Thursday, December 1, 2022

Does Medicare Cross State Lines

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Does Medicare Work Anywhere

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The short answer is No. Medicare coverage isnt equal anywhere you go. Some Medicare plans don’t provide for coverage beyond the state or county where you live and where the plan was purchased. That may be a concern for people who travel a lot or who live half the year in one place and half the year in another. You may fly south to winter in a warmer locale or travel north in the summer to escape extreme heat.

If you spend a good portion of the year somewhere other than your home state, you have some decisions to make about how you want your Medicare coverage to work and what youre willing to pay.

Original Medicare If You Live In More Than One Area

If you have Original Medicare, youll probably want supplemental coverage to help pay Original Medicares out-of-pocket costs, as Original Medicare on its own does not have a cap on out-of-pocket costs. More than eight out of ten Original Medicare beneficiaries have supplemental coverage, either from an employer-sponsored plan, Medicaid, or a Medigap plan.

Supplemental coverage from Medicaid includes Part D prescription drug coverage, and supplemental coverage from employers generally includes coverage for prescription drugs. But Medigap plans sold since 2006 do not include drug coverage. Medicare beneficiaries can purchase stand-alone Medicare Part D prescription coverage if they dont have creditable prescription coverage from another source.

Your Original Medicare will cover you anywhere in the nation. Youll just need to make sure that the doctors and hospital you select in your secondary location are participating providers with Medicare.

If youre going to buy a Medigap plan, youll select from among the plans available for purchase in your primary location. A Medigap plan will provide supplemental coverage anywhere in the country, as long as the doctors and hospital you visit accept Medicare.

If you have your supplemental coverage via Medicaid or an employer-sponsored plan, youll want to check with the plan for specifics about how your coverage will work when youre traveling or at your second home.

Can You Buy Health Insurance Across State Lines

Are you allowed to purchase health insurance across state lines? Well, no. Under current guidelines, you are only allowed to purchase health insurance in the state you reside in. Even if you moved from one state to another, youd be obligated to discard your old insurance and purchase the new states plan.

All of this is a result of states having the authority to regulate health insurance policies without federal intervention, which partly changed after the passing of the Affordable Care Act.

Nevertheless, the Trump administration has supported the idea of permitting interstate health insurance purchase in order to create a competitive market. Although the idea has been suggested, no action has occurred to make this practice a reality. Given this uncertainty, what is the reason people want accessible interstate insurance purchases?

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How To Transfer Medicare Supplement To Another State

Medicare Supplement plan enrollees may be able to stay with their current plan if moving out of state. Medicare Supplement benefits are standardized nationwide. So, once you enroll in a plan, it can be used nationwide by any doctor who accepts Original Medicare.

The only step you would need to take is to change your address with your plans carrier. This could result in a change of premium depending on your new location. You may also be eligible for Guaranteed Issue Rights to enroll in a new plan if allowable by your new state. If this is the case, you can enroll in any Medicare Supplement plan without underwriting health questions.

Since Medicare is a federal program, coverage is the same across the United States. You wont qualify for a Special Enrollment Period if you have Original Medicare and a Medicare Supplement plan because these plans operate in all states the same way. But, you can always shop coverage in your new state, you just might go through underwriting when you apply for a new plan.

Keep in mind, Medicare Supplement rules vary by state.

Can I Choose My Healthcare Provider

Medicare Supplement Insurance

With Original Medicare, a primary care provider is not required. You can healthcare provider who accepts Medicare.

With a Medicare Advantage plan, your choice of doctor depends on whether you select a health maintenance organization or preferred provider organization plan.

With an HMO plan, you can choose your primary care doctor from any doctor in the plans network. If you opt for a PPO plan, generally, choosing a primary care doctor is optional. With both types of plans, youll usually save money by visiting an in-network provider.

Its important to note that Medicare Advantage plans must offer emergency coverage outside the plans service area, anywhere in the U.S.

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The Fate Of Health Insurance

What does the future of health insurance entail? Will the purchasing of health insurance across state lines become more frequent? Theres no simple answer to this question. What comes within the next few months or years will be dependent on the political party in power.

On one side, the Republican party believes in repealing the Affordable Care Act in favor of a system that deregulates the health insurance market. The goal of such a measure being the reduction of costs and increased affordability for the consumer. Laws that deregulate the health insurance industry have been put in place across six states. How well have these policies fared? Not well enough.

Although the idea is to drive down healthcare costs with more insurance companies entering the market, the main obstacle isnt the regulations of the state, but the difficulty in creating an adequate, low-cost provider network for the patient. Together with the prominence of insurance companies that own a large percentage of shares within the market, it can prove to be near impossible for any new companies to set foot in a potentially deregulated market.

Tips For Traveling With Medicare

If you are planning to travel to another state and have Original Medicare, look up some doctors offices, health clinics and hospitals convenient to where youll 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 plans directory of network providers to see where you may be able to receive coverage during your travels.

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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.

Explore Medicare Advantage plan benefits in your area

Or call 1-800-557-6059TTY 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 hes written, helping Americans better understand their health insurance and Medicare coverage.

Christians 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.

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

Medicare has neither reviewed nor endorsed this information.

