Using Medicare in Another State

• by Christian Worstell
• November 8, 2023
• Reviewed by John Krahnert

Can I see a doctor in another state with Medicare?

With Original Medicare (Part A and Part B), you can see doctors anywhere in the United States, as long as they accept Medicare.

If you travel or move to another state, your Original Medicare coverage goes with you. The same is true if you move or travel to Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.

If you have a Medicare Supplement Insurance plan (Medigap), a Medicare Advantage plan (Medicare Part C) or a Medicare Part D prescription drug plan, this guide can help explain what you need to do to use your Medicare plan in another state.

Using Original Medicare in another state

You don’t have to do anything to use Original Medicare in another state. If you move, you will want to update the address that Social Security has on file for you.

If you use Original Medicare, your coverage spans over all 50 states and any territories. You can use your Original Medicare benefits in another state if you visit any health care provider who participates in the program.

Medicare participation in any state can be broken down into three categories:

1. Participating providers
   A health care provider who participates in Medicare accepts Medicare assignment, which means the provider has agreed to accept the Medicare-approved amount as full payment for services or medical devices.
   
   Medicare beneficiaries typically pay 20 percent of the Medicare-approved amount for qualified Part B services after meeting the Part B deductible ($240 per year in 2024). Medicare pays the remaining 80 percent.
   
   
2. Non-participating providers
   A non-participating provider may still accept the Medicare-approved amount as full payment for some services, but they retain the ability to charge up to 15 percent more for other (or all) services.
   
   This extra 15 percent cost is called a Medicare Part B excess charge.
   
   
3. Opted-out providers
   A provider who opts out of Medicare does not accept Medicare insurance, and beneficiaries will receive no coverage for services.

How to change your address with Medicare

If you are a Medicare beneficiary and move to another state, you can change your address that's on file with Medicare by contacting the Social Security Administration (SSA).

Here are some ways you can contact the SSA:

• Call 1-800-772-1213 (TTY 1-800-325-0778) to speak with an SSA representative Monday-Friday, 7 a.m. to 7 p.m.
• Visit the SSA website and submit an address change notice through the website.
• Visit your local SSA office in person.

Can I use Medicare Supplement in any state?

Yes, Medicare Supplement Insurance, or Medigap, may be used in any state with any provider that accepts Original Medicare. Any time that you use Medicare Part A or Part B benefits, you may use a Medigap plan along with it.

Additionally, some Medigap plans can provide coverage for qualified emergency care received outside of the United States, which is something that Original Medicare does not cover.

Using Medicare Advantage plans out of state

Medicare Advantage and Medicare Part D prescription drug plans are both sold by private insurance companies.

Medicare Advantage plans can come in a few different forms that can determine how the plan may be used in another state.

Two popular types of Medicare Advantage plans include:

• Health Maintenance Organization (HMO) plans
  Health Maintenance Organization (HMO) plans feature a network of providers who participate in the plan. These networks can be local or regional, so they can span multiple states in some cases. In order to use the plan’s benefits, you must visit one of these participating providers.
  
  Be sure to check with your plan to ensure you can use your Medicare Advantage HMO plan in another state.
    
• Preferred Provider Organization (PPO) plans
  Preferred Provider Organization (PPO) plans also feature a network of participating providers, but they typically have fewer restrictions than HMO plans on which providers you may see. You may pay more to receive care outside of your Medicare Advantage PPO network.
  
  Also be sure to check with your plan provider to ensure you can use your Medicare plan in another state.

Many Medicare Part D plans may feature a network of pharmacies. Some plans include regional or national networks, while other plans may have more localized networks.

You may qualify for a Special Enrollment Period when you move to another state

If you have a Medicare Advantage or Medicare Part D plan and move to a new state, you may qualify for a Special Enrollment Period.

Your current plan may no longer cover you at your new address, but you may be granted an opportunity to switch to a plan that does offer coverage in your new location.

Get answers to your Medicare questions

If you want more information about where you can use your Medicare plan and how to ensure you have the coverage you need when moving or traveling to another state, speak with a licensed insurance agent who can help answer your questions.

Call today to speak with a licensed agent.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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