Retirement may mean the freedom to spend winters in Florida, enjoy ski season at your condo in Colorado, or take off full-time in an RV. But what about health insurance? How does Medicare work if you are a resident of more than one state?
The good news is that traditional Medicare coverage is valid throughout the United States. However, there are things to think about as you explore Medicare options.
What is Dual Residency
Dual residency simply means you don’t live in the same state all year. Dual residents include “snowbirds” who spend the winter months in warm Southern states but return to their homes up north for the rest of the year. If you split your time between different states, it is important to have Medicare coverage that travels with you.
How Dual Residency and Medicare Works
You can only have a primary residence in one state. That’s where you pay resident income taxes, are registered to vote and have a driver’s license. When you become eligible for Medicare, you will sign up in the state that’s your primary residence.
Because Medicare is a federal program, your medical and hospitalization benefits stay the same when you travel to another state. If an out of state healthcare provider accepts Medicare, then Medicare will pay for your care, just the same as if you had seen someone in the state where you have your primary residence.
Medicare Supplement Plans and Dual Residency
Most people who choose Original Medicare supplement their coverage with a Medicare Supplement, or Medigap, plan. This is private insurance that pays for things that Medicare doesn’t cover, like deductibles and the 20 percent coinsurance for medical visits.
Like Original Medicare, Medicare Supplement plans allow you to visit any doctor who accepts Medicare. Even though the available Medicare Supplement plans – and their costs — may vary from one state or locality to another, the plan you choose will allow you to see providers anywhere in the country.
Medicare Advantage and Dual Residency
Medicare Advantage (also known as Medicare Part C) is an option you can choose instead of Original Medicare and a Medigap plan. Medicare Advantage plans are sold by private insurance companies.
They have the same benefits as Original Medicare, and many provide additional benefits like prescription drug coverage.
However, unlike Original Medicare, Medicare Advantage plans use provider networks. Some plans are PPOs. You may have the flexibility to see a doctor outside the network, but you will pay more for it. Other plans are HMOs. You typically must use providers within the network.
Provider networks can cause problems for people who live in two states because some plans don’t have very big networks. Some networks are restricted to providers who are in the same area or state as your primary residence.
If you are in an HMO, you will usually have to get authorization from your primary care doctor to see a specialist or have a procedure. All of this can make it very expensive to get medical care in the state where you live part time.
Medicare Advantage plans have two other drawbacks for people with dual residency: plans and provider networks can change from one year to another, and you cannot choose the prescription drug coverage that goes with your plan.
Prescription Drugs for People With Dual Residency
If you live in more than one state, it’s important to choose a prescription drug plan with your mobile lifestyle in mind.
Prescription plans typically have a network of preferred pharmacies, and you’ll pay less for your prescriptions if you use a pharmacy in the network. However, the size of the network can vary.
Some plans include only local and regional pharmacies, while others have nationwide networks with big names like Walmart and CVS.
If you live in more than one state, it’s smart to choose a Part D prescription plan whose network includes pharmacies convenient to all the places you live.
Whether you live in one place or two, MedicareFAQ can help you find the best Medicare and Medigap coverage for your situation. Just fill out our form to compare rates in your area or give us a call to get started with a free quote.