.

      • Jim@HiTek on December 16, 2015 at 7:28 pm

        I KNOW. There are tricks of course, like wrapping your propane tanks in a heated blanket but the hassle factor was just too big for me. And the WIND. Like 40 MPH every day.

        No thanks. And this is from a guy who spent 3 winters up in Fairbanks, Alaska!
        Jim@HiTek recently posted..On the way to Mexico…My Profile

        • Becky on December 18, 2015 at 6:23 pm

          RVs just aren’t meant for extreme cold, even ones with “winter” features.

          That does make wonder what it would cost to engineer a true cold winter RV. I doubt it would be cheap.

  13. David Michael on December 16, 2015 at 11:07 am

    Thanks for your updated health insurance article. Even for us Medicare people, PPO’s are hard to find. It seems the movement is towards HMO’s at all levels. We decided to stay with Healthnet again this year since they still have a PPO, although we stopped traveling full-time last year (almost age 80). We have been fortunate to have zero monthly payments with the plan we chose for the past four years. The HMO’s may be more cost effective for the insurance companies but they limit the options for all of us, such as selection of doctors, out of system.

    In my opinion we need a Single Payer or Medicare System for all citizens of the USA. I have had excellent treatment in many countries of the English Commonwealth (Canada, New Zealand, England, and Australia) when on hiking, kayaking, or biking trips in these countries. In most cases, private as well as the public (single payer) insurance is available for their citizens. Indeed, I talked with many who had both in retirement just to make sure they received the best care possible. In my experience, our medical costs in the USA are about 10 times those of many other countries. I know, sounds crazy but I found this again to be true when kayaking in British Columbia. The emergency medical care I needed was outstanding with most nurses from the local community. There is so much misinformation and propaganda that headlines our system it leads to confusion and frustration about meaningful change. Obamacare is one step towards a better system. We need to elect the right people to get a Single Payer System that reduces costs, increases efficiency, and offers better service.

    • Becky on December 16, 2015 at 6:45 pm

      Glad to hear that your insurance is still in place for next year David.

      You’re not the first to mention Medicare for everyone here in the comments. I definitely think something needs to change but I know I’m not knowledgeable (informed?) enough to have a solution. I have heard that European countries that are lauded for great healthcare, education system, and other public services have extremely high income taxes (to the tune of over 50% of their paycheck as I recall?) and here in America taxes are seen in an extremely negative light so I doubt it’s something we’d ever go for.

  14. Bryce on December 16, 2015 at 10:41 am

    Hello, thanks for the update, I hope this solution works out well for you! Could you detail what the plans consider an “emergency?” I know if I fell and broke my leg, sure get to the emergency room and your care will be covered. But what about doctor’s visits after you have your leg stabilized? What if you need surgery a week later? What about physical therapy sessions over the next few months? Also, what if I had a cold and needed antibiotics? That’s not really an emergency, so I’d either have to travel to my home state or pay over the counter for prescription drugs? Am I interpreting this correctly? Thanks for your help and your blog!

    • Becky on December 16, 2015 at 6:37 pm

      Hello Bryce,

      Every company (and even different plans within the same company) define “emergency” differently and that’s definitely something a person needs to look into closely when considering a plan – just one more hassle of health insurance. In your above example, follow-up visits and likely at least some of the longer-term drugs would not be considered “emergency” care. As a full-timer, I’d have to get myself back up to South Dakota after the leg was stabilized if I wanted my insurance to continue to cover the problem. Again – not nomad friendly.

  15. Karen on December 16, 2015 at 10:32 am

    Sure seems to me that there are so many folks under Medicare age who need more flexible plans (they don’t even have to be fulltime rv’s, some are temporary workers who are sent to different places every three months, medical workers, etc.). Sounds like they need to start lobbying congress to come up with flexible plans.

    This is why a “Medicare for all” option would be so useful.

    (But heavens no! That would be socialism, right? (Gues all those over 64 folks are socialists)).

    • Becky on December 16, 2015 at 6:34 pm

      The current situation is definitely sub-optimal Karen. I know the Escapees club in Texas actively speaks out on full-timer issues but the percentage of the total working-age population that is migratory is still pretty small I think.

  16. Rob on December 16, 2015 at 10:28 am

    It’s a drag to drive a 1700+ miles for a non-emergency doctor visit, I asked myself if it was cheaper to pay for it myself where I was than the fuel to go to the covered doctor?
    When I went back having the ‘that’ medical care somewhere I wanted be made it a touch easier.

    Having an ER visit covered by insurance makes it all worthwhile. Maybe it would be better saying “not” having an ER visit covered by insurance can ruin a whole year.

    The (growing) cost of an unconventional lifestyle.

    • Becky on December 16, 2015 at 6:30 pm

      Yeah Rob, I’d say health insurance is the #1 biggest hassle for me as a young full-timer. Well, actually it hasn’t been so far because I haven’t had any health issues, but I know that it could be and I wish there were better options. Hopefully someday soon there will be.

    • David Swanson on December 19, 2015 at 7:33 am

      Chances are there would be a sliding scale clinic closer then 1700 miles for the non-emergency care.

      • Rob on December 19, 2015 at 10:28 am

        Absolutely, any down the street urgent care clinic is usually cheaper than the long drive back!

