Why is Medicare Advantage Different When You Move?
Medicare Advantage plans have lots of rules. When you move your permanent residence, those Medicare plan rules take effect.
As it states on the Medicare.gov website,
Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow the rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
These “bundled” plans include Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Health Insurance) covers doctors visits and outpatient procedures. Medicare Part D is for prescription drug coverage.
“Original Medicare” (Part A & Part B) is a Federal program. It is homogenous throughout the country. Original Medicare is the same in Maine as in Arizona.
Private insurance companies construct Medicare Advantage plans (MA plans) following Center for Medicare & Medicaid Services (CMS) regulations. They build the plans for a specific geographic location and are based upon a particular demographic population. CMS must approve all plans and continually monitors and audits those plans. Your Medicare Advantage changes when you move outside your current plan area.
Medicare Advantage Is Local
Medicare Advantage plans are set up by county, a collection of conjoining counties, a state, or even regions, which can be multiple states. The insurance company needs a large enough pool of beneficiaries to scale the revenue, costs, and claims to design a plan that meets CMS’s (Center for Medicare & Medicaid Services) standards and is attractive to consumers. The number of plan participants in a geographic area determines a great deal about the plan. The geographic area of the plan is called the “service area.”
When a member of a particular plan leaves their “service area” permanently, they will no longer count as a member of that plan. In other words, your Medicare Advantage plan will change if you move. The member should contact their Medicare Advantage plan provider ahead of time. The member has several months to change to another plan with the same company in their new home area or to switch to a different insurance company that has a Medicare Advantage plan in their new location. Or, they can even return to Original Medicare and possibly purchase a Medicare Supplement.
Can I Use My Advantage Plan In Another State?
You are covered anywhere within the U.S. in the case of an emergency. When traveling outside of your service area, your coverage depends upon the type of plan you have. You may be able to use your Medicare Advantage plan in another state, but you may not.
An HMO (Health Maintenance Organization) plan generally includes only doctors and institutions in the network located in that service area. Some companies have “National Networks,” where an HMO member may tap into the national network for doctors and hospitals and pay in-network prices even though they are outside their service area.
The other type of plan is a PPO (Preferred Provider Organization) plan. You may access doctors in or out of the network. As long as the doctor or facility takes Medicare, you can get treatment from them. The out-of-network doctors and facilities will probably cost more than their in-network counterparts.
The Part D prescription drug part of the plan is less restrictive than the medical side. The network of pharmacies is more of the issue, but with a large number of national pharmacy chains with contracts with MA plans, you should be able to find your medications at approximately the same cost even away from home.
How Do I Switch My Medicare Advantage Plan If I Move?
Moving your Medicare Advantage plan to another state is very simple. Call the 800-number for customer service on the back of your MA medical card. Customer service at the insurance company will find you a comparable plan in your new location. Of course, they will only offer plans with their company.
You can also call your current agent. I receive phone calls every month from Medicare Advantage clients moving from one place to the next. Arizona and Florida seem to be the top choices currently. I can’t blame them! Texas and Colorado come in a distant second. I appreciate as much notice as you can give me so I can do some research before your move.
If you don’t have a relationship with a trusted insurance agent, you can certainly go on Medicare.gov and use their tool to find plans in the new area and do your own research when you move out of your Medicare Advantage plan service area.
The difficulty with the Medicare.gov “Find Plans” tool is the details of the plans are very general and incomplete. I use the Find Plans tool only for quick checks to see what insurance companies and plans are in the area. Then I go to my resources with the various insurance companies to do more in-depth research on the details of the plans.
How Do I Find A New Medicare Advantage Plan?
When a client calls me to let me know she’s moving to a new Medicare Advantage service area, I go to some aggregating tools that pull up the various Medicare Advantage plans for the new zip code.
I also check the Medicare Supplements in the new zip code as well in case the client wishes to move in that direction.
I also re-run their current medication list with dosages. Prescription drugs can be a significant determining factor between available policies, especially if the drugs are expensive.
Next, I compare their current plan to the future plans. Most of the time, people are moving their Medicare Advantage plan from the Omaha-Lincoln-Council Bluffs Metro area to an even higher population area, so the MA plans are often richer in benefits.
I help them sort through the plans weighing and sifting preferences and priorities until they settle on a plan that meets their needs. Then, depending on the time of the move, we execute the paperwork in person, via the internet, or snail mail. They receive their cards in approximately 10 days after approval and begin their new health coverage seamlessly. I follow up in a few months and during Annual Election Period (October 15th–December 7th) to make sure all is running smoothly.
What Are Some Problems For Medicare Advantage?
As I said, most of my clients who move their Medicare Advantage plans are moving from eastern Nebraska and western Iowa to higher-population areas. The plans are quite often richer in other areas than here. The plans in Orange County, California, for example, are incredible! Many of the copays are zero and the dental, vision, hearing, and other extra benefits are huge in comparison to here.
In almost a decade and thousands of clients, however, I had one couple move from here to Wyoming, into an area that was very rural even by Wyoming standards. There were NO MA plans in their new area at all. Those clients really wanted a Medicare Advantage plan.
Fortunately, it was their Initial Enrollment Period into Medicare for both of them, so we easily did a Medicare Supplement Plan N (coverage that fills in the gaps for the out-of-pocket expenses not covered by their Medicare Parts A and B) and Part D prescription drug plan instead.
As I said, that was a statistical anomaly, but it is a possibility. It is certainly something to consider when moving to a new Medicare Advantage service area, especially if you have health issues that may prevent you from passing Medicare supplement underwriting later on.
Can I Change My Medicare Advantage Plan if I Move?
People quite often get fixated on “Medicare Open Enrollment,” which is from October 15th–December 7th every year. They think they are stuck and cannot change mid-year when they move. You can change your Medicare Advantage plan anytime when you move. You do not need to wait until the Annual Election Period (AEP) from October 15th–December 7th. You have what is called a Special Election Period (SEP) to adjust your Medicare plan.
You need to notify your current Medicare Advantage plan of your move. You can also go through Medicare, or if you have a trusted agent licensed in the new state, you may be better served using them.
If you do not take care of your Medicare Advantage plan change when you move, there will be serious negative consequences for your health coverage, so do not delay!
The rule is you may make one change the month before your move, the month of your move, and up to two months after you move.
Moving is a difficult transition. I’ve done it too many times, in lots of different weather, to very distant and inconvenient places. Sometimes the move happens over a period of time. It is good to talk with someone who is knowledgeable about Medicare things to get help navigating the rules so you are not left out in the cold without health coverage.
Medicare is fantastic insurance. The MA plans have gotten stronger and stronger over the decade that I have offered them as well as more flexible and user-friendly. Medicare coverage will transfer easily to another state, but the rules are challenging. The best solution to all of these nuances is working with an insurance broker you trust. Omaha Insurance Solutions is ready to help you today! 402-614-3389.