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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.
Question: If I purchase Covered Cal PPO insurance and I find that I am not covered enough due to a horrible illness, can I then purchase private PPO insurance or will I be denied?
Answer: You cannot upgrade your coverage, either in-exchange or off-exchange, once the initial open enrollment period ends on March 31, 2014, until the next open enrollment period beginning 10/15/2014.
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The real problem with the original question is “Covered Cal PPO insurance.” There is no such thing. All insurance is from commercial providers, not Covered California. One selects his/her coverage based on a metal tier with its 60, 70, 80, or 90 percent actuarial value, and pays a premium based on age, location, and plan selected.
Like anything else, insurance is a bet. You bet you will get sick and need care, the insurer bets you won’t. At the blackjack table, you cannot suddenly increase your bet just because you we dealt an ace and a king. You cannot change your health insurance bet from “pay the least premium” to “pay the most premium” because now I need health care.
That’s an example of “adverse selection.” And while insurers must accept all applicants, they are still protected, to a limited extent, from this kind of “adverse seletion”.