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
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
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 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:
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.
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.
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
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.