Does Medicare cover me if I travel out of state?
Will my Medicare coverage apply if I receive medical treatment in another state?
Yes, Medicare coverage applies if you receive medical treatment in another state, but there are some important details to understand about how the coverage works depending on the type of Medicare plan you have. Here’s what you need to know:
1. Original Medicare (Parts A and B):
Original Medicare is a federal program and provides coverage nationwide. This means you can use your Medicare benefits at any hospital, doctor’s office, or healthcare provider in the United States that accepts Medicare. You do not need to worry about state boundaries with Original Medicare.
No Network Restrictions: There are no provider network restrictions, so you are free to see any doctor or healthcare provider across the country who accepts Medicare.
Emergency and Non-Emergency Care: Original Medicare covers both emergency and non-emergency care in any state, provided the healthcare provider accepts Medicare.
2. Medicare Advantage Plans (Part C):
Medicare Advantage (Part C) plans are offered by private insurance companies, and the coverage rules are different from Original Medicare. These plans often have provider networks that may limit your access to healthcare providers outside of a specific geographic area (such as your home state or region).
HMO Plans: If you’re in a Health Maintenance Organization (HMO) plan, you may need to get care from providers within the plan’s network unless it’s an emergency or urgent care situation. For routine care, you’ll likely need to return to your home state to use network providers.
PPO Plans: If you’re in a Preferred Provider Organization (PPO) plan, you can get care from out-of-network providers, but you’ll usually pay more out of pocket than you would for in-network care. Emergency and urgent care are always covered, no matter where you are.
Check Your Plan’s Rules: Before receiving care in another state, check with your Medicare Advantage plan to confirm what is covered and whether you need prior authorization for non-emergency services.
3. Medigap (Medicare Supplement) Plans:
If you have a Medigap plan in addition to Original Medicare, your coverage will also apply nationwide. Medigap policies are designed to supplement Original Medicare, helping cover out-of-pocket costs like deductibles, copayments, and coinsurance.
As with Original Medicare, you can visit any healthcare provider who accepts Medicare, no matter which state you are in, and your Medigap plan will help cover your share of the costs.
4. Medicare Part D (Prescription Drug Coverage):
If you have a Medicare Part D plan for prescription drug coverage, the pharmacy network may vary depending on your plan. While many Medicare Part D plans have nationwide pharmacy networks, it’s essential to check whether a pharmacy in another state is in your plan’s network.
If you use an out-of-network pharmacy, you may have to pay more out of pocket or file a claim for reimbursement.
5. Emergency Care:
Whether you have Original Medicare or a Medicare Advantage Plan, emergency care is covered anywhere in the United States, regardless of the provider network or location. This applies to sudden illnesses, accidents, or severe injuries that require immediate medical attention.
6. Medicare and Foreign Travel:
Original Medicare typically does not cover medical care outside of the United States, except in very limited circumstances (such as care needed during travel to or from Alaska through Canada, or if you are within the U.S. but the nearest hospital is in a foreign country).
Some Medigap plans provide coverage for emergency care outside the United States. Medigap Plans C, D, F, G, M, and N cover 80% of emergency medical costs incurred during the first 60 days of travel outside the U.S., after meeting a small deductible.
Medicare Advantage plans may offer foreign travel emergency coverage, but the extent of the coverage depends on the plan, so it’s important to check the details before traveling internationally.
Key Takeaways:
Original Medicare provides nationwide coverage, so you can receive care in any state from healthcare providers who accept Medicare.
Medicare Advantage Plans may have network restrictions, so check with your plan before seeking non-emergency care in another state.
Medigap plans supplement Original Medicare, offering additional coverage for out-of-pocket costs across state lines.
Emergency care is covered nationwide, regardless of your Medicare plan.
For help understanding your coverage when traveling or receiving care in another state, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.