Love spending the winter months in warmer climates but not sure about how that affects healthcare coverage? Dividing time between different dwellings and want to know if your health insurance will cover you in both locations? Whether you’re snowbirding or just splitting time between two states, we’re here to help.
Navigating Medicare coverage can be pretty confusing without bringing different locales into the mix. CoverRight makes figuring out what Medicare coverage is right for you a whole lot easier. We teamed up with the free Medicare concierge service to help savvy snowbirds and dual-state Medicare beneficiaries determine whether they’re covered, wherever they may be. Here’s the scoop for Medicare beneficiaries 65 and up.
Enrolling In Medicare
When you enroll in Medicare, you will typically enroll using the address of your primary residence, i.e., the state that issues your driver’s license, where you vote, and where you file taxes. Your primary residence location will impact the availability of plans that you can enroll in and potentially the price of your plan. Need help enrolling in Medicare? CoverRight has you covered.
Original Medicare: Understand The Assignment
If you are on Original Medicare, Medicare Part A (hospital insurance) and Part B (medical insurance) provide Medicare benefits no matter where you are in the U.S., as long as the doctor or hospital you visit “accepts assignment.” According to medicare.gov, “Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.” So, it all comes down to doctor availability. As long as your medical provider accepts Medicare, you’ll be covered, even out of state.
However, the downside of being in Original Medicare is that without any private or supplemental coverage, you are responsible for 20% of all costs and there is no annual limit on how much you spend, meaning you have unlimited exposure to medical costs.
This is where private plans such as Medicare Advantage and Medicare Supplement come in.
Medicare Advantage Plans
Medicare Advantage (Part C) plans are offered by private insurance companies and cover the same services as Original Medicare (Part A and Part B) but often bundle in prescription drug coverage at no additional cost as well as “extra benefits” such as vision and dental.
Instead of paying a blanket 20% for all medical costs, Medicare Advantage plans usually have fixed copays when using healthcare services as well as an annual maximum out-of-pocket limit that caps your out-of-pocket costs each year.
Copays can be as low as $0 to see your primary physician.
The downside of Medicare Advantage plans is that they typically have doctor networks you need to use to receive your healthcare services. The plan options, and therefore doctor network available, are determined by your primary residence.
If you are enrolling in a Medicare Advantage plan and must have specific doctors and prescription drugs, CoverRight can check to see if they are included in the plan.
PPO Vs. HMO Medicare Advantage Plans
PPO (Preferred Provider Organization) is a type of Medicare Advantage Plan. As the name implies, these plans have “preferred providers” that belong to the plan’s network. Using preferred providers (also known as using “in-network” providers) lets you achieve the lowest cost, however, PPO plans also give you the flexibility to see non-preferred or “out-of-network” providers. The copay will typically be higher when using non-preferred providers.
HMO (Health Maintenance Organizations), on the other hand, have a smaller network than PPO plans and don’t cover any out-of-network expenses, except in the case of emergencies. The benefit of an HMO is that you’re able to keep your healthcare costs down by staying within a network.
Between the two, a PPO plan may be more beneficial for those who have two residences as you can go “out of network.” Speak with a CoverRight representative about whether a PPO or an HMO plan that offers emergency out-of-network coverage is right for you.
Medicare Supplement: Bridging The Gap
As mentioned earlier, Original Medicare (Part A and Part B) does not cover all of the costs of hospital and medical services. There are still out-of-pocket expenses, including deductibles, copays, and coinsurance. To help pay for these “gaps” in coverage, private insurance companies offer Medicare Supplement Plans, or Medigap.
According to CoverRight, “Around 24 percent of all Medicare beneficiaries (or around 15 million people) chose to purchase some type of Medigap plans.” There are currently 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N. Each is standardized by the federal government so that coverage remains the same between companies. However, prices can vary by your primary residence location and the plan type you choose.
If the veritable alphabet soup of Medigap plans isn’t confusing enough, plans C and F are no longer available to those who became eligible for Medicare coverage after January 1, 2020. You may have noticed some more letters missing above: E, H, I, and J are also no longer available, though they still offer coverage to those who previously purchased them. So, if you are newly eligible, your choices for Medigap plans include A, B, D, G, K, L, and M.
“Plan A provides the most basic coverage while Plan F and G provide the most comprehensive coverage. The coverage provided by other plans falls in between these two extremes,” according to CoverRight.
Medigap plans can also come in handy when traveling abroad. According to medicare.gov, “Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.”
For more comprehensive coverage nationwide, you may want to consider pairing your Original Medicare with a form of Medigap coverage. Check out CoverRight’s site to compare Medigap plans and chat with, email, or call CoverRight’s team of expert licensed advisors any time.
Prescription Drug Plans
If you are on Original Medicare, you must purchase stand-alone Part D Medicare, also known as Prescription Drug Plans (PDPs). Medicare Advantage plans offer bundled prescription drug coverage.
The PDP options available to you will depend on your primary residence, and each plan varies in its coverage. Some have a regional pharmacy network while others are national. Obviously a national network would be a better choice for those who split their time between different states. If you are enrolling in a Prescription Drug Plan (PDP), CoverRight will help check if the plan covers your prescriptions.
CoverRight Can Help
Dedicated Medicare advisors from CoverRight can answer your questions, walk you through your best options based on your personal healthcare and budget, and help you understand everything so there are no surprises — all for free! Plus, they won’t bug you or give out your contact info like some other companies.
Other online options for comparing Medicare policies sell your information, which leads to your phone ringing off the hook with offers from salespeople who are just trying to make a buck.
Unlike these companies, CoverRight won’t sell your info or redirect you to other sites. Licensed experts only contact you with your permission — no spam calls! If you’re wondering whether your Medicare coverage will extend to any medical needs you may have while living in your second home, contact CoverRight today!