Medicare is among the leading healthcare insurance plans available today. Over 63 million people in the US have enrolled in Medicare. A smaller number of them have enrolled for Medicare Advantage plans and other plans.
People often pay a premium to use all medical facilities under these Medicare plans. So, it’s natural for them to wonder if the plans differ by state. If you’re one of these people, you may even be wondering if your plan is valid across states. Here, we’ll discuss how Medicare plans differ by state and much more.
Medicare Original Plan Transfers Across States
A common question that people over 65 in the US have is if they can transfer their Medicare plan across states. The answer to this question is twofold depending on the kind of plan you choose.
The Original Medicare plan is a federal program so it’s valid all across the country. But, this doesn’t mean that you can use Medicare in any healthcare facility of your choice. You’ll have to look for doctors that are enrolled in the Medicare program.
The most populated US states have the most number of Medicare beneficiaries. The same goes for Medicare service providers. You’ll find many takers for Medicare plans in Florida considering the population.
This state offers you some of the best Medicare plans and Medicare advisors. So, if you’re confused about transferrable benefits, you can talk to these advisors. Over half the Medicare beneficiaries in this state are enrolled in Original Medicare.
They’d be happy to discover that they can use the benefits of Original Medicare anywhere in the country.
Medicare Plans Eligibility
The Original Medicare plan consists of Parts A and B.
These parts cover inpatient and outpatient insurance. So, your doctor visits and lab tests are covered under the Original Medicare plan.
If you’re wondering how to apply for Medicare, you’ll need to look at eligibility criteria for the Original Plan:
- You would need to be above 65 and be a US citizen.
- Younger people with ALS or End Stage Renal Disease.
- Younger people with disabilities.
If you fulfill these criteria, you can qualify for Medicare and use it across the country. But, you would need to give your new address details to the authorities after you move. Then, you can access Medicare in your new location.
Medicare Advantage Differences
Medicare Advantage plans come at a premium for the extra benefits they offer you. The cost of this premium varies from state to state. Medicare Advantage plans in Florida have among the lowest premiums in the country.
This would explain why a high number of beneficiaries have enrolled in an Advantage plan. After all, not everyone in their retirement age can afford to pay a high premium for extra services. People opt for private health insurance over Medicare if the latter’s premium is too high.
Texas is another state with a low premium for Medicare Advantage and a high number of enrolments. Other states like Ohio and Michigan have higher premiums and fewer enrolments. So, the correlation between premium prices and enrolments is clear.
How to Choose Medicare Advantage Plans
There are other factors that affect Medicare Advantage enrolments across states. For instance, not every state offers you the same services under Medicare Advantage.
All Medicare Advantage plans need to cover what the Original Medicare plan offers. But, the same isn’t true for extra healthcare services. Medicare Advantage is supposed to cover prescription drugs and other healthcare services. These services include vision, hearing, and dental care.
Both local and national insurance companies offer you Medicare Advantage plans. You’ll need to weigh the pros and cons of each provider before you decide which plan to opt for.
The price you pay for the plan will depend on your provider and location. Also, some states provide eligible citizens extra insurance benefits through Medicare Advantage plans. These states include Pennsylvania and Illinois. You could even access Medicare Advantage in some states through union groups.
This would allow you to receive Medicare Advantage benefits at a lower rate than normal.
Medigap Plan Differences
The Medigap Plan covers expenses you may have after you enroll for Original Medicare. So, it’s ideal for those who don’t want to purchase a Medicare Advantage plan. You can opt for Medigap after you enroll in Medicare Part B.
So, you would have a period of 6 months after your 65th birthday to enroll in this plan. But, you would need to check the Medigap options available in your area. In most states, the different Medigap plans offer you the same services.
The exceptions are Wisconsin, Massachusetts, and Minnesota. These states offer you Medigap plans with the same benefits. These benefits include extra home healthcare visits and Part A and B coinsurance.
As for other states, there are currently 10 standardized Medigap plans. These plans vary according to their costs and benefits. There are differences in how each state charges you for these plans.
These differences arise because Medigap is offered by private insurers. The differences aren’t about pricing alone. You’ll also find differences in the services covered under Medigap plans.
Accessing Medigap Plans
You would need to check what the Medigap plans in your state cover before you pay for them. It’s also important to note that some states allow you to switch Medigap plan providers each year.
The time allotted to you to change providers varies from state to state. For instance, Missouri allows you to switch in 60 days around your plan’s anniversary period. But, Maine allows you to switch Medigap plans anytime if the new plan you choose has the same benefits.
So, it’s unwise to assume that you can access Medigap plans in the same way across the country. Many differences come into play here that will cost you time and money when choosing a Medigap plan.
Conclusion
These are the main differences in Medicare plans across different states. As you can see, these differences relate to more than just pricing. There are differences in services covered and enrollment as well.
It can be difficult to transfer Medicare plan benefits across states. This is especially true for Medicare Advantage and Medigap plans. You might miss the enrollment window or not fulfill the eligibility criteria in time. In such cases, you can try to enroll during a special enrollment period.
This would allow you to access the benefits of different Medicare plans when you need them. It would also make it easier to enroll in Medicare if you’re moving across the country.
