Affordable Care Act: Getting coverage in multiple states

I am 29 years old and a seasonal worker across several states, in 2013 I had 3 jobs in 3 states and 2014 is looking the same. I understand I need to purchase insurance in my state of residence (California) however, how do I make sure to get a plan that offers me sufficient out of network coverage in case I need care while working in one of the other 2 states? What if my income is low enough to qualify me for financial assistance? Will I still be able to opt for a provider with out of network care included? Thanks for the help.  My state’s website has no information on this topic.


The Wanderer

 Dear Wanderer, 

When you go the Covered California and apply for coverage, you will be shown the various plan options and their costs.  The plans are from private insurance companies with different groups of providers “in network” and “out of network”.   According to the Coverage Basics Booklet, the exchange has Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) plans; some HMO and PPO plans may include out-of-network coverage.

The exchange navigators can answer your questions about the plans, though I’m not sure if they will feel comfortable with the level of detail that you need.  Navigators are supposed to give information, but not advice about the plans offered.  You may want to find an insurance agent who could give you advice.  (Note: Covered California has certified insurance agents, but does not offer a list of them on its website.  You can ask the agent if he or she is certified.)

If you get financial assistance to buy your health plan, you will still be able to choose your plan.  You would not be barred from choosing a plan with out-of-network coverage.  If you qualify for “cost sharing subsidies” (help paying your deductible and co-pays), you will receive this help only if you choose the Silver plan level.   Cost sharing subsidies are available for anyone earning 250% of Federal Poverty or less, which is $28,725 for a household of one person.  It’s possible that the Silver plan options would not have out-of-network coverage.  You might have to give up the cost-sharing benefit to get the out-of-network coverage.  You will know more as you move through the enrollment process.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.