Can Medicare Advantage Plans be Used Out of State?

By Daniel Petkevich

Jun 12, 2023

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Read this before leaving for summer vacation

Understanding Medicare Advantage Plans

• Health Maintenance Organization (HMO) Plans: With HMOs, you typically can only go to doctors, specialists, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary care doctor to see a specialist.
• Preferred Provider Organization (PPO) Plans: PPOs give you the freedom to go to any doctor, specialist, or hospital that accepts Medicare, not just the ones in the plan's network. However, going out of network might cost more.
• Special Needs Plans (SNPs): SNPs provide specialized care for specific groups of people, like those with certain chronic diseases. All SNP plans must provide Medicare prescription drug coverage.
• Private Fee-for-Service (PFFS) Plans: PFFS plans determine how much they will pay providers and how much you must pay when you get care. You can go to any Medicare-approved doctor, specialist, or hospital that accepts the plan's payment terms and agrees to treat you.
• Medical Savings Account (MSA) Plans: These are high-deductible health plans combined with a bank account. Medicare deposits money into the account, and you can use it to pay for your healthcare services.

Can Medicare Advantage Plans be used out of state?

• Emergencies: In the case of an emergency, Medicare Advantage Plans are required to cover your care anywhere in the U.S. without additional charges beyond what you would pay in-network. Once your condition is stabilized, however, your plan may require you to be transferred to a network hospital for further care.
• Urgent Care: Urgent care needed for sudden illnesses or injuries that aren't life-threatening but need immediate attention is also covered anywhere in the U.S.
• Dialysis: If you have End-Stage Renal Disease and need dialysis when you're temporarily outside your plan's service area, your plan must cover your dialysis.

Choosing a Medicare Advantage Plan with Out-of-State Coverage

• Network Restrictions: Consider the size and spread of the provider network. Some plans may have a larger network or even offer nationwide coverage.
• Cost: Assess the costs of the plan, including the premiums, deductibles, and out-of-pocket maximums. Remember that out-of-network services may come with higher costs.
• Benefits: Look at the benefits offered by the plan. Some may offer additional benefits that can be useful when you're out of state, like telehealth services.
• Travel Habits: Reflect on your lifestyle and travel habits. If you frequently travel or live part of the year in a different state, a plan with broader coverage may be beneficial.

• Use the Medicare Plan Finder:

  This online tool

  allows you to compare Medicare Advantage Plans in your area. Look for plans with larger networks or those that specifically state they have out-of-state or nationwide coverage.
• Contact Plan Providers: Reach out directly to Medicare Advantage Plan providers to ask about their coverage areas.

• Consult a Fair Square Medicare expert

  : Our team of licensed brokers can help you find a plan that fits your specific needs and travel habits.

Tips for Traveling Out of State with a Medicare Advantage Plan

• Know Your Network: Before you travel, research the healthcare providers in your destination that are part of your plan's network.
• Telehealth Services: Check if your plan offers telehealth services. This feature could be very handy for non-emergency situations while you're on the move.
• Prescription Medications: Ensure you have enough prescription medications for the duration of your trip. Alternatively, find out if your plan covers prescriptions at pharmacies out of state.

• Emergency Services: Remember that in an emergency, go to the nearest emergency room. Medicare Advantage Plans are required to cover out-of-network emergency care.
• Notify Your Plan: Once you're safe and stable, inform your plan about the emergency as soon as possible. They can provide guidance on next steps and procedures to follow.
• Follow-up Care: If you require follow-up care, contact your plan to find out how to proceed, especially if you're still out of state.

• Insurance Information: Carry your Medicare Advantage Plan card with you at all times. This will have crucial information for healthcare providers.
• Emergency Contact Numbers: Keep a list of important numbers, including your primary care doctor, specialists, and the customer service number of your plan.
• Health Records: Consider carrying a copy of your medical records, particularly if you have a complicated medical history or multiple prescriptions.
• Travel Confirmation: If your plan offers out-of-state or nationwide coverage, bring a copy of the confirmation or the terms stating this, as some providers may not be familiar with your plan.

Conclusion