Medicare Advantage When You Travel: Coverage That Moves With You

How Medicare Advantage works when you're not home

Medicare Advantage plans cover you anywhere in the United States, but the cost and coverage details change depending on where you are. If you spend winters in Arizona and summers in Maine, or travel frequently, your plan's network of doctors and hospitals shifts with you. Most plans charge the same copay for in-network care whether you're home or away, but finding in-network providers in a different state takes planning.

The key difference from Original Medicare is that you're locked into a specific plan's network. Original Medicare works the same everywhere because it's federal. Medicare Advantage is run by insurance companies, and each company has different doctors and hospitals under contract in different regions. When you travel, you're using a different part of that same company's network — or sometimes no network at all, depending on the plan type.

Out-of-network care in Medicare Advantage is expensive. You might pay 40 to 60 percent of the cost, or sometimes the full cost. That's why knowing your plan's coverage rules before you leave matters more than it does with Original Medicare.

Key Takeaways

• Medicare Advantage covers you nationwide, but copays and deductibles may differ by state, and you must use in-network providers to get the lowest cost.
• Some plans offer out-of-network emergency coverage, but routine care outside the network can cost significantly more than in-network visits.
• Before traveling, call your plan to confirm which doctors and hospitals are in-network at your destination and whether you need referrals for specialists.
• If you split time between two states, you may be able to enroll in a plan that covers both regions, or you may need to switch plans when you move.
• Prescription drug coverage follows you, but the pharmacy network may be different in another state, so check your plan's formulary before you travel.

In-network and out-of-network costs while traveling

When you see a doctor in your plan's network, you pay the copay listed in your plan documents — usually $15 to $50 for a visit. That copay is the same whether the doctor is in your home state or across the country. The insurance company has negotiated rates with that provider, so the cost to you stays predictable.

Out-of-network care is where costs spike. If you need a doctor while traveling and can't find an in-network provider, you typically pay a percentage of the bill — often 40 to 60 percent — after you meet a separate out-of-network deductible. Some plans don't cover out-of-network care at all except in emergencies. Emergency room visits are usually covered out-of-network, but a follow-up visit with that same hospital's doctor might not be.

The best protection is to know your plan's rules before you travel. Call the customer service number on your insurance card and ask: Which hospitals and urgent care centers are in-network where I'm going? Do I have out-of-network coverage for non-emergencies? What's my out-of-network deductible? Write down the answers and take them with you.

Finding in-network providers at your destination

Every Medicare Advantage plan has a provider directory on the insurance company's website. You can search by location and specialty. Before you travel, search for primary care doctors, specialists you see regularly, and hospitals near where you'll be staying. Write down their phone numbers and addresses.

Provider directories are not always current. A doctor listed as in-network may have left the plan, or a new doctor may not be listed yet. Call the provider's office directly to confirm they accept your plan and are currently taking new patients. Also ask whether they require a referral from your primary care doctor — some plans do, even for specialists.

If you can't find an in-network provider for something you need while traveling, call your plan's customer service line. They can sometimes locate an in-network provider you missed, or they can tell you exactly what you'll pay out-of-network. Some plans have a nurse line you can call for advice on whether you need to see a doctor at all.

Prescription drug coverage when you travel

Your Medicare Advantage prescription drug coverage travels with you, but the pharmacy network may be different in another state. A pharmacy that's in-network at home might not be in-network where you're traveling. You'll pay more if you use an out-of-network pharmacy — sometimes significantly more.

Before you travel, check your plan's pharmacy directory for pharmacies near your destination. If you take regular medications, call ahead to confirm the pharmacy has your prescriptions in stock and accepts your plan. If you're traveling for more than a month, ask your doctor for a 90-day supply before you leave, or ask whether they can send prescriptions to a pharmacy at your destination.

Mail-order pharmacy is an option for some plans. If your plan offers it, you can have medications mailed to you while you travel. This works best if you know your travel dates in advance and can arrange delivery before you leave.

