How a Medicare Advantage plan works away from home
Medicare Advantage plans are approved for specific counties, called the service area, and most use provider networks there. If your plan is based in Minnesota or Iowa and you spend the winter in Hidalgo or Cameron County:
- Emergencies and urgent care are covered. Federal rules make your plan pay for emergency and urgently needed care whether you get it inside or outside its network, without prior authorization.
- Routine care may not be. Checkups, scheduled tests and visits for ongoing conditions usually have to be in network. A PPO may pay something out of network at a higher cost; an HMO usually won't.
- The six-month rule. Under 42 CFR §422.74, if you're out of the service area for more than six months in a row, the plan must disenroll you, unless it offers a visitor or travel program that lets you stay up to 12 months.
Original Medicare and Medigap travel well
Original Medicare covers you with any provider in the U.S. that accepts Medicare, and a Medigap policy follows it. If you want to switch to Original Medicare and buy Medigap, watch the timing: outside your Medigap open enrollment period and guaranteed-issue situations, the Medigap company can ask about your health.
Before you head south
- Call your plan and ask what it covers in Texas, including any visitor or travel benefit.
- Check your drug plan's pharmacies near your winter address.
- Bring your plan ID card and your Medicare card.
- If you're staying longer than six months, ask in writing whether your plan will keep you.
Going across to Mexico? Medicare generally doesn't pay for care there. See does Medicare work in Mexico.
Get help
If you're moving to Texas permanently, a licensed insurance agent with Benefits Life can compare plans in your new county from the companies they work with, at no cost to you, at (512) 265-6565, TTY 711. You can also see plans in your ZIP code. See Winter Texans and Medicare.
Related questions
Does Medicare work in Mexico?
The rare exceptions and Medigap travel coverage.
Can I use Medicare for prescriptions in Mexico?
Part D and drugs bought across the border.
Can I switch Medicare Advantage plans after open enrollment?
Moving gives you a Special Enrollment Period.
Sources
- 42 CFR §422.74 — Disenrollment by the MA organization (temporary absence)
- 42 CFR §422.113 — Emergency and urgently needed services
- Medicare.gov — Emergencies, disasters and getting care away from home
- Medicare.gov — Special Enrollment Periods
Frequently asked questions
Does Original Medicare work in Texas if I live up north?
Yes. Original Medicare works with any doctor or hospital in the U.S. that accepts Medicare, so it works the same in McAllen or Harlingen as it does at home. A Medigap policy pays its share wherever Original Medicare pays.
What is a visitor or travel program?
Some Medicare Advantage plans offer a benefit for members who are out of the service area for more than six months but less than 12. Federal rules let a plan keep you enrolled in that case, but you're disenrolled on the first day of the 13th month away. Check your plan's Evidence of Coverage.
Should a Winter Texan switch to a Texas plan?
Only if you've made Texas your permanent home. Medicare Advantage eligibility is based on where you permanently live. If you move to Texas for good, you get a Special Enrollment Period to choose a plan here.
Can I fill prescriptions while I'm in Texas?
Ask your plan which pharmacies near your winter address are in its network. Medicare.gov suggests asking whether your plan offers a 60- to 90-day supply if you'll be away for a long time.
Medicare in your Texas county
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