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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.

EPO and HMO Coverage Out-of-State?

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Question: I have to be in another state for half the year but am a resident of CA. What I am seeing is all plans offered in my area for 2015 are going to be either EPO or HMO plans. In the past I had doctors in both states that I used that were in-network. What am I to do now for non emergency coverage when I am out of state?

Answer: You are correct. EPO and HMO plans will only cover emergency medical care in another state. This is only an issue if you are eligible for a subsidy and must buy your coverage through Covered California. Otherwise, there are PPO plans available off-exchange that can provide out-of-network benefits at your second home.

1 Comment

One option may be this:

When you move from one state to the other, establish your move as a Qualifying Event, so that you can enroll in a plan local to your area, and therefore have In-Network providers where you reside.


Michael Freedman.

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