Can I Use My Medicare in Any State?

You’ve signed up for Medicare insurance and are all set to receive health care coverage under the program. But you’re traveling to another state next month and are wondering if you can use your Medicare in another state. 

Depending on the type of Medicare insurance you have, the answer may be yes. Below is a breakdown of each type of Medicare coverage and the rules about using it on the go.

How to Use Original Medicare In Other States

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare is the federally-administered portion of Medicare that is provided by the government. 

Both Medicare Part A and Part B may be used in any U.S. state or U.S. territory, including Puerto Rico, Guam, the U.S. Virgin Islands, the Mariana Islands and American Samoa. Most Doctors and hospitals can take Original Medicare and will cover you even if it is in another state.

It should be noted, however, that just because you can use Original Medicare all over the U.S. doesn’t mean that it’s necessarily accepted by every health care provider.

Each provider may have one of three arrangements with Medicare:

1. The provider accepts and treat Medicare beneficiaries.
   
   
2. The provider treats Medicare beneficiaries but does not accept the Medicare-approved amount for services as full payment. These providers reserve the right to charge up to 15% more than the Medicare-approved amount for their goods or services. These extra costs are known as an “excess charge.” This is less common, as most providers who treat Medicare beneficiaries accept Medicare reimbursement as payment in full.
   
   
3. The provider does not accept Medicare beneficiaries or Medicare insurance in any way.

How to Use Medicare Advantage in Another State

Medicare Advantage, or Medicare Part C, is another type of private Medicare insurance. Medicare Advantage plans cover everything covered by Medicare Part A and Part B, while most Medicare Advantage plans also offer prescription drug coverage (which isn’t covered by Part A and Part B). Many Medicare Advantage plans may also offer extra benefits like dental, vision, hearing, transportation, home meal delivery and more. 

Medicare Advantage plans operate much like traditional health insurance plans in that they typically come in the form of HMOs or PPOs.

• An HMO (Health Maintenance Organization) plan generally restricts members to seeing providers who are part of the plan’s preferred network. Networks are often limited within state boundaries, but it’s not uncommon for Medicare Advantage plans to have regional networks that allow plan members to cross state lines and still receive covered care, if even just partial coverage. 
  
  
• A PPO (Preferred Provider Organization) plan is typically less restrictive about where care is received, and a PPO plan member can often use their coverage in another state and still receive coverage. If you have a PPO plan and receive care from an out-of-network provider, you will typically pay higher out-of-pocket costs than you would if you visit an in-network doctor, hospital or provider.

How to Use Medigap Out-of-State

Medigap, or Medicare Supplement Insurance, is a form of private Medicare insurance that covers some of the out-of-pocket costs associated with Original Medicare such as deductibles, copayments and coinsurance.

Medigap insurance is accepted by any health care provider who accepts Original Medicare. If you can use your Original Medicare coverage, you can use your Medigap plan, too. 

In fact, one of the benefit areas that is covered by some Medigap plans is foreign emergency care. Original Medicare only covers emergency care received outside the U.S. or U.S. territories under limited circumstances. But certain Medigap plans can cover 80% of the cost of such care. 

How to Use Your Medicare Part D Plan in Other States

Medicare Part D plans cover prescription drugs and typically operate much like Medicare Advantage plans in that they often include a network of participating pharmacists and pharmacies.

Whether or not you can use your Part D plan to fill a prescription in another state will depend on the terms of your plan and the pharmacies that are part of your plan network. Some Part D plans have agreements with large national pharmacy chains and retailers such as Walmart, CVS, Walgreens and others. Some Medicare prescription drug plans also offer mail delivery for prescriptions, which you may be able to use if you’re going to be away from your home pharmacy.

What Happens to Your Medicare if You Move to Another State

If you have Original Medicare and move to a new state, nothing will change. Simply notify Medicare of your new address so your information can remain accurate. The same goes for any Medigap plan you may have. 

If you have Medicare Advantage or Medicare Part D and move to another state, you should contact your plan carrier directly, notify them of your move and discuss your options. It may be possible that you are moving to an area that is still included as part of the plan’s service area and you can remain enrolled in the same plan. 

However, it’s likely that you won’t be able to use your plan in your new state and will have to enroll in a new plan. In this case, you will qualify for a Special Enrollment Period (SEP), during which you may be able to enroll in a Medicare Advantage or Part D plan that’s offered in your new location. 

Tips for Traveling With Medicare

If you are planning to travel to another state and have Original Medicare, look up some doctor’s offices, health clinics and hospitals convenient to where you’ll be staying and find out if they accept Medicare insurance. 

If you will be traveling and you have a Medicare Advantage or Medicare Part D plan, contact your plan carrier or consult the plan’s directory of network providers to see where you may be able to receive coverage during your travels.