Original Medicare travels with you
Original Medicare (Parts A and B) works with any doctor, hospital or other provider in the United States that accepts Medicare. If you spend winters in Phoenix or Palm Springs, your Medicare card works the same way it does in Seattle. There are no networks and no referrals needed to see a specialist.
That portability is why some snowbirds, especially those who split time between two states, choose Original Medicare with a Medigap (Medicare Supplement) policy and a separate Part D drug plan.
Medigap: nationwide protection
A Medigap policy pays its share of Medicare-covered care from any provider in the country that accepts Medicare. If your Plan G pays the Part B coinsurance in Bellingham, it pays it in Tucson too. Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N), so a plan letter has the same benefits wherever you get care.
Plans C, D, F, G, M and N also pay 80% of emergency care outside the U.S. during the first 60 days of each trip, after a $250 yearly deductible, up to a $50,000 lifetime limit.
Tip: Washington law (RCW 48.66.045) generally lets Washington residents who already have a Medigap policy replace it with certain other plans without health questions, and requires community rating, so premiums don't vary by age. Those are Washington rules. If you move your permanent home to another state, its rules apply to policies you buy there.
Medicare Advantage and travel: read carefully
Medicare Advantage plans usually have local or regional networks. They must cover emergency and urgently needed care anywhere in the U.S., but routine care outside your service area may not be covered or may cost more. Check these points on your plan:
- The 6-month rule: under federal rules (42 CFR 422.74(d)(4)), a plan must disenroll you if you've been out of its service area for more than 6 months.
- Visitor or travel benefit: if the plan offers one, it can let you stay enrolled while you're away for more than 6 but less than 12 months; you are disenrolled on the first day of the 13th month. Not every plan offers this. Get the details in writing.
- Emergency vs. routine: emergency and urgently needed care is covered anywhere in the U.S. Routine office visits and follow-ups away from home may not be.
- PPO vs. HMO: PPO plans cover out-of-network care, usually at a higher cost; HMO plans generally cover only network providers except for emergencies and urgent care.
If you're weighing a change, you can see plans in your ZIP code, or a licensed insurance agent with Benefits Life can compare plans from the companies they work with: (206) SENIORS (206-736-4677), TTY 711.
Part D and out-of-state pharmacies
Part D plans cover drugs at pharmacies in their network. Many plans have network pharmacies in other states, but networks differ, so look up pharmacies in your winter town before you leave. Mail-order through your plan can send maintenance medicines wherever you ask.
If you can't reasonably get to a network pharmacy, Part D plans must cover drugs filled at an out-of-network pharmacy, as long as you don't do it routinely (42 CFR 423.124). Medicare drug plans don't cover drugs bought outside the U.S.
Decisions before you leave
- Keep your permanent address current with Social Security and your plan; Medicare plans are based on where you live.
- Ask your Washington Medicare Advantage plan in writing about out-of-area coverage and whether it has a visitor or travel benefit.
- If you'll be away for months at a time, compare whether Original Medicare with Medigap fits better than your current plan.
- Set up mail-order prescriptions before you leave so refills follow you.
- Carry your Medicare card and plan ID cards, and keep photos of them on your phone.
- Find an urgent care clinic and a primary care office near your winter home that accept Medicare (and your plan, if you have Medicare Advantage).
Establishing residency in another state
If you make Arizona, Nevada, California or another state your permanent home and leave your plan's service area, you get a Special Enrollment Period to change Medicare Advantage and Part D plans. It begins when you move and lasts 2 full months after you move; if you tell your plan before you move, it can start the month before. Medigap rules differ by state, so check your new state's rules before you replace a policy, and talk with a licensed insurance agent who is licensed in your new state. Coming the other way? See moving to Washington with Medicare.
Sources
- eCFR — 42 CFR 422.74(d)(4), disenrollment after more than 6 months out of the service area; visitor/traveler exception
- eCFR — 42 CFR 422.113, Medicare Advantage emergency and urgently needed services
- eCFR — 42 CFR 423.124, out-of-network access to Part D drugs
- Medicare.gov — Special Enrollment Periods
- Medicare.gov — Travel outside the U.S.
- Medicare.gov — Learn what Medigap covers
- Washington State Legislature — RCW 48.66.045, Medigap replacement policies and community rating
Frequently asked questions
Can I see a doctor in Arizona on my Washington Medicare Advantage plan?
For emergencies and urgently needed care, yes; Medicare Advantage plans must cover them anywhere in the U.S. For routine care, only if the provider is in your plan's network, your PPO plan covers out-of-network care, or your plan has a visitor or travel benefit. Ask your plan in writing before you go.
Does Original Medicare cover me if I go to Mexico for a few weeks?
Generally no. Original Medicare doesn't cover care outside the U.S. except in narrow situations. Medigap Plans C, D, F, G, M and N pay 80% of emergency care outside the U.S. during the first 60 days of a trip, after a yearly deductible, up to a lifetime limit.
Can I keep my Washington Medigap policy if I move permanently to another state?
A Medigap policy works anywhere in the U.S. with providers that accept Medicare. Before you move, ask your insurer whether you can keep the policy and how your premium may change. Washington's Medigap rules apply to Washington residents, so check your new state's rules before you replace a policy.
How long can I be out of Washington and still keep my Medicare Advantage plan?
Under federal rules, a Medicare Advantage plan must disenroll you if you've been out of its service area for more than 6 months, unless the plan offers a visitor or travel benefit. Plans with that benefit can keep you enrolled up to 12 months, and you are disenrolled on the first day of the 13th month. Check your plan's Evidence of Coverage.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