Who Is Eligible For Medicare

With restricted abortion access in Ohio, some cross state lines for care

depends on factors such as:

  • Age: You must be 65 years or older to enroll in a Medicare plan. You can receive Part A without a premium if you are receiving or eligible to receive benefits from Social Security or the Railroad Retirement Board. In addition, you can qualify for a premium-free Part A, if you or your spouse had Medicare-covered government employment.
  • Disability: If you are under 65 years old and have a disability, you qualify for Medicare.
  • End Stage Renal Disease: With this disease, you are experiencing permanent kidney failure and require dialysis or a transplant. You qualify for Medicare.

If you have not been paying for Medicare taxes while you worked, are older than 65 and are a citizen or permanent resident of the U.S., you may have to purchase Part A.

If you are younger than 65, you can receive Part A without a premium if:

  • You have been granted Social Security or Railroad Retirement Board disability benefits for at least 24 months.
  • You are a patient that requires a kidney transplant or dialysis.

Most people do not have to pay for Part A. However, if you desire Part B, you must pay for it. The premium is deducted monthly from your Social Security, Railroad Retirement or Civil Service Retirement check. If you do not receive these types of payments, you will receive a bill every 3 months from Medicare.

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Have You Notified Social Security About Your Address Change

Make sure you notify Social Security of your change of address. The Social Security Administration handles Medicare enrollment. If you receive Social Security benefits, you can change your address online by accessing My Social Security and answering a few security questions prior to making the change if you have set up a My Social Security account.

Alternatively, you can call the Social Security Administration at 1-800-772-1213 and speak to one of their representatives from Monday through Friday, from 7AM to 7PM. You can also visit the Social Security office nearest you and fill out a change of address form.

If you receive your retirement or disability benefits from the Railroad Retirement Board , notify the agency either through its website or by calling 1-877-772-5772 Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative.

Do you have questions about Medicare when moving to another state? Learn more about me by clicking the View profile link below. There are also links that let you schedule a phone appointment or have me email you more information. Want to compare plans on your own? Use the Find Plans button on this page.

New To Medicare?

Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

How To Use Original Medicare In Other States

Original Medicare consists of Medicare Part A and Medicare Part B . 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.

It should be noted, however, that just because you can use Original Medicare all over the U.S. doesnt mean that its necessarily accepted by every health care provider.

Each provider may have one of three arrangements with Medicare:

  • The provider accepts and treat Medicare beneficiaries.
  • 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.
  • The provider does not accept Medicare beneficiaries or Medicare insurance in any way.
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    Using Medicare Advantage Or Medicare Part D In Another 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 plansHealth Maintenance Organization 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 plans 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 plansPreferred Provider Organization 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.

    Does Medigap Work In Two States

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    If you visit doctors accepting Original Medicare, Part A and Part B will cover most of the costs. Medigap plans are standardized by the federal government, meaning that each plans benefits are equal for all enrollees.

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    Medigap benefits are not affected by the carrier and state offering a policy. So, you can use your Medicare Supplement plan wherever you are in the U.S.

    Unlike Medicare Advantage plans, it does not matter which state your doctor or facility is in if they accept Medicare assignment when you have a Medigap plan. When you travel outside the United States, your Medigap plan may even cover some foreign travel emergency benefits.

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    When Does Medicare Coverage Start

    Medicare coverage is dependent on when you have signed up and your sign-up period. Coverage always starts on the first of the month.

    If you meet the criteria for Premium-free Part A, your coverage starts the month you turn 65-years old or the month before if your birthday is the first of the month.

    Part B and Premium-Part A plans are dependent on sign-up:

    You can also sign up for Premium-free Part A after your 65th birthday. Coverage starts 6 months back from sign-up or when you apply for benefits from Social Security or the Railroad Retirement Board.

    After your IEP is over, you can only sign up for Part B and Premium-Part A during the other periods of General Enrollment or Special Enrollment.

    For Original Medicare, the General Enrollment Period is Jan. 1 March 31, with coverage beginning on July 1. You may have to pay a monthly late enrollment penalty if you do not qualify for Special Situations.

    Under Special Situations or the SEP, you can sign up for Part B and Premium-Part A without paying a late enrollment penalty. Your coverage will start next month. Access your situation and

    Counselors: Licensed Mental Health Counselor Portability Intiviatives

    Counselor interjurisdictional initiates have been led by the American Mental Health Counselor Association Interstate Portability Task Force. They have published a position paper on portability to identify their view of the best features of several portability proposals that have recently developed. Details can be found here on the AMCHA website.

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    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 .

    Here are some ways you can contact the SSA:

    How To Use Medigap Out

    Can a PT Charge Medicare for a Progress Report

    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.

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    State Control Of Licensing Across State Lines

    Traditionally, beginning in the 1800s and growing substantially in the 1950s, states have had the authority to license healthcare professionals. States have a vested interest in maintaining that authority because it allows them to exert control over the quality of care given to their citizens by setting standards including the passing of a licensing exam. They respond to citizen complaints and increasingly in some states, coordinate efforts with other professional boards in the same state. States also have been responsible for keeping out bad apples, shouldering the cost of providing disciplinary action and following up with corrective interventions when needed.

    As noted by Dr. Ateev Mehrotra of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston and two colleagues, Alok Nimgaonkar, B.A., and Barak Richman, J.D., Ph.D., in an article in the New England Journal of Medicine, Telemedicine and Medical Licensure Potential Paths for Reform, maintaining the expanded use of telehealth post-pandemic will require permanent rather than the temporary licensure reform that now exists due to COVID-19. Per Dr. Mehrota et al, the growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of healthcare markets and telemedicine across state lines. A similar movement to reduce the barriers to telehealth practice across state lines is evident in many professions beyond medicine.

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