Stuck in a Bad Covered CA Plan? You May be Able to Switch Plans

Under a provision of the Affordable Care Act, Covered CA enrollees can switch plans outside of open enrollment if they were provided with misleading information from insurers.

Individuals can obtain health insurance through the Covered CA exchange during open enrollment periods or after a “qualifying life event” such as loss of employer-sponsored coverage, marriage, birth or a permanent move. However, the qualifying event provision also allows individuals to enroll in coverage or switch plans if they:

  • Experience misconduct by insurers; or
  • Receive misinformation or incorrect plan data from insurers

According to the Contra Costa Times, this provision is especially relevant here with Covered CA, where thousands have complained that they felt “duped” by insurers over inaccurate lists of physicians and providers on the health plan’s websites.

This week, Consumer Watchdog filed a lawsuit against Anthem Blue Cross for allegedly misinforming consumers about the providers included in their Covered CA plan networks.   The lawsuit states that many members received thousands of dollars in unexpected medical bills and were unable to see doctors they have seen in the past.

The Contra Costa Times reports that Covered CA has been “quietly” implementing the ACA’s qualifying life event provision and allowing consumers to switch plans over the past several months.

Covered CA spokesperson, Dana Howard, said that the exchange will consider “each and every complaint,” and “we will do everything we can to try and get [consumers] the type of coverage they were expecting”,  but added, it’s not a guarantee just because you had some issues with your plan” you will be able to switch.

Bottom line: if you are having issues with your Covered CA health plan and have a valid reason, our experience is that in most cases our clients are able to switch plans with our assistance.   If you think you’ve been provided with misinformation by your health plan and need to change plans, call us at 1-800-788-2197, there is no cost or fee for our service.



AUTHOR - Ali Nagy