Splitting time between two states

If you spend half the year in one state and half in another, you have two main options: enroll in a plan that covers both regions, or switch plans when you move.

Some Medicare Advantage plans are offered by large national insurance companies and cover multiple states. You can search for plans that serve both your home state and your winter destination. These plans usually have different copays and deductibles in each state, so read the plan documents carefully. You'll stay enrolled in the same plan year-round, but your costs may change depending on which state you're in.

The other option is to switch plans. If you move to a different state for more than a month, you can change Medicare Advantage plans during the Annual Enrollment Period (October 15 to December 7 each year) or during a Special Enrollment Period if you move. Some people enroll in one plan for their home state and a different plan for their winter state, switching each time they move. This takes more paperwork but may give you better coverage in each location.

Talk to a Medicare counselor before you decide. Your State Health Insurance Assistance Program (SHIP) offers free counseling. Find yours at shiptalk.org or call 1-877-839-2675.

Emergency care and urgent situations while away

Emergency room visits are covered by Medicare Advantage even if you're out of network, as long as it's a true emergency. A true emergency is a sudden, serious medical condition that requires immediate care to prevent death or serious harm. Chest pain, difficulty breathing, severe injury, and sudden loss of consciousness count. Wanting to see a doctor for a sore throat while traveling does not.

If you go to an out-of-network emergency room, tell the hospital you have Medicare Advantage and give them your plan information. The hospital will bill your insurance company. You'll pay your copay (usually $250 to $500 for an ER visit), and your plan covers the rest. After the emergency, follow up with an in-network provider if you can, because ongoing care from an out-of-network doctor will cost more.

Urgent care centers are different from emergency rooms. They handle injuries and illnesses that need care today but aren't life-threatening — sprains, minor cuts, infections. Some urgent care centers are in-network and some are not. Before you travel, find urgent care centers in-network at your destination. If you need urgent care and can't find an in-network center, call your plan first to ask what you'll pay out-of-network.

Enrollment and plan changes for travelers

You can change Medicare Advantage plans once a year during the Annual Enrollment Period, which runs October 15 to December 7. Changes take effect January 1. If you're planning to spend the winter in a different state, you can switch to a plan that covers that state during this window.

If you move to a different state for more than 30 days, you may be able to change plans outside the Annual Enrollment Period through a Special Enrollment Period. You have 60 days from the date you move to make the change. Call Medicare at 1-800-MEDICARE to confirm whether you're may be able to access and to enroll in a new plan.

Some people keep their home-state plan year-round even when traveling, accepting higher out-of-network costs. Others switch plans seasonally. There's no single right answer — it depends on how long you travel, where you go, and which doctors you need to see.

Frequently Asked Questions

Can I use my Medicare Advantage plan in other countries?

No. Medicare Advantage only covers care in the United States. If you travel internationally, you need separate travel health insurance. Some travel insurance policies cover pre-existing conditions and some do not, so read the policy carefully before you buy.

What happens if I'm traveling when my plan year ends?

Your coverage continues without interruption. If you're enrolled in a plan on December 31, you stay enrolled in that plan on January 1, even if you're in a different state. If you want to switch plans, you must do so during the Annual Enrollment Period before you travel.

Do I need to tell my Medicare Advantage plan I'm traveling?

No, you don't need to notify your plan. However, it's a good idea to call customer service before you leave to confirm which providers are in-network at your destination and to ask about any coverage rules specific to your plan.

Can I have two Medicare Advantage plans at the same time?

No. Medicare rules allow you to be enrolled in only one Medicare Advantage plan at a time. If you want different coverage in a different state, you must switch plans, not add a second one.

What if I get sick while traveling and need ongoing treatment?

Call your plan's customer service line and explain the situation. Some plans will temporarily cover out-of-network care if you're traveling and need ongoing treatment. Others will help you find an in-network provider. The sooner you call, the more options your plan may have to help you.