United States residents need to know that all health insurance plans provide coverage for emergency medical services at any hospitals, regardless of the state in which the health plan was purchased, except for the state Hawaii. For all the emergency medical treatments that are considered life-threatening, the treatment will be covered as in-network, irrespective of whether the hospital is included in the patient’s plan network or not. Though there are some limitations. Every health plan comes with a network of healthcare providers, and if any member visits a health care provider outside of the network, then he or she will require to pay a large share of the health care cost.
In the year 2020, Ambetter was the only health insurance carrier that offers out-of-state routine care, mainly because both HMO and PPO plans have moved to constricted and local networks to keep their costs down. Individuals need to be aware that if they are permanently moving to another state, then they will qualify for a special enrollment period during which they can switch to a local health plan that will provide them health coverage. However, individuals temporarily moving to another state for a limited duration cannot use their health plan issued in their prior location.
It is essential to note that out-of-state coverage only includes emergency medical care and not anything else. Though there are many loopholes in identifying emergency medical care. In the majority of cases, health insurance carriers are supposed to pay for reasonable emergency medical expenses regardless of the hospital in which treatment is availed. Ironically, there is no fixed definition of emergency, taking advantage of which some insurance carriers deny claims to insured which they judge as being not true medical emergencies. Thus, individuals should try to have a better understanding of what their insurance carriers will pay before visiting an out-of-network provider rather than taking the risk of a denied claim. In such a scenario, individuals can think of having supplemental accidental coverage, especially if they travel a lot for work.
National PPO Network
Health insurance provider networks vary by state and Blue Shield of California was the last insurance carrier that offered a national PPO network through the BlueCard program that has been discontinued from 2019. In 2020, no state has any national network PPO available. Therefore, people who travel a lot for work or live in different states should either take supplemental coverage or switch to catastrophic coverage. People who are planning to travel to a different state can look for the below-given options to have health coverage in the new state.
Supplemental coverage is an add-on to the individual’s current plan. To have national coverage, individuals have two options for supplemental coverage. Individuals can either obtain additional critical illness or accident coverage that will reimburse them regardless of their network if unfortunately they met with an accident or get diagnosed with a severe illness. Supplemental coverage is probably the best idea for individuals who frequently travel or individuals who are most concerned about out-of-network cost. Individuals can also get hospital indemnity style plans where members are paid cash to cover the covered medical services like doctor’s visits, hospital stays, and second opinions, all with a national network.
United Healthcare offers a year-long Catastrophic health plan that has a national PPO network, some states offer catastrophic plans for up to 36 months. The Catastrophic plans are less expensive than individual plans and these plans don’t even cover preventative care or pre-existing conditions. These plans also come with optional co-pay plans and additional accident or critical illness plans for more comprehensive-level coverage. Besides, United Healthcare, National General is another insurance carrier offering Catastrophic plans that have a national PPO network. This carrier offers catastrophic plans having competitive lifetime limits, a $50 urgent care copay, and offers a guaranteed issue option.
Individuals who need to spend some time in another state due to personal or professional reasons and wish to have coverage for more than just emergencies, then they can consider having a domestic travel medical plan or an international travel plan if they are living overseas for some part of the year. These plans are less expensive compared to major medical coverage because these plans offer limited coverage and do not provide coverage for pre-existing conditions. And these plans even come with caps on the total benefit amount that will be paid by the plan.