Medicare Coverage for Snowbirds: Using Medicare Benefits in Other States
- December 8, 2021
Many Baby Boomers and Medicare beneficiaries spend their time on the move. “Snowbirds” find lots of reasons for travel, be it vacations, traveling to visit grandchildren or just heading south in the winter to escape the cold.
Fortunately, your Original Medicare coverage (Part A and Part B) can cover you in any state. But did you know that Medicare Supplement Insurance (Medigap) policies can cover you in other states?
And if you have a Medicare Advantage (Part C) plan, you may be able to find in-network providers when you travel away from home.
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Below we’ll take a look at how different types of Medicare coverage can work when you’re on the road.
Is Medicare different in different states?
Original Medicare is accepted in all 50 states, Washington D.C., Puerto Rico, Guam, the U.S. Virgin Islands and the Northern Mariana Islands.
No matter where you reside, you can see a doctor in another state with Medicare, as long as that doctor accepts Medicare patients.
There aren’t state-specific residency requirements for your Original Medicare benefits, as long as you are a U.S. citizen or have been a legal resident for at least five consecutive years.
While the majority of health care providers in the U.S. accept Medicare, there are three different categories of Medicare acceptance a provider might fall into:
- Participating provider
A participating provider accepts Medicare assignment, which means they agree to accept Medicare reimbursement as full payment for their services or equipment. - Non-participating provider
A non-participating provider accepts Medicare patients but does not accept Medicare reimbursement as full payment.
Non-participating providers reserve the right to charge you up to 15 percent more than the Medicare-approved amount for their services. This extra charge is called an “excess charge.” Certain Medicare Supplement Insurance plans cover Medicare excess charges.
If you visit a non-participating provider, you may also have to pay your entire bill at the time of service. - Opt-out provider
Some providers have chosen to opt-out of the Medicare program completely and do not accept Medicare insurance.
You could still visit an opt-out provider, but Medicare won’t pay anything for the services you receive, even if the service would typically be covered by Medicare.
You may be required to set up a private contract with the provider agreeing to pay whatever they charge for the services you receive. You won’t have to set up a private contract for emergency care or urgent care.
Some Medicare Advantage plans offer local or regional coverage
Medicare Advantage plans provide the same benefits as Original Medicare, and some plans may cover additional benefits such as prescription drug coverage or dental and vision care.
But some Medicare Advantage plan networks may come with more provider restrictions than Original Medicare.
Many Medicare Advantage plans generally feature either local or regional networks of participating providers. But there are several different types of Medicare Advantage plans, and the specific type of plan can determine how and where it may be used.
- HMO (Health Maintenance Organization)
Medicare HMO plans feature a network of health care providers who participate in the plan. Depending on the plan, these networks can be hyper-localized or extend to a broader region.
If you seek care outside of the plan’s network, you may not receive any coverage (except in an emergency), or you may be required to pay higher out-of-pocket costs for covered services.
Depending on your carrier and your individual plan, you may be able to find in-network providers in the area where you live as well as in some areas in other states.
- PPO (Preferred Provider Organization
Medicare PPO plans often include a network of participating providers. However, these plans typically offer more freedom to receive care from out-of-network providers. You typically pay higher out-of-pocket costs when going outside of the plan network.
Like HMO plans, a PPO network can be restricted to local providers or extend to a broad region. Your coverage may vary depending on your individual plan.
- PFFS (Private Fee-for-Service)
Medicare PFFS plans don’t typically have a network of local providers. With a PFFS plan, you can visit health care providers who agree to accept the payment terms and conditions of the plan and who also accept Medicare.
- SNP (Special Needs Plan)
A Medicare SNP is designed for patients with a specific chronic health condition or who are dual-eligible for Medicare and Medicaid.
Medicare SNPs typically include specific networks of providers that may not extend beyond where you live. - MSA (Medical Savings Account)
Medicare MSA plans combine a high-deductible health care plan with a savings account that you can use for qualified health care expenses.
Medicare MSA plans may include a network of participating providers, and they all must provide at least some coverage for out-of-network care. As with other types of Medicare Advantage plans, your out-of-pocket costs may be higher when you visit an out-of-network provider.
We recommend that you speak directly to your plan and your doctor to find out how your services may be covered by your Medicare Advantage plan. All Medicare Advantage plans provide coverage for emergency care received outside of the network.
Some Medicare Advantage plans may extend special coverage to accommodate the “Snowbird” or “Sunbird” population who split their time between two different states. Be sure to check with your plan carrier to learn more about your options for receiving covered care when you travel.
Medigap plans can be used anywhere Medicare is accepted
Medicare Supplement Insurance (Medigap) is used alongside your Original Medicare coverage to help cover costs like deductibles and copays that Medicare doesn’t pay for.
Any provider who accepts Medicare will accept Medicare Supplement Insurance plans, no matter what state you are in.
There are two other features of Medigap plans that pertain to travel:
- Medigap Plan F and Plan G both cover Medicare excess charges, which means you can see non-participating providers and not have to pay your excess charges out of your own pocket.
- Some Medigap plans provide coverage for emergency care received outside of the U.S., which Original Medicare doesn’t typically cover. If you enjoy traveling abroad, you might consider finding a Medicare Supplement plan that offers this benefit.
Some Medicare Part D prescription drug plans may cover costs in other states
Medicare Part D plans provide coverage for prescription drugs, which Original Medicare doesn’t typically pay for.
Some Part D plans contract with national retail pharmacies. Depending on your plan, you may be able to have prescriptions filled at preferred pharmacy locations across the U.S.
Some Part D plans may restrict you to a more local or regional network of pharmacies. Be sure to check with your plan carrier and your pharmacist or doctor for more information.
Find Medicare coverage options for snowbirds
When you travel away from home, be sure to bring your Medicare card with you. Before seeking any treatment from a new provider, find out if they accept Medicare insurance and if they accept your private Medicare plan, if you have one.
You can call to speak with a licensed insurance agent who can help you compare Medicare Advantage plans in your area. You may be able to find a plan with coverage that fits your snowbird lifestyle.
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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.
