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Can Medicare Be Used in Any State?

Summary: Although Medicare is a federal program, Medicare by state may have some different rules that you should be aware of to be sure you’re getting the best health coverage for your needs. Estimated Read Time: 6 mins

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Table of Contents:

    1. Is Medicare State Specific?
    2. Are Medicare Benefits the Same in Every State?
    3. Is Medicare Different in Each State?
    4. States That Do Not Allow Medicare Excess Charges
    5. State-Specific Medicare Supplement Rules
    6. Guaranteed Issue Rights and Open Enrollment Periods
    7. State-Specific Employer Coverage Rules

Original Medicare (Medicare Part A and Medicare Part B) can be used in all 50 states, and most healthcare providers nationwide accept Medicare. You can also use Medicare Supplement (Medigap) plans, Medicare Advantage (Medicare Part C), and Medicare Part D prescription drug plans anywhere in the United States.

However, there are some states where Medicare is a little different, mainly regarding Medicare Supplement plans. Below, we will highlight unique Medicare rules and their applicable states.

Is Medicare State Specific?

Although Medicare is a federal program, states can implement various rules if they meet the basic Medicare regulations. Most states implement rules to ease the requirements for beneficiaries to make changes to their Medigap plans. More than half of the states in the U.S. have a state-specific Medicare rule.

Are Medicare Benefits the Same in Every State?

Since Original Medicare is a federal program, benefits must be the same in every state. This is also true when it comes to Medicare Supplement (Medigap) plans. Even though Medigap plans are offered through private insurance companies, they still must adhere to Medicare rules and regulations set by the Centers for Medicare and Medicaid (CMS).

However, while Medicare coverage by state is the same nationwide, there are some plans that may not be available in your state or zip code. Medicare Advantage (Medicare Part C) and Medicare Part D plans are subject to location so it’s vital to research the plans in your area to be sure the plan you’re considering is available where you live.

Is Medicare Different in Each State?

While Medicare benefits are the same throughout the United States, there are some states with state-specific rules that may affect changing your Medicare coverage or the type of coverage you can enroll in. These rules include annual birthday rules, guaranteed issue rights, excess charges, and more. With over 65 million Americans on Medicare, there’s a good chance you live in a state with a state-specific rule.

Established by state governments, these regulations give you more options when it comes to Medicare Supplement policies outside of initial enrollment.

Depending on your state, you may be subject to a state Medicare rule if you are under 65 with a qualifying disability. If you have Medicare coverage before 65 due to a disability, ESRD, or ALS, you may be unable to enroll in a Medigap policy until you turn 65.

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Federal law does not require carriers to sell Medigap to people under 65. Still, some states require companies to sell Medigap, even if the beneficiary has not had their 65th birthday yet.

Another example of how Medicare can vary by state is that while Medigap plans are standardized nationwide, three states offer distinct types of Medigap plans. These states are Wisconsin, Massachusetts, and Minnesota. Rather than the traditional letter plans, these states provide more variety in coverage.

If you’re moving or considering dual residency, it’s beneficial to understand the rights you’ll have in your new state. Medicare state rules may be different, so familiarizing yourself with them can save you a headache.

Medicare Fun Facts

States That Do Not Allow Medicare Excess Charges

When enrolling in a Medigap plan, you will notice that some cover excess charges and others do not. For some, this can make or break their decision to enroll in a policy.

In the following states, policyholders will not need to worry about excess charges as they are not permitted.

  • Connecticut
  • Massachusetts
  • Minnesota
  • New York
  • Pennsylvania
  • Ohio
  • Rhode Island
  • Vermont

Medicare Excess Charges by State

State-Specific Medicare Supplement Rules

The following states have rules allowing you to change your Medigap plan with no health underwriting questions.

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Birthday Rule

  • California – The California birthday rule lets you change Medigap plans during a 91-day open enrollment window.
  • Idaho – The Idaho birthday rule is a 63-day guaranteed issue period beginning on your birthday.
  • Illinois – The Illinois birthday rule extends an open enrollment period to Medigap policyholders in a specific age range during a 45-day window.
  • Louisiana – The Louisiana birthday rule allows a 93-day open enrollment period around your birthday.
  • Oregon –The Oregon birthday rule offers policyholders a 31-day open enrollment period beginning on their date of birth.
  • Nevada – The Nevada birthday rule is a 61-day open enrollment period for Medigap beneficiaries residing in the state.
  • Maryland – The Maryland birthday rule is a 30-day window for changing your Medigap plan or carrier that starts on your birthday.
  • Oklahoma – The Oklahoma birthday rule is a 60-day window, starting on your birthday, that allows you to change your Medigap plan or carrier.

