Haris Ashley
Whether you're travelling out of state or moving permanently, it's important to understand how your health insurance coverage works in a different state. The type of insurance plan you have will determine whether you can use your health insurance in another state. 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.
| Characteristics | Values |
|---|---|
| Coverage for emergency services | Covered in all states except Hawaii |
| Coverage for non-emergency services | Not covered in all states |
| Coverage for outpatient clinic services | Covered if approved by the insurance plan |
| Coverage for multiple permanent residences | Covered by travel or short-term insurance |
| Coverage for dependents | Covered as dependents on their parents' health plans until they're 26 years old |
| Coverage for employer-based insurance | Covered in the new state of residence |
| Coverage for Medicare beneficiaries | Covered by Medicare Advantage or Medigap plans |
| Coverage for supplemental insurance | Covered by accident or critical illness insurance |
| Coverage for PPO plans | Covered by United Healthcare's national PPO network |
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What You'll Learn
- Emergency services are covered by all plans in the US, except Hawaii
- Non-emergency care is not always covered
- Supplemental coverage can be purchased for out-of-state care
- Medicare Advantage plans have more limited provider networks than Original Medicare
- If you have employer-based insurance, check if your plan is covered in your new state
Emergency services are covered by all plans in the US, except Hawaii
If you're travelling or moving out of state, you may wonder how your health insurance coverage works in your new location. Health insurance rules and coverage details can vary by plan and location, so it's always best to check with your specific health plan.
In general, all health insurance plans, regardless of the state of purchase, will cover emergency services at any hospital in the United States, with the exception of Hawaii. This means that if you experience a health emergency or accident while travelling or living in another state, your insurance plan will cover emergency medical procedures. However, it's important to note that Hawaii is the only state where this may not apply. If you are a resident of Hawaii, be sure to review your Guide to Benefits for coverage while away from home and always carry your current HMSA membership card while travelling.
It's important to understand that emergency services are typically defined as life-threatening situations. If you require non-emergency or post-emergency care, such as outpatient clinic visits or routine health care, your insurance plan may not cover these expenses. These types of services are often considered outside of the "emergency" category and may require separate approval from your insurance provider. Additionally, you may be responsible for higher out-of-pocket costs when seeking treatment from out-of-network providers, which can include providers outside of your insurance plan's network or providers in a different state.
To ensure you have adequate coverage while travelling or relocating to another state, consider the following options:
- Contact your insurance provider: Get in touch with your current insurance provider to understand their specific plan network and coverage details for out-of-state care. Ask about any limitations or exclusions, especially if you are moving to Hawaii.
- Supplemental coverage: If you travel frequently or live in multiple states, consider supplemental coverage as an add-on to your current plan. This can include critical illness/accident coverage or hospital indemnity plans that provide reimbursement for a range of medical services.
- Short-term insurance: If you have multiple residences or travel extensively, short-term insurance or travel insurance can boost your coverage when you're outside of your plan's network for extended periods.
- Compare plan options: If you're moving to another state, take the opportunity to shop around and compare different plan options available in your new state. Consider factors such as network providers, coverage limits, and overall cost.
Remember, while emergency services are generally covered across the US, each health plan has its own unique details and limitations. Always review your specific plan's coverage and costs, especially before travelling or relocating, to ensure you understand the extent of your protection.
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Non-emergency care is not always covered
Whether you are travelling for a few weeks or moving out of state, it is important to understand how your health insurance coverage works in your new location. While emergency services are typically covered at any hospital in the United States, with the exception of Hawaii, non-emergency care is not always covered. This means that routine care, such as wellness visits, preventive care, and vaccinations, may not be covered if you are outside of your plan's network.
If you are seeking non-emergency care while out of state, it is important to understand how your insurance plan defines an emergency. In some cases, your insurance plan may not cover non-emergency care, such as doctor check-ups, if it is out-of-state. This is because every health plan has a "network" of healthcare providers and facilities, and when you visit a provider outside of your network, you will typically pay a larger share of the cost.
If you are moving to a new state, it is important to update your health insurance plan to ensure that you have coverage in your new state of residence. Under the Affordable Care Act, moving to a new residence qualifies you for a Special Enrollment Period to enroll in new coverage, even outside of the Open Enrollment Period. You may need to find a new health plan if your previous plan does not have network providers in your new state.
If you are travelling or living in multiple states, you may want to consider supplemental coverage to add to your current plan. This can include additional critical illness or accident coverage, which can provide financial protection in the event of an accident or bad diagnosis, regardless of location or network. Alternatively, you can consider hospital indemnity-style plans, which provide cash payments to cover services such as doctor's visits, second opinions, and hospital stays.