  17. David Swanson on December 16, 2015 at 9:44 am

    In a similar situation as you in that I have medicad insurance that only covers me for emergency services when outf my home state of Minnesota. So far its been fine and not much risk for me to travel. (az maybe some tx untill April.) I can get my persciptions through any Wallgreens. I did not hear a word from my provider about doing this out of state last winter. I can still call my doctor on many issues and get prescriptions.
    Last summer out of state on Madeline island in Superior I swam 35 minutes numb with hypothermia and was hellicoptered to Duluth for a 3 day stay. The $40,000 bill paid entirely as emergency my Minnesota Care.
    As a younger person in good health with out issues I think its low risk for you to be out of state. If in fact you dont need emergency services for a health concern, chances are you would still be able to drive yourself to your domicle state for other issues.
    Thanks for all your research on this Becky!

    • Becky on December 16, 2015 at 6:24 pm

      You’re welcome David, glad you found this post helpful and I’m glad that Medicaid paid for your emergency care.

  18. Christina on December 16, 2015 at 5:57 am

    Although it wasn’t too number specific, I find this article (along with some of the others you have written) to be incredibly useful. I actually stumbled upon your blog via your detailed Amazon work camping post. I have read a number of full time blogs, but yours is the only one I subscribed to.

    In preparation for our own family of 4 with smaller children, insurance is very important to us. I knew the insurance marketplace was shifting after speaking with Kyle in December. He had mentioned the loss of the TX PPO. It actually made me VERY apprehensive about our plans and how much of our monthly budget would be sucked up by premiums. I am glad you found an option that you are comfortable with. We are also considering where to domicile, as I am a native Texan, but we have family in SD and TX. One of many decisions, but your post reminded me to not let my fear of insurance premiums overshadow the excitement of what is ahead of us!

    • Becky on December 16, 2015 at 6:22 pm

      Hello Christina and welcome to IO! I’m so glad to hear that you’ve found my blog helpful as you prepare to hit the road yourself. You all must be very excited!

      I’ve found that sharing numbers is a double-edged sword. The cost of things varies so much from person to person that the number itself is rarely relevant to my readers. I hate to give people false expectations about what the numbers will look like for them (yes, have had issues with that in the past) so now I’m more careful. As a family your cost will likely be radically different from mine, and I haven’t the foggiest idea by how much. It’s good that you’re in contact with Kyle though, he’s the best person I could recommend to help you sort it out. For what it’s worth, I’m going to be paying $52.18 a month for mine.

      Best of luck to you and I hope to hear from you on the road someday soon!

  19. Terri on December 16, 2015 at 5:51 am

    This is great for me to hear as I am now seriously thinking about workamping starting next summer, like you do at the national parks, etc. I can’t believe how expensive it is and then you still get basically no coverage at all, if you think about the deductibles, etc. At least that is how it feels, if not the reality.

    So your premium still comes to less than 695? At your and my salary levels, it’s still a big amount of cash to save up for…

    Terri recently posted..ThankfulMy Profile

    • Becky on December 16, 2015 at 6:15 pm

      You’re welcome Terri.

      I pay my premium in monthly increments, that works much better for me than a lump sum. It’s going to be $52.18 for 2016 which I think is plenty fair. Again, that price varies based on age and income level.

  20. FrugalRVGals on December 16, 2015 at 5:51 am

    Great information. That is a very important topic that I will have to address soon myself. Thanks for sharing your experiences.
    FrugalRVGals recently posted..Oh Deer! Do You See What I See?My Profile

    • Becky on December 16, 2015 at 6:12 pm

      You’re welcome Frugal, glad you found this helpful. 🙂

  21. Loup Garou on December 16, 2015 at 3:14 am

    Can you use your parents address as your home address?

    • Becky on December 16, 2015 at 6:12 pm

      Not really Loup. Wisconsin’s insurance and vehicle registration rates are higher and they’d demand a portion of all my wages in the form of income taxes.

      I do know some full-timers though who use a relative’s address as their home address and it works well. Just depends on the state.

  22. Carla on December 15, 2015 at 10:11 pm

    Hi, Becky,
    I signed up again about a week ago using Healthcare.gov. I’m also a SD resident who is “never there,” but there was a box to check this year under the address that said something like “This is not a physical address.”

    Because of all the mail forwarding services and full-timers “residenced” in SD, I guess that box is a new addition.

    And no wonder Avera did not argue about it. Consider that they get your full premium for coverage yet the know in advance that you will hardly ever be in the state to USE your benefits. What a deal for the insurance company!!
    Carla recently posted..Gifts of Preparedness for the New YearMy Profile

    • Becky on December 16, 2015 at 6:09 pm

      Carla, I tried checking and not checking that box, it made no difference for me but happy it worked for you.

      And yeah, Avera wins but at least I’m not screwed in case of an emergency. 🙂

  23. Norm on December 15, 2015 at 9:37 pm

    Thanks for your information in this post. I have already shared it with a young family who are thinking of full timing. It’s an important topic. Hope your final days at Amazon go well. Merry Christmas.

    • Becky on December 16, 2015 at 6:05 pm

      Thanks Norm, merry Christmas to you too.

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