Can Medicare Advantage Plans Be Used Out of State?

Imagine planning a dream vacation, only to find out that your medical insurance coverage isn’t as comprehensive as you thought it would be when you’re out of state. This scenario is all too real for many people enrolled in Medicare Advantage Plans.

Understanding how these plans work and their coverage limitations when traveling is crucial to ensure a worry-free trip.

One common question is, “Can Medicare Advantage plans be used out of state?” Knowing the answer to this will help you make informed decisions about your healthcare coverage while traveling.


Key Takeaways



  • Additional travel insurance options are available for seniors, with varying costs and conditions that should be considered when traveling internationally.

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Medicare Advantage Plans: The Basics

Medicare Advantage Plans are an all-in-one alternative to Original Medicare, offering health care services through private insurance companies approved by Medicare.

These plans can provide more extensive coverage than Original Medicare, often including prescription drugs.

However, unlike Original Medicare, which provides coverage for health care anywhere in the United States and its territories, Medicare Advantage Plans may have limitations when it comes to out-of-state coverage.


Medicare Advantage Plans- The Basics

One of the main factors affecting out-of-state coverage for Medicare Advantage Plans is network restrictions. These restrictions can limit prescription drug coverage and other health care services when traveling out of state, potentially increasing costs.

Moreover, Medicare Advantage Plans may have specific regulations, such as prior authorization, and may involve additional cost-sharing for out-of-network healthcare providers or services outside of the service area.


Network Restrictions

In a Medicare Advantage Plan, utilizing healthcare providers within the plan’s network is necessary for non-emergency or non-urgent care to receive full Medicare benefits.

Otherwise, you could face higher costs or even the full cost of the services. An in-network provider is a healthcare provider that has a contractual agreement with the health plan concerning the rates for services, while an out-of-network provider does not have a contract with the health insurance plan and may not be covered for out-of-state care.

Using out-of-network providers can lead to increased out-of-pocket expenses and may not be taken into account when meeting the plan’s deductible or out-of-pocket maximum.

Medicare Advantage Plans typically cover services provided by in-network providers, but out-of-network care may not be covered, leaving you accountable for the entire cost of the services.

To determine if a provider is in-network or out-of-network for your specific Medicare Advantage Plan, visit the plan’s website and search their directory, contact the plan’s Customer Service department, or check your online member portal if available.

Out-of-State Coverage with Medicare Advantage Plans

Generally, Medicare Advantage Plans have restricted out-of-state coverage. However, exceptions may be made for emergency, urgent care, and dialysis services.

Before enrolling in a Medicare Advantage Plan with out-of-state coverage, understanding the plan’s terms and conditions, especially those related to out-of-state coverage, network restrictions, and costs for out-of-network services, is paramount.


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While traveling, you should carry your Medicare Advantage Plan card, a list of important contact numbers, and a copy of your medical records with you.

If you travel outside your plan’s service area for more than six months, most plans will automatically disenroll you, granting a Special Enrollment Period to join a different Medicare Advantage Plan.

If you don’t make a different selection, you’ll stay enrolled in the Original Medicare plan. This applies even if you do nothing.


Emergency and Urgent Care Coverage

When traveling out of state, Medicare Advantage Plans typically cover emergency and urgent care services, providing access to necessary care.

When a medical emergency or urgent care is needed while traveling, you are always protected with in-network cost-sharing.

That’s great peace of mind! Medicare Advantage Plans provide emergency and urgent care across the U.S. without charging extra. They also do not require additional conditions to be accepted for coverage.

Choosing a Medicare Advantage Plan for Travelers

When choosing a Medicare Advantage Plan suitable for travel, you should weigh factors like network size, cost, benefits, and your travel habits. You can utilize the Medicare Plan Finder or directly reach out to providers to investigate your options.

Medicare Advantage Plans have special benefits for continuous travel within the U.S. and its territories.


Does medicare cover travel expenses



This allows subscribers to stay in the plan for a maximum of 12 months. However, certain areas may not be included, certain care may not be covered, and additional costs may be incurred if care is sought from providers outside the plan’s network.

It’s important to note that not every Medicare Advantage Plan includes a travel benefit.

The Medicare Plan Finder allows you to:


  • Compare Medicare Advantage plans available in your area
  • Get information on coverage and benefits, including coverage for out-of-network providers and services
  • Choose a plan that best suits your needs while traveling.


The network size of a Medicare Advantage Plan can impact the availability of healthcare providers outside the plan’s network. Plans with smaller networks may have limited provider options and coverage away from their service area.

