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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 Dependents

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Question: I have 3 kids, the two older kids will live in another state for school. Do they have take that state’s ACA-compliant Marketplace plan, or can they be on our Covered California family PPO plan? Is the dependent-through-age-25 rule only a consideration if the child is filed as dependent on taxes?

Answer: Your “children” between the ages of 19 and 26 can be included in your family plan (PPO) with Covered California even though they are out of state and/or are not claimed as dependents. However, that may not be your best option financially. Let’s say that your older child attends school but has a low-income job and maintains a residence off-campus. He or she may qualify for Medicaid or highly subsidized exchange coverage individually.

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At least one carrier, Blue Shield of California, offers a national PPO network with it’s Covered California PPO plans. The Blue Card is a feature of the Blue Cross and Blue Shield association of licensees in each state to offer each other reciprocal claims processing. What this means to the consumer is that if you see a provider in another state who is in the BCBS network you are covered at the in-network rate for your plan. The local provider is paid the BCBS company in that state who then gets reimbursed from Blue Shield CA. Anthem Blue Cross has not confirmed if they will honor Blue Card coverage with it’s Exchange qualified plans.

The other consideration is that as PPO subscribers living out of state, all of their expenses will be covered as OUT OF NETWORK, which results in a much higher deductible and coinsurance. Although total out of pocket cannot exceed the statutory maximum, why be exposed to that.

Proper analysis of your situation is of critical importance. Navigators, in-person assisters, application counselors, and most insurance agents will not be able to do that correctly.

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