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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Out-of-State Coverage Under Obamacare?

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Question: How does coverage work for dependent children (e.g., college students) or other family members who live out of state? Won’t all their providers/hospitals etc including PCP be out of network?

Answer: That really depends on the plans itself, the ACA nor Covered California have done nothing to change this issue. HMO and EPO plans do not offer coverage out of network, however PPO plans with national or multi-state agreements offer in-network coverage outside of California.

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It’s one thing to say, “Children under 26 can remain on their parents’ health plan,” as the changes wrought by the PPACA did, and another to actually receive a benefit by doing so. The PPACA was deafeningly silent on this reality — choosing to ignore the reality for many persons under age 26.

Persons covered under an HMO have only emergency coverage when outside the plan’s network region. It doesn’t matter that they are college students, living alone, or married to someone else. Coverage under a PPO provides coverage for claims in or out of the local network (but out-of-pocket and total costs outside the network are usually higher), whether there is a national network available or not.

The PPACA requires, at least, that emergency services received out of network are paid for in the same manner and to the same extent as if received in network (no higher copays or coinsurance or deductibles).

Children who are college students attending school outside their parents’ HMO network region should strongly consider choosing coverage under their college/university student health plan instead. When they are finished with their education and come back home to live with mom and dad “for free”, they can be restored to coverage under their parents’ health plan for the remaining couple of years to age 26.

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