Using Your Insurance Out-of-State: Coverage and Limitations Explained

Pinterest LinkedIn Tumblr

Navigating the complexities of using your insurance out-of-state can be a daunting task. Whether it’s for emergency services or routine care, understanding the coverage and limitations is essential. This comprehensive guide will delve into the intricacies of out-of-state insurance usage, providing real-life examples, case studies, data, practical tips, common mistakes to avoid, and best practices to follow.

Emergency Services Coverage: A Universal Right

The Short Answer

All plans cover emergency services at any hospital in the United States, except Hawaii. If an emergency is considered life-threatening, it will be covered as in-network, regardless of the hospital’s network status.

The Long Answer

Your out-of-state coverage primarily covers emergencies, but there are loopholes to what’s considered an emergency. Insurance companies must pay for reasonable emergency medical expenses, even if the hospital is outside your network. However, there is no concrete definition of “emergency,” and some insurance companies may deny claims they judge as non-emergencies. Understanding your insurance coverage before traveling is crucial to avoid denied claims.

Real-life Example

Imagine being involved in a car accident and taken by ambulance to a hospital outside of your network. Your insurance company should still be responsible for paying this expense. But understanding the fine print of what constitutes an emergency can save you from unexpected costs.

Limitations and Network Constraints

Understanding Network Limitations

Every health plan has a “network” of healthcare providers. Visiting a provider outside of your network will result in a larger share of the cost. Contacting your current insurance provider for specific plan network information is essential.

Case Study: Ambetter’s Out-of-State Routine Care

For 2022, Ambetter is the only company known to offer out-of-state routine care. Both HMOs and PPOs have moved to local, more constricted networks to keep costs down. This case study illustrates the importance of understanding your specific plan’s network constraints.

Supplemental Coverage and Catastrophic Plans

Supplemental Coverage Options

Supplemental coverage is an add-on to your current coverage. Options include additional critical illness/accident coverage or hospital indemnity style plans. These can cover services like doctor’s visits, second opinions, and hospital stays, all with a national network.

National PPO Network Plans – Catastrophic

Companies like United HealthOne and National General offer year-long plans with national PPO networks. While less expensive, they don’t cover preventative care or pre-existing conditions. Understanding these limitations is crucial for those considering catastrophic plans.

Data and Statistics

  • National General: Known for competitive lifetime limits, a $50 urgent care copay, and a guaranteed issue option.
  • United HealthOne: Offers optional co-pay plans and additional accident/critical illness plans for more comprehensive coverage.

Best Practices and Tips

Practical Tips and Advice

  • Know Your Plan: Understand the specific details of your plan, including network limitations and emergency definitions.
  • Consider Supplemental Coverage: If you travel frequently, consider supplemental accident coverage.
  • Be Aware of Catastrophic Plans: Understand the limitations of catastrophic plans, including lack of coverage for preventative care.

Common Mistakes to Avoid

  • Ignoring Network Limitations: Not understanding your network can lead to unexpected costs.
  • Misunderstanding Emergency Definitions: Not knowing what constitutes an emergency can result in denied claims.

Best Practices to Follow

  • Consult Your Provider: Always consult your insurance provider for specific information about your plan.
  • Consider Your Travel Needs: Tailor your coverage based on your travel frequency and needs.


Using Your Insurance Out-of-State: Coverage and Limitations Explained is a complex subject that requires careful consideration and understanding. From emergency services to network limitations and supplemental coverage options, this guide has provided a comprehensive overview to help you navigate the complexities of out-of-state insurance usage. Always consult with your insurance provider and consider your specific needs to make the best decision for your health and financial well-being.