Before travelling or moving out of state, it is important to review your health plan's Summary of Benefits and Coverage (SBC) to understand what types of services are included and how you will be covered in an emergency. If you feel that your current plan does not provide adequate out-of-state coverage, you can also consider purchasing travel medical insurance to help cover unexpected medical or dental bills while you are away from home.
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Supplemental coverage can be purchased for out-of-state care
Supplemental coverage is meant to be an add-on to your current coverage. When it comes to supplemental coverage that will cover you nationally, you have a few options. You can get additional critical illness/accident coverage that will pay you money if you encounter an accident or bad diagnosis, regardless of location or network. This is probably the best option for frequent travellers or those most concerned about out-of-network emergency costs. Alternatively, you can get hospital indemnity-style plans where they pay you cash to cover services, including doctor's visits, second opinions, and hospital stays, all with a national network.
United Healthcare offers a year-long plan with a national PPO network (some states offer plans for up to 36 months). While less expensive than most individual plans on the market, they do not cover preventative care or pre-existing conditions. They also offer optional co-pay plans and additional accident/critical illness plans for more comprehensive coverage.
National General is an insurance company known for its auto insurance. They also offer some of the best "short-term" or "catastrophic" health insurance on the market. Because National General offers longer-term options, the Aetna Signature national network PPO, competitive lifetime limits, a $50 urgent care copay, and a guaranteed issue option, it is a stand-out insurance provider in a crowded field of competitors. Few short-term or catastrophic plans can offer these levels of benefit at an affordable price.
If you have employer-sponsored supplemental coverage, you likely won't need to purchase additional coverage. However, it's a good idea to check with your employer-sponsored plan to see exactly how your coverage will work if you split your time between multiple locations. In most areas, Medicare Advantage is an alternative for Medicare beneficiaries who prefer to receive all their Medicare coverage in one plan offered by a private insurer. However, Medicare Advantage plans have provider networks that are more limited than the nationwide network of providers who accept Original Medicare. If you're enrolled in a Medicare Advantage PPO, you'll have some coverage for out-of-network care, but your costs will be significantly higher than if you remained in-network.
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Medicare Advantage plans have more limited provider networks than Original Medicare
The limited network of providers in Medicare Advantage plans can result in higher costs for beneficiaries when they seek care outside of their plan's network. This is because individuals typically pay a larger share of the cost when they go outside of their provider network for healthcare services.
To address this issue, some Medicare Advantage plans offer lower out-of-pocket expenses for in-network services, making them more affordable for enrollees. However, it's important to note that these plans may not always provide adequate coverage, with some plans found to be non-compliant with "network adequacy" standards.
In contrast, Original Medicare does not have specific provider networks, and beneficiaries can generally seek care from any provider that accepts Medicare. This provides more flexibility in choosing healthcare providers without being restricted to a limited network.
It's always important to carefully review the details of any health insurance plan, including Medicare Advantage and Original Medicare, to understand the specific coverage, costs, and provider networks associated with the plan.
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If you have employer-based insurance, check if your plan is covered in your new state
If you have employer-based health insurance and are considering a move out of state, it is important to check whether your current plan will be covered in your new state of residence. Health insurance rules and coverage details can vary by plan and location, so it is always best to check with your specific health plan.
Firstly, you should find out if your current plan is covered in your new state. If your new state of residence is outside of your plan's service area, you may need to find a new health plan. This is because each health plan has a "network" of healthcare providers, and you will likely pay a larger share of the cost when you visit a provider outside of your network.
If you are moving to a different state, your employer may need to update your health insurance. This can be a complicated and time-consuming process for your employer, especially if they are a small business or have employees in multiple states. In this case, your employer may opt for a national group health plan, which provides the same coverage to all employees regardless of where they live, or a self-insured group health plan, which allows your employer to create and manage their own group health plan.
If your employer does not offer a health plan that includes your new state of residence, you may need to purchase your own private coverage. Moving to a new residence (whether that's a different state, zip code, or county) qualifies you for a Special Enrollment Period to enroll in new coverage under the Affordable Care Act. You can also look into supplemental coverage, which can provide additional critical illness or accident coverage, or hospital indemnity-style plans, which pay out cash for covered services.
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Frequently asked questions
Yes, all health insurance plans cover emergency services at any hospital in the United States, except in Hawaii. However, non-emergency care may not be covered.
If you have to move between two or more locations due to your job, your employer has likely 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.
You may need to update your health insurance. If you have employer-based health coverage, find out if your plan is covered in your new state of residence. If not, you may need to find a new health plan.
