Do Medicare Advantage Plans Cover You When You Are Out of State?

Medicare Advantage plans provide you with your Medicare Part A and Part B coverage, and often Part D prescription drug coverage as well. These plans are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare but you get your Part A, Part B, and usually D coverage through the Medicare Advantage Plan, not Original Medicare.

One question that often comes up is whether your Medicare Advantage plan will cover you if you travel out of state. The answer depends on the specific plan you have enrolled in. Here is what you need to know about getting coverage from your Medicare Advantage plan when you are out of state:

Original Medicare Covers You Nationwide

With Original Medicare, your Part A hospital coverage and Part B medical coverage apply nationwide. You can see any provider or facility that accepts Medicare, in any state, without restrictions.

Original Medicare will also cover you for emergency and urgently needed care while traveling outside of the United States. Coverage is limited for non-emergency care outside of the U.S. You generally have to pay 100% of the costs for non-emergency care when traveling internationally.

Medicare Advantage Plans Have More Restrictions

Medicare Advantage plans are not required to cover you nationwide like Original Medicare does. Each Medicare Advantage plan can set its own rules regarding out-of-network and out-of-state coverage.

Some Medicare Advantage plans have a wider coverage area and will cover you in multiple states. Other plans only cover a certain service area, such as a specific county or region within a state.

It’s important to understand your plan’s specific rules for out-of-network and out-of-state coverage before you travel. The level of coverage provided can vary significantly from one Medicare Advantage plan to another.

Review Your Evidence of Coverage

Your plan’s Evidence of Coverage document outlines the details of your medical and prescription drug coverage, including any out-of-network or out-of-state coverage provisions. Study this document closely before relying on your Medicare Advantage plan to cover you when traveling.

Key sections to review include:

• Service area: This shows the geographic region where your plan has contracted providers. Within this area you will usually pay lower in-network rates.

• Coverage outside the service area: Details any out-of-network or out-of-state coverage and applicable cost-sharing amounts.

• Emergency and urgently needed care: Medicare Advantage plans must cover these services nationwide. But it’s good to understand the cost-sharing.

• Prescription drug coverage: Are your medications covered when traveling outside your plan’s service area?

Minimum Coverage Rules for Medicare Advantage

While coverage varies, Medicare Advantage plans must follow certain rules:

• They must cover emergency and urgently needed care when you travel anywhere in the United States. And you pay the same cost sharing as if you got the care in-network.

• They must cover dialysis services when you travel inside the United States. Again, your in-network cost sharing applies.

• Other out-of-network care may or may not be covered. The plan can charge higher copays or coinsurance when you get non-emergency care outside their provider network.

• If a service requires prior authorization or a physician referral when you are in-network, this requirement applies out-of-network as well.

Travel Benefits Offer Enhanced Coverage

Some Medicare Advantage plans provide a travel benefit that expands your out-of-network coverage when traveling within the United States.

With a travel benefit you can get routine or specialty medical care outside your plan’s service area and still pay in-network cost-sharing amounts. These benefits typically cover you for 6 months of continuous travel per year.

Look closely at travel benefit details:

• Is pre-approval required for certain services out-of-network?
• Are there limits on how much your plan will pay?
• Does the benefit extend to prescription drug coverage?

Travel benefits give you greater flexibility and cost savings when you need medical care while traveling within the U.S.

When Traveling Internationally most Plans Offer Emergency Coverage Only

As mentioned earlier, Original Medicare does not provide coverage for most care when traveling outside the United States.

Likewise, most Medicare Advantage plans only cover emergency and urgent care services while traveling internationally. Some plans may provide additional coverage for emergency medical transportation or inpatient care. But in general, these plans only cover you for true medical emergencies when traveling abroad.

And remember that Medicare Part D prescription plans do not cover medications purchased outside of the United States and its territories. You will pay 100% of prescription costs out-of-pocket when traveling internationally.

If you plan to travel internationally, consider purchasing a travel insurance policy to cover medical emergencies. Otherwise, you will be responsible for paying the full costs of care you receive in foreign countries.

Special Rules for Snowbirds

Some Medicare Advantage plan members head south for the winter each year. If you are a snowbird who spends several months away from your primary residence, pay close attention to these Medicare Advantage plan rules:

• You must continue to reside in the plan’s service area for at least 6 months per year to remain enrolled in that MA plan.

• Your plan may allow you to be out of the service area for up to 12 consecutive months and still remain covered. But always check with your plan first.

• Once you are out of the service area for more than 6 or 12 months (depending on the plan’s rules) you can be disenrolled from your MA plan and placed back in Original Medicare.

• If you are disenrolled for being out of the service area too long, you may not be able to reenroll in the same MA plan when you return. You would need to shop for a new MA plan instead.

Snowbirds should connect with their Medicare Advantage plan before heading south to confirm they understand the rules for being out of the service area. This helps avoid any surprises or gaps in coverage.

Tips for Traveling with a Medicare Advantage Plan

If you will be traveling out of state or out of the country, take these steps to make sure your Medicare Advantage plan covers your medical needs:

• Call your plan to ask about coverage where you are going. Get confirmation in writing when possible.

• Bring your plan ID card and contact information so providers can confirm coverage.

• Locate in-network providers at your destination ahead of time if it’s a planned medical trip.

• Refill medications before leaving to ensure an adequate supply while traveling.

• Arrange for medical equipment rentals or replacements if needed at your destination.

• Know emergency care locations like hospitals and urgent care centers where you are traveling.

• Review your costs ahead of time – deductibles, copays, coinsurance – so you can budget appropriately.

• Save receipts to document any payments you make for medical services while traveling.

Choosing a Medicare Advantage Plan with Travel Coverage

If you travel frequently or for long periods, choosing the right Medicare Advantage plan is critical to getting the coverage you need when out of state.

Here are some tips for picking a good MA plan for travelers:

• Look for a plan with a nationwide or multi-state service area so you have in-network coverage options outside your home state.

• Consider a plan with an extensive pharmacy network so you can get your prescriptions while traveling.

• Ask if the plan has a travel benefit providing in-network coverage for non-emergency services out of their home service area.

• Verify the plan offers emergency coverage worldwide, not just in the U.S.

• For snowbirds, pick a plan that allows up to 12 months out of area.

• For global travelers, look for plans that include foreign emergency care in their benefits.

Taking the time to pick the right Medicare Advantage plan can give you the peace of mind that your health and medications are covered wherever your travels take you.

The Bottom Line

While Original Medicare covers you nationwide, Medicare Advantage plans have more restrictions that can affect your coverage when traveling out of state. Rules vary significantly among MA plans.

To travel confidently under your Medicare Advantage plan:

• Review your Evidence of Coverage for travel coverage details.

• Know your plan’s rules for out-of-area and foreign travel.

• Consider plans with travel benefits or worldwide emergency coverage.

• Contact your plan before traveling to confirm your coverage.

With the proper Medicare Advantage plan and some pre-travel research, you can stay covered when traveling anywhere in the United States or even internationally.