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I travel between two states throughout the year (Connecticut and Florida). Is there a Medicare Advantage plan that can provide coverage in both states without additional cost?



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Question: I travel between two states throughout the year (Connecticut and Florida). Is there a Medicare Advantage plan that can provide coverage in both states without additional cost?
Category: Traveling with Your Medicare plan

Answer: Yes.  Usually a Medicare Advantage HMO or PPO plan has an established healthcare network and, if you seek a healthcare provider as you travel outside of the plan's network, you will pay more for coverage.

However, some Medicare Advantage plans do provide extended coverage for people who split their time between two different states.

For example, over the past several years, some Medicare Advantage plans provided by UnitedHealthcare offer the UnitedHealth "Passport ®" feature that provided coverage benefits in two different states (or specific counties within different states) to meet the needs of the "Snowbird" or "Sunbird" population.

These Medicare Advantage plans have established networks in different states and plan members could receive the same coverage or use healthcare providers in either network for the same cost and the same Maximum out-of-pocket (MOOP) limits continue to apply.

In this example, the Medicare plan member is required to notify the Medicare plan carrier that the member is traveling outside of the service area and the "Passport" feature is then activated.   The member can continue to use the Passport feature for up to 9-months and must notify the plan carrier when the member returns to the original service area.  (Please note, if a member stays outside of their original service area over 9 months when the Passport feature is activated, the member can be disenrolled from the Medicare Advantage plan.)

If you do not have any Medicare Advantage plans in your area that provide a "passport"-like feature, you still are able to travel with your Medicare Advantage plan.

As you may know, any Medicare Advantage plan will provide you with emergency coverage outside of your plan’s service area or as you travel across the country.

In addition, Medicare Advantage plans will provide other forms of coverage outside of your local service area. 

However, depending on your chosen Medicare Advantage plan, you may pay much more for out-of-network coverage and, perhaps more importantly, out-of-network coverage may not count toward meeting your annual Maximum Out-of-Pocket limit (or MOOP) - meaning that your out-of-network medical costs are not "capped" and could be very high.

As background, Medicare Advantage plans come in several forms and the availability of plans will depend on the ZIP Code region or county where you have your permanent address (the address used on federal income tax filing).

Here is a brief overview of the type of Medicare Advantage plans that might be in your area:

(1) Health Maintenance Organization (HMO) – This is usually the Medicare Advantage plan with the lowest premiums as they have the most restrictive network of healthcare providers. In other words, if you travel, you may pay the highest costs when seeking healthcare services outside of the plan's established provider network.  As mentioned above, the "passport" option may be included in a HMO.

(2) Health Maintenance Organization with a Point of Service option  (HMO-POS) - An HMO-POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment - all for an additional cost or co-payment rate. Again, your out-of-network spending may not count toward your annual MOOP limit.

(3) Preferred Provider Organization (PPO) - This type of Medicare Advantage plan has a more flexible provider network as compared to a HMO Medicare Advantage plan. With a Medicare Advantage PPO you can generally use doctors, hospitals, and providers outside of the network without a referral - but for an additional cost.  As mentioned above, the "passport" option may be included in a regional PPO (RPPO).

(4)  Medicare Advantage Private Fee for Service (PFFS) plan - This type of Medicare Advantage plan has the most flexible options as it is designed to be accepted by any healthcare provider that accepts both Medicare and the terms and conditions of the specific Medicare Advantage PFFS plan. So in theory, there is no established network of healthcare providers and instead, you will need to ensure that your chosen providers accept the plan – no matter where you are located.  The challenge with a PFFS plan can be that your doctors or healthcare provider may or may not accept the plan's terms and conditions - and each subsequent visit to a healthcare provider required that you re-affirm that the PFFS plan is still accepted.  PFFS plans are not currently as popular as they were in past years due to changes in Medicare Advantage plan design requirements and many older PFFS plans were consolidated into more conventional Medicare Advantage plans with established networks.  Today, only a limited number of Medicare Advantage PFFS plans still exist. You can click here to read about the decline of the Medicare Advantage PFFS plan.

To see Medicare Advantage plans that are available in your Service Area, you can use our Medicare Advantage plan finder (MA-Finder.com). If you click on the Medicare plan name, you can see an overview of the plan's coverage.  For more information, please contact the Medicare Advantage plan or telephone a Medicare representative at 1-800-633-4227.





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