Each state’s birthday rule is unique. For example, California allows you to switch to any carrier regardless of the carrier your current plan is through. On the other hand, Louisiana requires you to stay with the same carrier.

Medicare Supplement Differences by State

Guaranteed Issue Rights and Open Enrollment Periods

Guaranteed issue rights are protections for Medicare enrollees in certain situations. These rights prevent insurance companies from denying you enrollment in a Medigap plan if you have a pre-existing condition or meet any other potentially disqualifying criteria under normal circumstances.

To utilize guaranteed issue rights, beneficiaries must abide by MACRA when selecting their plan. At this time, only those who got Medicare Part A before January 1, 2020, can sign up for Medicare Supplement Plan F or Medicare Supplement Plan C.

Like Open Enrollment Periods, guaranteed issue rights let you enroll in a Medigap plan with no Medicare Supplement underwriting questions. Those who receive Medicare after January 1, 2020, must abide by MACRA when in an open enrollment period. Thus, individuals with Medicare since before January 1, 2020, may enroll in any Medigap plan they wish.

Annual Guaranteed Issue

Missouri – Policyholders may change from like-to-like benefits during a 62-day period beginning 30 days before the annual policy anniversary and ending 30 days after.

Washington – Policyholders may change from like-to-like or like-to-lesser benefits year-round.

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States with Guaranteed Issue Windows

No Health Underwriting Year-Round

The following states don’t require you to undergo the medical underwriting process when enrolling in a Medigap plan. Thus, you cannot be denied a Medigap policy due to a pre-existing condition.

  • Connecticut
  • Maine – Open Enrollment only in the month of June
  • New York
  • *Vermont – Mutual of Omaha and UnitedHealthcare only

States with Open Enrollment Windows

 

State-Specific Employer Coverage Rules

When combining employer coverage and Medicare, each state has different rules regarding who pays first and how you can utilize the coverage.

Voluntary Group Termination

Voluntary group termination means you choose to drop your group insurance plan while you are still working. Sometimes, people pay more for their group coverage than they pay for Medicare. If this is your current situation, group termination may benefit your wallet.

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Generally, choosing to leave your health care coverage will not land you in a guaranteed issue situation. However, your location may provide an exception to this rule. You CAN use guaranteed issue rights to change from employer coverage to Medigap in the following states.

  • Alaska
  • Arkansas
  • California
  • Colorado
  • Florida
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Louisiana
  • Maine
  • Missouri
  • Montana
  • Nevada
  • New Jersey
  • New Mexico
  • Ohio
  • Oklahoma
  • Pennsylvania
  • South Dakota
  • Texas
  • Virginia
  • West Virginia
  • Wisconsin

Voluntary Group Termination by State

Medicare by State Infographic

How to Get Help with State-Specific Medicare Rules

Keeping track of these different Medicare rules can be confusing. We have licensed agents who are happy to help you make sense of any Medicare rules that apply to your state.

Remember, Medigap costs vary from state to state as well. Our agents can help you find the best Medicare coverage by state that will suit your healthcare needs. Call the number above or fill out our online form to see rates in your area.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

19 thoughts on "Can Medicare Be Used in Any State?"

  1. Hi. I live in New Mexico and am 67 years old. I was found to be disabled when I was 61 by the SSA and in 2019, I was automatically enrolled in Medicare parts A and B and Medicaid. Medicaid just sent a termination letter due to excess income and I want to get Medigap Part F. However, there is a six month window when the insurance company doesn’t have to cover certain preexisting conditions like cancer. I am being treated currently for Bladder cancer, have a surgery planned and many treatments of immunotherapy. The state of NM seems unable to tell me if I have “guaranteed issue” given the termination from state Medicaid was involuntary. I have to get medical care to deal with the cancer and if I don’t due to lack of coverage for six month, my health will be at serious risk. Please help!

    1. Hi Ed! Great question! You because of your loss of Medicaid, you will have guaranteed issue rights to a Medigap plan if that is what you wish to enroll in. Your best option is to work with a licensed insurance agent who can gather more details about your situation and recommend the right plan and carrier to you!

  2. I live in Florida and have medicare part B and a medigap plan G now but am going back to work for a large employer and want to drop Part B and Medigap G. When I retire or leave this company will I be eligible for guarantee issue rights to enroll back into Medigap Plan G here in Florida or do i have to worry about qualifying and any pre-existing conditions?

