Jane Dotson
If you live or work in two different states, you may be able to use your health insurance in both, depending on the insurance plan type you have. Some plans, like PPO or OAP, allow for full access to any and all participating providers in a 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. Multi-state plans, available in 35 states as of 2020, are another option, but they don't necessarily have network providers or cover services in multiple states. If you have employer-sponsored health insurance, your employer has likely already worked out the details, and you may have coverage in all the areas where you live and work.
| Characteristics | Values |
|---|---|
| Medicare | Coverage is the same in every state and includes nationwide access to providers |
| Medicaid | Benefits, eligibility, and provider access vary from one state to another |
| Multi-state plans | Available in 35 states as of 2020 |
| Employer-sponsored health insurance | The employer has likely worked out the details if employees move back and forth between two or more locations due to their job |
| Individual health insurance | If you choose a plan in one state, you might not have coverage for anything other than emergency care when you’re living in the second state |
| PPO or OAP plans | Allow for full access to any and all participating providers in that carrier’s network, regardless of which state you reside in |
| HMO or POS plans | Will cover emergency services anywhere in the country but may not cover routine care in another state |
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What You'll Learn
Multi-state plans
If you have employer-sponsored health insurance and you move between two or more locations for your job, your employer has likely already worked out the details. Employers with employees in that situation likely have a plan with a nationwide network and coverage in all the areas where their employees live and work.
If you buy your own health insurance or are covered by Medicare or Medicaid, the specifics vary depending on the coverage you have and where you live. If you choose to buy a plan in one state and keep it all year long, you might not have coverage for anything other than emergency care when you're living in the second state. If the plan has a network that is limited to providers within the state (which is true of most individual market plans), you'll have to return to your first home to receive in-network medical care. However, if you experience a medical emergency at your second home, your plan will cover your emergency care.
Medicare is run by the federal government, so Original Medicare coverage is the same in every state and includes nationwide access to providers. On the other hand, Medicaid is run jointly by the federal government and each state. Each state has its own Medicaid 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 for out-of-state providers in specific cases.
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Medicaid and Medicare differences
If you have health insurance and move between two or more locations, your employer has likely already worked out the details. If you have employer-sponsored insurance, your plan may have a nationwide network with coverage in all the areas where their employees live and work. However, if you buy your own health insurance or are covered by Medicare or Medicaid, the specifics vary depending on the coverage you have and where you live.
Medicare and Medicaid are US government-sponsored programs designed to help cover healthcare costs for certain American residents. While both programs are funded by taxpayers, they have different eligibility criteria and benefits.
Medicare is federal health insurance for anyone aged 65 and older and some people under 65 with certain disabilities or conditions. It is the primary medical coverage provider for seniors and those with disabilities. It does not limit enrollment based on income level, but to be eligible for Medicare Part A, you or your spouse must have worked and paid Medicare taxes for at least 10 years. Most people don't pay a premium for Part A, but deductibles and coinsurance apply. Medicare Part B covers medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Medicare Part D provides prescription drug coverage.
Medicaid, on the other hand, is a joint federal and state program that provides health coverage to people with limited incomes and resources. It is designed for people of any age who meet the income and resource eligibility requirements, which vary from state to state. People with Medicaid usually don't pay anything for covered medical expenses but may owe a small co-payment for some items or services. Medicaid offers benefits that Medicare doesn't typically cover, such as nursing home care, personal care services, and dental services for people under the age of 21.
If you have Medicare and live in multiple states, talk with the Medicare Advantage insurer to understand how you'll be covered when you're outside of your home state. If you have Medicaid, it's important to note that each state has its own program, so benefits and provider access may vary. This means that Medicaid generally only covers care received in the state that provides the coverage, although there are exceptions for emergency care and when an out-of-state provider is closer.
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Employer-sponsored insurance
If you have employer-sponsored health insurance and you're required to travel between two or more locations as part of your job, your employer has likely already arranged for your insurance to be valid in all the areas where you work. This is usually achieved through a nationwide network plan, which provides coverage in all states.
However, if you're considering purchasing a second home in another state, or you're an early retiree who hasn't yet qualified for Medicare and is moving to a warmer climate during the colder months, you may need to purchase individual health insurance. This is because your existing insurance may only cover emergency care in the second state, requiring you to return to your primary location for non-emergency treatment.
