Multi-State Health Plans Don't Always Cover Care in Other States

Map of the United States
Image ©CSA Images/Getty Images

If you’re considering a multi-state health plan because you might need to use your health insurance in another state, you’d better read the health plan’s fine print carefully first. Although it sounds like a multi-state health plan should cover you in multiple states, that’s not always true.

The term multi-state wasn’t coined from a consumer’s perspective but from an insurer’s perspective. It refers to the fact that the insurer sells health plans across state lines, something the Affordable Care Act’s authors hoped would increase competition in markets where there weren’t very many health insurance options.

But, just because your health insurance company sells plans across states lines, doesn’t necessarily mean you can get your care across state lines if you buy a multi-state plan. In fact, your multi-state plan could restrict non-emergency coverage to a small number of providers in a single geographic area.

Do you travel frequently throughout the country and want to be covered when you get care away from home? Do you live close to the border between two states and wish your insurance would pay for care you got in either state? Do you migrate seasonally from a home in one part of the country to a home in another part of the country? What you’re looking for is a health plan with a nationwide provider network, regardless of whether it’s a multi-state plan or a single-state plan.

The Difference Between a Broad Network & a Narrow Network

Having a nation-wide provider network means the health plan has in-network providers across the country.

In any given metropolitan area, you may be able to choose from among multiple in-network providers within a single specialty. This is known as a broad-network health plan.

Contrast this with a health plan that only contracts with providers in a small geographic area and limits the in-network providers within that area to just a few.

This is known as a narrow-network health plan.

Let’s say you’re taking a medication that can have dangerous side effects; you need a blood test to monitor those side effects every 10 weeks. You live in California where your health plan is based, but you’re visiting your sister in Texas when your lab test is due. If your California-based health plan has a robust nation-wide provider network, you should be able to find a Texas lab that’s in-network with your health plan and reasonably close to your sister’s house. If your plan has a narrow network, you probably won’t be able to find an in-network provider anywhere in the state of Texas. You’ll have to go back home for your blood test or pay out-of-network rates.

Most health plans, whether they’re broad-network or narrow-network, cover emergency care you get at an out-of-network emergency room at the in-network rate. So, a broad network might not be necessary if you plan to get all non-emergency care near home.

A Multi-State Plan Could Have a Narrow Network

There’s a chance that a multi-state plan offered on your Affordable Care Act health insurance exchange has a broad provider network.

However, just because it’s a multi-state plan doesn’t mean it has to offer a broad provider network. It's just as likely to have a narrow network. You won’t know unless you check the provider network before you enroll.

The term multi-state doesn’t describe where you can find in-network providers or where you can receive covered health care services. It describes how the insurer sells the health plan rather than how the health plan member uses the health insurance.


Multi-State Program and the Health Insurance Marketplace. Office of Personnel Management. Accessed August 23, 2015.

Marketplace Eligibility, Enrollment Periods, Plans and Premiums. Health Reform FAQs. The Henry J Kaiser Family Foundation. Accessed August 24, 2015.

Continue Reading