If you are thinking about moving to a different state, or outside your current Medicare service area, you many have questions about how this move will affect your healthcare coverage. The correct answers depend on what type of Medicare coverage you have. There are different procedures if you have Original Medicare coverage, Medicare Advantage, or a Medigap plan. Generally speaking, if your plan requires that you use a set network for healthcare service providers, you will need to make more changes when you move.
Because having continuous healthcare coverage is so important, you should have all the facts about how your Medicare benefits are affected by your move before you start packing. Here is a look at the different situations and what actions you may need to take before you move.
Is Medicare coverage affected when you move to a different state?
If you are enrolled in Original Medicare Part A (hospital insurance) and/or Part B (medical insurance), you do not need to make changes to your coverage. This is true if you move to a new state, or to a new area within the same state.
Medicare does not require you to use healthcare providers or hospitals in networks, as is the case with some Medicare Advantage plans. Once you have moved, you can choose any physician, hospital, or other healthcare provider as long as they accept Medicare assignment.
Using healthcare providers who accept Medicare assignment ensures that you are charged the Medicare-approved amount for your care and you pay the correct amount for your copayments or deductibles. If you visit a healthcare provider or medical facility that does not accept Medicare assignment, you may have higher out-of-pocket charges.
In order to find qualifying healthcare providers close to your new residence, you can check Medicare’s online site for a list of participating providers in the area.
When you move, you should also contact the Social Security Administration to change your on-file mailing address. You can do this online at the official S.S.A. site which is www.ssa.gov, or you can phone them at 1-800-772-1213 Monday through Friday from 7:00 a.m. to 7:00 p.m. You can also update your information in person at your local Social Security office.
Does moving affect your Medicare Advantage or Medicare Prescription Drug Plan?
If you have a Medicare Advantage (Part C) or Prescription Drug (Part D) Plan, your coverage is likely restricted to a specific service area. If you are moving outside your current plan’s area, you must enroll in a new plan which includes the area where your new home is.
You can take advantage of a Special Enrollment Period (SEP) to make changes to a Part C or D plan. SEPs are available for Medicare recipients who experience certain life events. If you are moving outside your plan’s area of service and need a new plan, or if you are moving within the plan’s area of service and wish to include new plan options that are only available in the new area, you’ll have the opportunity to do that. You may also use your SEP to switch to a new plan through a new insurance provider.
Whether you want to make changes to a current plan or to enroll in a different plan, you must contact your plan provider to disenroll. If you notify your provider before you move, your SEP begins the month before you move and continues for two months after the move. If you wait until after you move to notify your provider, your SEP begins the month of notification and ends after two months have passed.
If you have a Medicare Advantage plan before you move and there are no MA plans available in your new area of residence, you can return to Original Medicare coverage. In cases such as these, you are also granted guaranteed issue rights and can purchase a Medigap plan if they are offered in your new state.
How does moving affect a Medigap plan?
Because the purpose of Medicare Supplement (Medigap) plans is to cover gaps in your Original Medicare coverage and not provide healthcare services, they are generally not affected by moving to another state.
If you want to switch to a different Medigap plan that is offered in your new state or area of residence, you may be able to switch, but it is important to know that if this is the case, you are not eligible for guaranteed issue rights. You may end up paying a higher premium, or you may be refused if you have pre-existing health issues.
However, if you have a Medicare SELECT plan, guaranteed issue rights are in effect when you move to a different state or within the same state but in a different service area.
Guaranteed issue rights in this case allow you to do the following:
1. Enroll in a Medicare Supplement Plan through your current Medigap provider if it covers the same, or fewer benefits than your current SELECT plan.
2. Enroll in a Medigap plan offered by any provider in your new area of service.
Also, if you have a Medicare Advantage plan in your current state but there are no available Part C plans in the state (or area) you are moving to, you can switch back to Original Medicare and enroll in a Medigap plan sold by any provider in your new state with guaranteed issue rights intact.
If you are moving, no matter what type of Medicare coverage you have, you must inform the Social Security Administration of your new address. If you cannot keep your current healthcare providers, perhaps they can recommend people in your new state. Also, ask them to forward your medical records to your new doctor and get copies for yourself.
How Does a Medicare Advantage Plan Work?(Opens in a new browser tab)