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 actually for one of them.

Her friend is currently uninsured 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 a month. But she’ll be without insurance for another couple of months because the plan doesn’t kick in until January.

YouTube video

Video by Megan Burks

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 likely 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 than $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 whether 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.

Megan Burks is a reporter for Speak City Heights, a media project of Voice of San Diego, KPBS, Media Arts Center and The AjA Project. You can contact her...

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