Jeffrey Wade
Whether you're going on a road trip, visiting family in another state, or moving permanently, you'll likely want to know if your medical insurance will cover you. The short answer is that it depends on the insurance plan type you have. Most plans cover emergency services at any hospital in the US, regardless of the state, but some plans may not cover routine care in another state. If you have employer-based health coverage, it's a good idea to find out if your plan is covered in your new state of residence.
| Characteristics | Values |
|---|---|
| Whether you can use your medical insurance in another state | Depends on the insurance plan type |
| Plan types that allow full access to any and all participating providers in any state | PPO or OAP plans |
| Plan types that cover emergency services anywhere in the country but may not cover routine care in another state | HMO, POS, and EPO plans |
| Whether you can use your Medicaid in another state | Yes, but benefits, eligibility, and provider access vary from one state to another |
| Whether you can use your Medicare in another state | Yes, but Medicare Advantage plans have more limited provider networks than Original Medicare |
| Whether you can use your short-term insurance in another state | Depends on the plan |
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What You'll Learn
Emergency care
The short answer is that it depends on the insurance plan type you have. For PPO and OAP plans, if there are participating providers in the insurer's national network, the plan will pay for out-of-state care at the in-network level. It doesn't have to be an emergency. However, for HMO and POS insurance plans, most out-of-state care is seen as out-of-network care and is typically not covered, except in emergency situations.
If you are travelling in another state and get into a bad car accident, for instance, you will be taken to a hospital that ordinarily would not accept your insurance. But given that you need emergency care, that hospital visit would be billed as in-network. However, insurance companies may have different definitions of what constitutes an "emergency", and some may deny claims that they judge are not true emergencies.
Medicaid, for example, generally only covers care received in the state that provides the coverage, although there are some exceptions in cases where an out-of-state provider is closer or a metropolitan area straddles two states. It also covers emergency care outside the state, just as it is with private plans. However, each state has its own Medicaid eligibility requirements, so just because you're entitled to coverage in one state doesn't mean it's guaranteed in another.
If you travel a lot for work or live in multiple states, you should consider supplemental coverage, a type of health insurance that can cover some of the unexpected costs of out-of-state medical care.
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Supplemental coverage
There are two main types of supplemental coverage: accident insurance and critical illness insurance. These plans have specific stipulations as to what they may cover. Accident insurance will pay out if you encounter an accident, regardless of location or network. Critical illness insurance will pay out if you encounter a bad diagnosis, regardless of location or network.
Medigap plans, also known as Medicare supplements, are another type of supplemental coverage. They are sold based on where you live, but once you have the coverage, you can use it nationwide. This allows Medicare beneficiaries the flexibility to live in another state for part of the year. Original Medicare plus a Medigap plan will cover most costs, but not prescription drugs. For prescription drugs, you will need a Medicare Part D prescription drug plan. These are sold by private health insurance companies and are based on your primary location.
If you have employer-sponsored supplemental coverage, you likely won’t need to purchase a Medigap or Medicare Part D plan. However, it is important to check with the employer-sponsored plan to see exactly how your coverage will work if you split your time between multiple locations.
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Medicaid and Medicare
Medicaid is a federal-state partnership that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Each state has its own eligibility requirements, and there is no formal program to transfer coverage from one state to another. As such, transferring your Medicaid coverage from one state to another is not possible. If you move to another state, you must reapply for Medicaid and meet the eligibility requirements of that state.
Medicare is a federal health insurance program that covers hospital care and doctor visits for adults 65 and older, people with disabilities, and people with certain medical conditions. Original Medicare (consisting of Medicare Part A and Part B) covers you anywhere in the US, as long as the healthcare provider accepts Medicare. However, Medicare Part D (Prescription Drug Plan) and Medicare Advantage plans have specific coverage areas, and you need to check if your plan covers the location you are travelling to within the US. If you are moving to another state, you need to update your Medicare contact information by providing your new home address.
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Short-term insurance
It is important to note that short-term plans may not cover all categories of essential benefits, and their specific offerings can vary. Additionally, they may impose limits on the amount payable for certain services. Before enrolling in a short-term plan, it is advisable to review the specific coverage details, understand the exclusions, and ensure that the plan meets your individual needs.
When considering short-term insurance for out-of-state coverage, it is crucial to check with the insurance provider to determine if their service area includes your destination state. Even if your current insurance plan is available in the state you are visiting, the costs and coverage may differ. Understanding the details of your plan and its out-of-state coverage is essential before travelling or relocating to another state.
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Changing insurance provider
If you are moving out of state, you will need to start a new application and enroll in a new insurance plan in your new state. You will need to do this without delay to avoid a break in coverage and to prevent paying for coverage that doesn't apply in your new state. The application process will depend on whether your new state uses HealthCare.gov or its own website. You should log in to your Marketplace account and select "Start a New State Application" or "Report a move to a new state" if you are in the process of reporting a life change. You will then need to select the year and new state from the drop-down menu. You should also update your HealthCare.gov profile with your new address.
If you are moving in-state, you will not need to get a new insurance policy or change your insurance provider. However, you will need to notify your insurance provider of your new address, and your insurance rate may change.
When moving out of state, you may be able to remain with your current insurance provider if they serve your new state of residence. This could allow you to preserve any existing loyalty discounts and avoid the hassle of changing insurance companies during an interstate move. However, the cost of your policy may change depending on your new geographic area, your new commute to work, and other factors. You should check with your insurance provider to ensure they offer coverage in your new state. If they do not, you will need to switch providers.
Before switching insurance providers, it is recommended that you get quotes from at least three different companies. You can also get recommendations from friends and family who reside in your new state or from your employer if you are starting a new job. Once you have decided on a new provider, you will need to complete the required documentation and make your first payment. It is important to get the start date of your new policy in writing. You will also need to decide on your deductible, bearing in mind that the higher the deductible, the lower your premium cost will be.
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Frequently asked questions
It depends on the insurance plan type you have. Some plans, like PPO or OAP, allow full access to any and all participating providers in that carrier's network, regardless of which state you reside in. Other plans, like HMO or POS, will cover emergency services anywhere in the country but may not cover routine care in another state.
Medicaid is available in every state, but each state has its own program, so benefits, eligibility, and provider access vary. This means that Medicaid generally only covers care received in the state that provides the coverage, although there are some exceptions.
Original Medicare coverage is the same in every state and includes nationwide access to providers. However, Medicare Advantage plans have provider networks that are more limited than the nationwide network of providers who accept Original Medicare.
Unlike short-term travel, when moving states, health insurance may need to be updated. If you have employer-based health coverage, find out if your plan is covered in your new state of residence. If you're moving to a state outside of your plan's service area, you may need to find a new health plan.
