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Using Medicare Out of State: Coverage and Considerations

Medicare provides medical coverage for individuals 65 or older or with specific qualifying disabilities. If you are a beneficiary of Medicare, you may be wondering if you can see a doctor in another state with Medicare. Understanding the benefits of your Medicare coverage will help you meet your medical needs even while traveling.

Key takeaways:

Understanding Medicare basics

The federal government originally designed Medicare to provide medical coverage for various medical needs to those who qualify based on their age or disability. The level of coverage you receive while out of state depends on the type of Medicare plan you are assigned. However, you can always count on out-of-state coverage for emergency situations. Medicare consists of four parts, which are explained below. Read along to identify which plan you fall under.

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Part A: Hospital insurance

Medicare Part A is billed when a beneficiary has received care in an inpatient hospital or a skilled nursing facility. Part A also provides coverage for hospice and some home healthcare services. While you may still be responsible for a copay, deductible, or coinsurance, your coverage will remain out of state as long it is deemed medically necessary by a physician or other qualified healthcare provider.

Part B: Outpatient services

Medicare Part B provides coverage for services in outpatient settings such as a doctor’s office, laboratory, and medical equipment. Most beneficiaries pay a monthly premium for this coverage, a yearly deductible, and a copayment to receive services under this portion of Medicare.

Part C: Medicare Advantage

Original Medicare differs from Medicare Advantage plans in its structure. You will typically have Medicare Part A and B, along with a prescription drug plan, to cover your drug costs. Medicare Advantage groups all the parts together to provide coverage from one insurance entity. Usually, Medicare Advantage plans also include Part D, which provides coverage for prescription drugs.

Part D: Drug coverage

Prescription coverage under Medicare has its category under Part D. Thanks to Medicare Part D, prescription costs are far more manageable for seniors and those with disabilities. This coverage is often obtained through a specific prescription drug plan or a Medicare Advantage Plan.

Medigap plans

Many Medicare beneficiaries also opt for a Medicare Supplement or Medigap plan. These types of plans are designed for those who are eligible for Original Medicare with the intent to cover any gaps of coverage in the Original Medicare or Medicare Advantage plan. Many Medigap plans offset the costs of copays, coinsurance, and deductibles. There are also additional benefits provided under such plans such as dental, vision, hearing, or prescription drug coverage.

Can you use Medicare in another state?

What coverage can you expect during your travels when using Medicare? Medical needs arise unexpectedly during travels. Whether you run out of a prescription or need emergency care, you must be able to rely on Medicare to cover those expenses.

Traveling with Original Medicare

When you have Original Medicare, receiving medical care and having it covered is fairly simple. Because it is a federal program, beneficiaries of Original Medicare are entitled to coverage in all 50 states and all U.S. territories, including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. All you have to do is show your Medicare card and the services will be billed appropriately.

Selecting a healthcare provider who accepts Medicare when you see a doctor or specialist outside your usual residence is important. Medicare Interactive states your Medicare coverage will limit how much the participating provider can charge you for the visit. If the provider does not accept Medicare, your out-of-pocket expenses for the services may be higher.

Traveling with Medicare Advantage plans

Things may get a little trickier with a Medicare Advantage Plan because its coverage is normally limited to a specific area of service. You must familiarize yourself with out-of-network coverage terms, including any additional costs, restrictions, and rules. Some out-of-network services will require prior authorization from the insurance company to receive coverage.

With some preparation and communication with the health plan, your desired healthcare services may be covered if approved beforehand. If you experience a medical emergency outside the approved network, a Medicare Advantage Plan must cover the necessary services to treat the emergency.

Traveling with Medigap Insurance

Traveling across state lines with Medigap is fairly simple as it is accepted by most healthcare providers who accept Original Medicare. If you do need to see a healthcare provider during your travels in another state, just be sure that they accept Original Medicare and if they do, you'll know that your Medigap plan will work without a hitch.

Moving to another state with Original Medicare

If you're getting ready to move permanently to another state, your Medicare benefits will remain the same. Original Medicare Parts A and B will continue to provide coverage as they did in your current residence. You will need to establish care with a new primary care physician and other required healthcare providers.

If you have a Medicare Advantage Plan, you must notify the plan before your move. Most Medicare Advantage plans function on a network basis based on your residence. Your health plan will either help transfer your coverage to a new network within the new state or recommend you choose another health plan. The Medicare Advantage plan in your old state often drops you off their coverage, allowing you to return to Original Medicare, covering any medical care you need until you sign up for a new plan.

Getting ready to travel to another state?

If you’re preparing for a trip to another state, it will be beneficial to be ready for any situation that will lead you to seek medical care. Whether you get sick or are in an accident, it is always good to be prepared. Here are some tips for preparing to travel to another state with Medicare as your coverage:

  • Research potential healthcare providers and facilities at your destination to learn if they will accept your Medicare plan.
  • Do not forget to bring your Medicare cards with you on your trip.
  • If you have non-urgent needs, use the telehealth options to communicate with your regular primary doctor.
  • Bring your prescription drug coverage card and pick a pharmacy at your destination just in case you run out of your medications.

Following these tips will make your trip smoother even if you need medical attention while traveling to another state. Overall, traveling with Medicare to another state is not difficult. Coverage is available to all beneficiaries in emergencies, and with some planning beforehand, even non-emergency medical services will be covered. Take a look at your Medicare plan today and take a moment to understand what plan you have before you travel out of state.

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