Editor’s note: For people buying on the individual market who want health insurance starting Jan. 1, the deadline to sign up is Monday, Dec. 23. We are running one post a day with questions and answers on the Affordable Care Act and Covered California until that deadline. Readers can also consult KQED’s Obamacare Guide, written specifically for Californians.
By Emily Bazar, CHCF Center for Health Reporting
About 130,000 Americans pick up and move somewhere else every single day, the U.S. Census Bureau estimates. And guess who are among the most mobile? We itchy Californians.
Perhaps you’re wondering what moving around has to do with Obamacare. Quite a lot, actually.
Your health plan options – and prices – vary by geography, and the Golden State is divided into 19 regions. Los Angeles is so large that it accounts for two regions, and that doesn’t even include the Inland Empire or Orange County.
Today, I’ll tell you what happens to your coverage when you travel or move, and whether you’ll be able to see a doctor when you’re in Boise, Berlin or even Berkeley.
Q: I am considering enrolling in one of the Covered California plans. How will my coverage work if I am traveling out of state or out of the country and need medical care?
I’m adding one other part to Suellen’s question: What happens when traveling within California?
As I mentioned above, health plans sold on the open market and through our health insurance exchange, Covered California, vary by region. That means not all plans are sold in all regions. In fact, some have a very limited geographic reach, including the Chinese Community Health Plan and the Contra Costa Health Plan, both in the Bay Area.
So, if you’re traveling within the state and need care, it depends on who your insurer is and what kind of network of doctors and hospitals it offers. If, say, you have a Kaiser plan, you can visit a Kaiser doctor or hospital outside of your region and have the costs covered.
If, however, your insurer’s network doesn’t extend to your travel destination, you will only be reimbursed for emergency and urgent care services, not routine services, says Lizelda Lopez of Covered California.
When you’re traveling outside of California, your insurer doesn’t matter: You are only eligible to have emergency and urgent medical services covered.
“None of our plans have out-of-state networks,” Lopez says.
By the way, this isn’t necessarily new. Earlier this year when I visited the East Coast, I got a scary infection that needed immediate attention. I called my insurer first, which directed me to choose from specific ERs and urgent cares. I dutifully complied, but still had to fight to get my urgent care visit covered.
Lopez’s advice? Wherever you’re visiting, do what I did and double-check with your insurer to find out if a provider is covered. My advice: Be prepared for a fight afterward.
Q: What happens if an individual moves from one state to another after signing up for a plan? I’ll be living in California for the first few months of 2014, but there’s a definite chance I may be moving to Washington. Will it be possible to transfer my plan to a different state partway through the year?
A: Once again, I’m adding another part to John’s question that may sound familiar: What if you move within California?
The answer also may sound familiar: It depends on your insurer. If you have a plan that also is offered in your new locale, you keep that plan. If you want to change it, you’ll have to wait until the next open-enrollment period.
If you can’t get the same plan in your new hometown, you’ll be eligible for a special-enrollment period and can sign up for a new plan.
And now, back to John’s question. If you move to another state, you will need to enroll in a new plan through that state’s exchange or buy on the open market. If that state doesn’t run its own exchange (Washington state does), you would use the federal exchange, healthcare.gov.
Moving to another state also triggers a special enrollment period, so you’d be able to choose a new plan immediately.
Q: What about American citizens living in another country such as Sweden, where health insurance is covered? Why should I be required to have health insurance in the states when I don’t even live there?
A: As most of you know, Ask Emily is geared toward a California audience. But that doesn’t stop people from writing from all corners of the country. And, it turns out, from all corners of the world. I have received similar questions similar from readers in New Zealand, Thailand, Malaysia and Australia.
The answer depends on how long you live abroad during a calendar year. According to the Internal Revenue Service, U.S. citizens who live abroad for at least 330 days within a 12-month period don’t have to comply with the Obamacare insurance mandate, which requires most Americans to have health insurance as of Jan. 1.
That also means you won’t have to pay a tax penalty for not having insurance.
You don’t even have to be insured in your country of residence, like Artie is, to get out of the insurance requirement, the feds say.
In other words, if you don’t want to trigger the mandate, try to keep your annual trips back home to under five weeks each year!