Thus, consider the network size when selecting a plan to ensure access to healthcare services while traveling.


Tips for Traveling with a Medicare Advantage Plan

While traveling with a Medicare Advantage Plan, understanding your plan’s network and coverage boundaries is fundamental. Consult with your specific Medicare Advantage plan regarding coverage details while traveling.


Which medicare advantage plans cover international travel



Take advantage of telehealth services available through your plan, which allows you to receive consultations and medical health services from care providers who are not at your location.

To ensure you have enough prescription medications while traveling, follow these steps:


  1. Allow ample time to obtain the prescriptions before departure.
  2. Have enough medications to last the entire trip.
  3. Consider utilizing a vacation override to refill medications prior to traveling.


Emergency services may be covered during travel, but coverage and limits may differ. Consult with your specific Medicare Advantage plan for details on coverage while traveling.

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Additional Travel Insurance Options

Alongside your Medicare Advantage Plan, medical insurance, such as travel insurance, can cover health care costs as well as supplement your coverage for both medical and non-medical costs during travel.

Reading the conditions or restrictions meticulously is significant.

Travel insurance policies for seniors can vary in cost, but on average, they are approximately $499 per trip.

Navigating International Travel with Medicare Advantage

Coverage for international travel with Medicare Advantage may be limited. Nonetheless, certain plans extend travel benefits such as pre-travel consultations, worldwide logistical support services, and medical evacuation.

Medicare may offer financial aid for hospital, doctor, and ambulance services taken from a foreign country.

However, one should bear in mind that such cases are very rare. Locals outside the 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands are not included.


Best medicare plan for travelers



These areas are not part of the United States. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa is considered outside the United States for Medicare considerations.

A travel benefit for international travel may encompass emergency and urgent care and certain ambulance services, but there may be a limit to the amount the plan will cover for international care and services.

During international travels, having a clear understanding of your Medicare Advantage Plan’s coverage limitations is crucial, and you should always carry the necessary documents.

Understanding Medigap Policies

Medigap policies serve as supplemental insurance that can assist with some out-of-pocket costs for emergency care outside the U.S. Understanding the limitations and coverage rules of these policies is key:


  • They might cover emergency care during international travels, but not routine check-ups or elective procedures.
  • Medigap coverage is restricted to the initial 60 days of the trip.
  • Typically, Medigap policies pay 80 percent of the billed charges.


Foreign hospitals are not required to submit claims for your medical expenses incurred during travel. Consequently, these costs will have to be paid by you personally.

Medicare requires you to provide an itemized bill for any doctor, inpatient, and ambulance services relevant to ensure Medicare pays and covers hospital care at a foreign hospital. Failure to do so will result in the inability to receive coverage.

Medigap policies can significantly supplement your Medicare Advantage Plan for emergency care outside the U.S., but understanding their limitations and coverage rules is important.


In conclusion, understanding how Medicare Advantage Plans work and their coverage limitations when traveling out of state is essential for a worry-free trip.

From network restrictions to international travel, being informed and prepared can save you from unexpected costs and ensure access to necessary healthcare services while away from home.

Frequently Asked Questions



Does Medicare Advantage work in other states?

Yes, Medicare Advantage plans can be used in other states, as long as they provide emergency and urgent care coverage.

These plans are required to cover emergency and urgent care within the United States without imposing additional costs or coverage rules, although some limit coverage to a defined service area.


→  What is the biggest disadvantage of Medicare Advantage?

The key disadvantages of Medicare Advantage plans include limited provider networks, additional out-of-pocket costs, and restrictions on coverage. These disadvantages can leave seniors with fewer healthcare choices and higher costs.


→  Why are people leaving Medicare Advantage plans?

People are leaving Medicare Advantage plans due to high prior authorization denial rates and slow payment processing from insurers, as well as various allegations of billing fraud from the federal government.


→  Can you change Medicare Advantage plans if you move?

When moving, you are eligible to switch Medicare Advantage plans or enroll in Original Medicare through a Special Enrollment Period (SEP).

This SEP allows for at least two months to make the change and can be activated if you move out of your current plan’s service area or within it if different options are available.


→  How can I find out if a healthcare provider is in-network or out-of-network for my Medicare Advantage Plan?

To find out if a healthcare provider is in-network or out-of-network for your Medicare Advantage Plan, visit the plan’s website and search their directory, contact the plan’s Customer Service department, or check your online member portal.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.