There are several options for employers to provide health insurance for their employees in multiple states. One option is a national group health insurance plan, where all distributed employees receive the same coverage regardless of their state of residence. This simplifies the process for employers as they don't have to manage different regulations across states. However, only a few insurance companies offer these plans, resulting in limited selection and higher premiums.
Another option is to offer individual state health insurance plans, allowing employees to receive coverage tailored to their location, needs, and preferences. This option is particularly suitable for companies with employees located in several main clusters or regional offices. Alternatively, employers can opt for a health reimbursement arrangement (HRA), where they contribute a fixed amount of money for employees to use on their individual health insurance expenses. This provides flexibility for employees to select the best local healthcare plan for their needs, while also offering tax advantages for both employers and employees.
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Individual/family health insurance
If you live in one state and work in another, you should generally buy health insurance in the state where you live. If you split your time between multiple states, you should buy health insurance in the state where you live most of the year. If you spend a substantial amount of time in more than one state, you should still buy health insurance in the state where you legally reside, which is usually the state where you pay taxes or register to vote.
If you have employer-sponsored health insurance and you need to travel between two or more locations for work, your employer has likely already worked out the details. They probably have a plan with a nationwide network and coverage in all the areas where their employees live and work.
Multi-state plans are sold through the Health Insurance Marketplace under a contract between the U.S. Office of Personnel Management (OPM) and insurance companies. Despite the name, multi-state plans don't necessarily have network providers or cover services in multiple states. Some multi-state plans offer in-network coverage nationally or in multiple states, but many don't.
If you choose to buy a plan in one state and keep it all year long, you might not have coverage for anything other than emergency care when you're in the second state. If the plan's network is limited to providers within the state, you'll have to return to your first home to receive in-network medical care. However, if you experience a medical emergency at your second home, your plan will cover your emergency care.
If you're unsure about what types of out-of-state care are covered by your plan, contact your insurer. An agent will be able to explain your coverage and answer any questions you may have. It's also a good idea to review your insurance plan details to see what kind of care or providers are considered to be in-network.
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In-network and out-of-network coverage
The answer to whether you can use your health insurance in another state depends on the insurance plan type you have. Some plan types, like Preferred Provider Organization (PPO) or Open Access Plus (OAP) plans, allow for full access to any and all participating providers in that carrier’s network, regardless of which state you reside in. You pay less if you use in-network providers, but you won't need a referral to see out-of-network providers (including those in other states), although you will need to pay more.
Other plan types, like Health Maintenance Organization (HMO) or Point of Service (POS) plans, will cover emergency services anywhere in the country but may not cover routine care in another state. Coverage is limited to in-network providers (typically those you live or work close to), and it usually won’t cover out-of-network care at all except in emergency situations.
If you choose to buy a plan in one state and keep it all year long, you might not have coverage for anything other than emergency care when you’re living in the second state. If the plan has a network that is limited to providers within the state (which is true of most individual market plans), you’ll have to return to your first home in order to receive in-network medical care.
If you have multiple permanent residences in different states, it might be worth looking into travel or short-term insurance to boost your coverage when you’re out of your plan’s network for an extended period. Alternatively, you could switch plans and find a health plan that covers providers in both states you live in.
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Frequently asked questions
It depends on the insurance plan type you have. Some plans, like PPO or OAP, allow for full access to any and all participating providers in a 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.
Original Medicare coverage is the same in every state and includes nationwide access to providers. Medicaid, on the other hand, is run jointly by the federal government and each state, so benefits, eligibility, and provider access vary. Medicaid generally only covers care received in the state that provides the coverage, but there are exceptions for emergency care or if you live near a state border.
If you buy a plan in one state and keep it all year, you might not have coverage for anything other than emergency care when you're in another state. Multi-state plans are available in 35 states as of 2020, and some insurers offer nationwide networks, so shop around and read the plan details carefully.
If you have to move between locations due to your job, your employer has probably already worked out the details. They likely have a plan with a nationwide network and coverage in all the areas where their employees live and work.
Contact your insurer. An agent will be able to explain your coverage and answer any questions. You may also want to consider supplemental coverage, which can help with the unexpected costs of out-of-state medical care.
