Traveling or moving out-of-state can raise questions about your health insurance coverage. Understanding the nuances of using your insurance outside your home state is crucial to ensuring you get the care you need without unexpected costs. This comprehensive guide examines out-of-state coverage across different types of insurance, along with key limitations and recent updates impacting coverage in 2024.
Out-of-State Coverage in Original Medicare
If you have Original Medicare (Part A and Part B), your coverage generally travels with you anywhere in the U.S. You can visit any doctor or hospital that accepts Medicare across all 50 states without needing referrals.
However, Original Medicare provides limited coverage for care outside the U.S. You may consider buying a Medicare Supplement Insurance (Medigap) policy that covers foreign emergency care or a separate travel insurance policy.
Medicare Advantage Plan Rules
If you have a Medicare Advantage Plan, also known as Part C, coverage rules differ.
In emergency situations, your plan generally covers care from out-of-network doctors or hospitals anywhere in the U.S. For non-emergency care, the rules vary:
- In-network coverage: Many Medicare Advantage plans only cover non-emergency care from in-network providers, except in rare cases. This means care is only covered within a certain service area.
- Out-of-network coverage: Some plans offer non-emergency coverage out-of-network, but typically at a higher cost. If you get care from an out-of-network doctor or hospital, you may need prior authorization from your plan first.
- Travel coverage: Most Medicare Advantage plans do not cover non-emergency care outside of the U.S. Some may offer emergency care as a supplemental benefit when traveling internationally.
If you move out of your plan’s service area, you can switch to a new Medicare Advantage Plan in your new location. You typically have a three-month window from when you move to make changes.
Medicaid and CHIP Coverage Out-of-State
Rules for using Medicaid and the Children’s Health Insurance Program (CHIP) out-of-state vary significantly depending on your situation:
- Emergencies: Medicaid covers emergency services anywhere in the U.S. CHIP plans generally cover emergencies out-of-state.
- Temporary travel: Medicaid may cover non-emergency care, often requiring prior approval, if you are temporarily out of state. Timeframes range from a month to a full year, depending on state rules.
- Moving: If you move out of state permanently, you typically can’t transfer Medicaid coverage across state lines. You’ll likely need to reapply for coverage in your new home state.
- Border communities: If you live near state borders, regional compacts may exist, allowing broader coverage. Check if your states participate.
As rules differ greatly, contact your state Medicaid office to understand coverage before seeking care outside your home state.
Using Marketplace Plan Coverage Out-of-State
Health plans sold on the Marketplace must cover emergency services when traveling, similar to other major medical plans. Each year, your plan documents clarify the details.
For non-emergency care, Marketplace plans often only cover in-network providers. However, some plans may offer out-of-network coverage to cover additional costs. Common scenarios include:
- National networks: Some plans sold nationwide have in-network coverage across the U.S. Check provider directories.
- Traveling: Care may be covered, but pre-approval is often required. You may need to pay higher out-of-network rates.
- Moving: You typically must enroll in a new plan if permanently moving between states. You can’t take your old Marketplace plan with you.
Using Other Health Insurance Out-of-State
For employer, union, student, or individual major medical plans, rules for out-of-state coverage have similarities:
- Emergencies: Emergency care is covered nationwide based on federal law.
- In-network coverage: Plans often only cover non-emergency services from in-network doctors or facilities.
- Out-of-network coverage: Some plans may offer out-of-network coverage but require higher cost-sharing. Get pre-approval if possible.
- Traveling: Care may be covered when traveling, but pre-approval is often required, along with higher out-of-network rates.
- Moving: You can’t take your individual market plan to a new state if you are permanently moving. Employer plans may allow broader coverage when relocating.
Balance Billing Protections
Starting in January 2022, the No Surprises Act provides new federal protections against surprise medical bills when:
- Getting emergency care from an out-of-network doctor or hospital
- Receiving non-emergency services from out-of-network providers at an in-network facility in certain cases
- Using an out-of-network air ambulance
In these situations, your health plan must cover your care without requiring higher out-of-network cost-sharing. Any out-of-network providers also can’t bill you for additional costs beyond your plan’s in-network rates, a practice known as “balance billing.”.
However, these billing protections don’t apply to ground ambulance services in most states currently. You may still face much higher costs if you use an out-of-network ground ambulance service.
Marketplaces and Medicare Advantage Updates for 2024
As we enter 2024, some key updates regarding out-of-state coverage include the following:
Marketplace:
- A record 21+ million Americans enrolled in 2023 thanks to enhanced subsidies, leading to increased affordability and accessibility of coverage.
- Enhanced premium tax credits were extended another year through 2025 to limit costs for middle-income enrollees.
Medicare Advantage:
- Continued rapid growth with over 28 million enrollees in 2023, now representing 47% of all Medicare beneficiaries and projected to rise higher.
- New limits on prior authorization requirements and other policy changes to improve access and health equity.
Medicare Part B and Part D:
- Premiums, deductibles, and copays for Part B medical services increased slightly in 2024, but Part D prescription premiums decreased by 3% on average.
- Elimination of beneficiary cost-sharing for Part D catastrophic coverage once out-of-pocket spending exceeds $8,000 as of 2024.
Stay up-to-date on any policy changes impacting your health coverage, especially when traveling or moving between states. Reach out with any other questions!