  3. Medicare is federal ,so why are States allowed to make changes or alter it. Why is Mississippi only allow certain insurance companies to operate there ! What happened to the Obama care

    1. Original Medicare does not vary from state to state. However, Medicare Supplement plans and Medicare Advantage plans are allowed to differ based on the state you live in.

  4. I’m moving from ACA (Obamacare) insurance to Medicare, but I haven’t actually been enrolled in Medicare yet. I turn 65 this month and may not be enrolled in Original Medicare until March. I only applied on 2/8/2021 for Medicare and haven’t heard back from Social Security that I’m actually enrolled yet. I’ve heard that Social Security sometimes backdates the start date of Part A to the first day of your 65th birthday month, but that it’s not consistent about this policy. The ACA website says that when Medicare Part A starts that you lose your ACA discount. I won’t be actually enrolled in Medicare until sometime during months 4-7 of my initial enrollment period for Medicare (which for me runs from 11/1/2021 to 5/31/2022). I haven’t yet cancelled my ACA insurance. Do you think I’ll have to pay back my ACA discount when I file my taxes next year (when the IRS reconciles the ACA discount)? Have you ever run into this situation? Thanks.

    1. Brian, the only reason you would need to pay back your ACA discount is if your Medicare is backdated. If you receive your Medicare ID card and it does have a backdated enrolment date, contact your local Social Security office to have this error corrected.

  5. I live in Texas. My former employer made a decision to move all folks on Medicare to an Advantage Plan on Jan 1,22. I have been Medicare A&B for 7 years. My understanding is that since Texas is a Voluntary State I am not under the 63 day rule to get a guaranteed issuance of a medigap program with the clock ticking as of Jan 1. Am I correct in that I have this issuance right if and when I decide to voluntary leave the Advantage Plan. Thanks, Bob

    1. Bob, once enrolled, leaving an Advantage plan mid-year can be difficult. However, if your employer plan allows you to leave, the 63-day period does apply. You will be able to pick up a new plan without penalty using the guaranteed issue right.

  6. I’m an insurance agent and I was researching what different guarantee issue rules apply in different states. I am licensed in 17 states and was specifically looking at New Jersey. I found this to be a terrific resource. For some reason, I thought Massachusettes also had some guarantee provisions. California birthday rule allows someone on an existing Medicare supplement plan to apply within 60 days following their birthday. One carrier allows them to apply 30 days prior and make an effective date the 1st of the month in which they have a birthday. One carrier allows submission on the 1st of the month for that effective date. All other carriers that I know of won’t make the new policy effective until after their birthday, but there’s a 60-day window following the birthday.

    1. Hi Paul! That’s great information, thank you for sharing! So happy you found the article to be a good resource for you.

  7. In Florida, if I am 65, and covered under an employer-retiree GROUP Medicare Advantage Plan PPO. Can I choose to opt-out and still have guarantee issue rights to enroll in Medigap Plan G and a PDP? If yes, would I have to opt-out during my former employers annual open enrollment period?
    Also, is there somewhere I can find this in writing? I have been searching for days.
    Thank you!

  8. I switched to Anthem Medigap because prescription coverage was free and the plan offered extra coverage at no additional cost. Well nothing is free friends, what they did not tell me was that they have a separate company that acts as a go-between, that is between me and my doctor that must preapprove of all procedures that my doctor recommended. About 1/2 of my procedures were denied and I had to pay for them myself or just skip them. I have been skipping them.

    1. Hi Warren! It sounds like you got mixed information from whoever you purchased the plan through… a Medigap plan does not cover prescriptions drugs. To get prescription drug coverage, you would add Medicare Part D to your Medigap plan. Unfortunately, we’ve never heard of a separate company acting as a go-between. If you would like to enroll in a plan that fits your healthcare needs, give us a call.

  9. Warren, it does not sound like you enrolled in a Medigap plan. There are no preapproval requirements or go betweens in a Medigap plan. If a service is a Medicare covered service, then the Medigap plan pays its share. Period! No if ands or buts. Now keep in mind, Medicare only covers medically necessary services. If Medicare pays, then Medigap pays. No Medigap plans sold after 2010 will cover prescription drugs. Some companies may offer you a discount card, but that is NOT a drug plan. And no Medigap plans offer additional coverage for non Medicare services. Medigap plans may offer added benefits, such as Silver Sneakers, but these added benefits can not be insurance benefits.

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