Medicare provides vital healthcare coverage for millions of Americans, but understanding how it works when you travel or move outside your home state can help you avoid unexpected costs and ensure seamless care.
Below, we’ll outline everything you need to know about how Medicare coverage works outside your state.
Understanding How Each Medicare Plan Works While Traveling
If you’re traveling outside your state, your Medicare coverage depends on the type of plan you have.
Original Medicare (Parts A and B)
Original Medicare is a federal program, meaning its coverage is the same across all 50 states.
- Part A (Hospital Insurance): Covers hospital stays, skilled nursing facilities, and some home health care. If you’re hospitalized while traveling within the U.S., Part A will generally cover your costs as it would in your home state.
- Part B (Medical Insurance): Covers outpatient services like doctor visits, lab tests, and preventive care. Part B coverage also applies nationwide, so you can see any provider who accepts Medicare.
However, you should confirm that the healthcare provider or facility you visit accepts Medicare to avoid unexpected costs.
Medicare Advantage (Part C)
Medicare Advantage plans, offered by private insurance companies, work differently than Original Medicare. These plans often have networks of providers, such as HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), and your coverage may be limited when you travel outside your home area.
- HMO Plans: Typically, you must use in-network providers for non-emergency care, which can be restrictive when traveling.
- PPO Plans: Offer more flexibility by allowing you to see out-of-network providers, though you may pay higher out-of-pocket costs.
Most Medicare Advantage plans cover emergencies and urgent care anywhere in the U.S., but routine care may not be covered outside your plan’s network. Check with your plan before traveling to understand its specific policies.
Medigap (Supplemental Insurance)
If you have Original Medicare with a Medigap policy, your supplemental insurance may help cover costs that Medicare doesn’t, such as deductibles and copayments. Medigap plans are also valid nationwide, so you can enjoy added peace of mind while traveling.
If You Want to Escape Winter to Enjoy a Sunny State
If you’re a snowbird spending part of the year in another state, it’s crucial to understand how your Medicare plan accommodates your lifestyle.
- Original Medicare: This plan provides nationwide coverage, so you’re covered whether you’re in Florida for the winter or back home in Michigan during the summer.
- Medicare Advantage Plans: This may require additional planning. If your plan doesn’t have a network in your secondary location, you might need to switch plans during the Medicare Annual Enrollment Period to one that provides coverage in both areas.
- Part D (Prescription Drug Plans): Coverage depends on the plan’s pharmacy network. If you split your time between two states, confirm that your plan’s preferred pharmacies are accessible in both locations.
How Medicare Coverage Works When You Move
Relocating to another state can affect your Medicare coverage, particularly if you’re enrolled in Medicare Advantage, Medigap, or Part D plans. Here’s how to handle the transition:
Original Medicare
Your coverage remains the same regardless of your new address. However, make sure to update your address with the Social Security Administration to ensure uninterrupted communication and billing.
Medicare Advantage
Medicare Advantage plans are region-specific. If you move outside your plan’s service area, you’ll need to enroll in a new plan. You qualify for a Special Enrollment Period (SEP) when you move, which allows you to choose a new plan without waiting for the Annual Enrollment Period.
Medigap
Medigap plans are standardized in most states, but premiums may vary depending on where you move. If your new state offers different Medigap plans, you may have to adjust your coverage. Keep in mind that switching Medigap plans may require medical underwriting, depending on the timing of your move.
Part D
If you’re enrolled in a standalone Part D plan, check whether your current plan is available in your new state. If not, you’ll need to select a new plan during your SEP.
Traveling Abroad with Medicare
Medicare coverage is limited outside the U.S., but there are exceptions:
- Emergency Care: Medicare may cover emergency medical services in Canada if you’re traveling directly between Alaska and another state and a Canadian hospital is closer than a U.S. hospital.
- Cruises: Medicare covers medically necessary services on a cruise ship if the ship is in U.S. territorial waters (within six hours of a U.S. port).
- Supplemental Coverage: Some Medigap plans (C, D, F, G, M, and N) provide limited coverage for foreign travel emergencies, covering 80% of approved costs up to $50,000.
For extended trips abroad, consider purchasing travel insurance for comprehensive coverage.
Know Your Plan Inside and Out Before Traveling or Moving
Always notify your Medicare Advantage or Part D plan provider about your travel or move to confirm coverage details and make sure you carry your Medicare card with you at all times. It’s also recommended to bring a list of medications, allergies, and emergency contacts in case you need care while traveling. These tips, along with thoroughly understanding how your Medicare coverage works outside of your state, can save you time, money, and stress while traveling or moving.
By knowing your plan’s details and taking proactive steps, you can ensure seamless coverage wherever life takes you.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
