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Second Opinion: What If I Get Sick Before My Obamacare Coverage Starts?

Second Opinion: What If I Get Sick Before My Obamacare Coverage Starts?

Above: Diane Matsumoto has helped her friend sign up for an affordable health plan through Covered California. But that doesn't mean her friend can start scheduling check-ups. What happens between October and January?

Aired 10/21/13 on KPBS News.

Nearly 100,000 Californians have started applications on the state's new insurance exchange, Covered California. But completing the process won't mean they can start scheduling check-ups. What happens between October and January?

Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.

The Question: What If I Get Sick Before My Obamacare Coverage Starts?

Diane Matsumoto lives in Cardiff with her husband. Both are retired firefighters.

But before joining the fire service — for the health benefits, she said — Matsumoto worked as a waitress. She still keeps in touch with her restaurant colleagues and her question is for one of them actually.

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Her friend is uninsured currently because an unlucky streak of health problems — an appendectomy, breast cancer and gallbladder surgery — caused her premium to quadruple to $1,700 a month. She dropped the plan to help save her house.

Matsumoto helped her friend find a plan on the state's insurance exchange, Covered California, that will cost a manageable $146. But she'll be without insurance for another couple of months because the plan doesn't kick in until January.

Here's Matsumoto's question:

"Her concern is, you know, what happens between October and January if she has another surprise medical emergency?"

The Takeaway: The Affordable Care Act doesn't offer special gap coverage unless you're low-income.

All Covered California plans won't go into effect until Jan. 1. The health reform law doesn't have provisions to protect people from emergency costs in the interim.

Matsumoto's friend could try to take out a private policy and cancel it in January, but the new protections for people with pre-existing conditions also don't go into effect until next year. So the chances she'll be denied coverage are pretty high, as are the premiums, said Linda Keller, the executive vice president of San Diego-based insurance brokerage Intercare.

There is gap coverage, however, for low-income people who will be newly eligible for Medi-Cal next year. It's called the Low Income Health Plan and it's run through the county. Individuals must make less that about $1,238 a month to qualify.

The Orders: Cross your fingers and be careful.

The choices are limited for Matsumoto's friend. She can explore the private market to see if there's a catastrophic plan that will take her.

Update: There may be help through program called the Major Risk Medical Insurance Program. Californians who cannot obtain health insurance because of a pre-existing condition and who are not eligible for Medicare or Cobra may be able to pay for benefits through the state.

Comments

Avatar for user 'cosmoquark'

cosmoquark | October 21, 2013 at 7:54 p.m. ― 10 months, 4 weeks ago

A moment ago I watched with chagrin as Megan Burks misleadingly responded to the question posed by Diane Matsumoto with the following: “The Affordable Care Act doesn't offer special gap coverage unless you're low-income. . . . The health reform law doesn't have provisions to protect people from emergency costs in the interim. . . . the new protections for people with pre-existing conditions also don't go into effect until next year.”

California’s Major Risk Medical Insurance Program (MRMIP), is a state-funded program that provides medical coverage to Californians — not just low-income people — with pre-existing health conditions who cannot obtain health insurance or affordable coverage options in the individual commercial market. Californians qualifying for the program participate in the cost of their coverage by paying premiums. The State of California supplements those premiums to cover the cost of care in MRMIP. Tobacco tax funds currently subsidize the MRMIP.

To qualify for MRMIP, one must be a California resident unable to secure adequate coverage, cannot be eligible for Medicare (unless eligible solely because of end-stage renal disease), and cannot be eligible to purchase any health insurance for continuation of benefits under Cobra or CalCobra.

Information about this program can be found at the following website.

http://www.mrmib.ca.gov/

In the public interest, KPBS should forthwith post an erratum notice online and announce a correction on its broadcasts at its earlier opportunity so that people who need health insurance between now and January 1, 2014 are not misled and discouraged by this broadcast from exploring this opportunity — possibly suffering negative effects on their health.

Note — The Preexisting Condition Insurance Plan (PCIP) — enacted into law as part of the Affordable Care Act and currently covering people with pre-existing conditions since October 2010 — unfortunately is no longer taking applications.

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