8/21/2025
What Counts as an Emergency?
Under federal law, Marketplace plans must cover emergencies anywhere in the U.S. However:
- Once you’re stabilized, your plan may require transfer back to an in-network facility.
- Follow-up care out of state may not be covered.
Example: You break your leg skiing in Colorado. The ER visit is covered, but your follow-up orthopedic appointments there are not.
The Out-of-State Specialist Problem
If you have a rare or complex condition and the best specialist is in another state, your Marketplace HMO/EPO likely won’t cover it. You’d pay the full bill out of pocket.
Why PPO Coverage Changes Everything
A National PPO plan offers:
- In-network coverage across state lines.
- Out-of-network benefits if you need care from a non-network provider.
- Peace of mind while traveling for business or leisure.
Real-Life Scenarios
- Frequent Traveler – A consultant from New York who visits clients in multiple states has seamless access to care with a PPO.
- Snowbird – Someone who spends winters in Florida avoids paying out-of-pocket for routine care there.
- College Student – Parents in one state, student in another—both have full coverage with a PPO.
How to Protect Yourself
- Review your current plan’s out-of-state coverage.
- If you travel often, consider switching to a national PPO.
- Ask your broker for options that match your travel and lifestyle.
Final Thought: Marketplace plans work fine if you stay in one place, but if you cross state lines often, they can leave dangerous gaps in coverage. A national PPO ensures you’re protected anywhere in the U.S.
Want nationwide health coverage that travels with you? Call (716) 503-1113 for a free consultation.