- July 6, 2020
Today, we’re going to answer the question, “Can I use my Medicare plan anywhere in the USA?” We’ll do this by looking at several different scenarios for each type of Medicare plan.
Two Medicare Choices
When you go on Medicare, you only have two choices for using your benefits. The first choice is to get an Advantage plan. The other is to get a Supplemental plan. The answer to our question, “Can I use my Medicare plan anywhere in the US?” depends on whether you get an Advantage plan or a Supplemental plan.
If You Have an Advantage Plan...
You can only use your Advantage plan benefits anywhere in the U.S. if you have an emergency situation and need emergency or urgent care. For example, if you had a heart attack and went to the emergency room or developed the flu and had to visit Urgent Care, your Advantage plan would be accepted, no matter where you are in the US.
If, however, you are in a non-emergency situation and try to visit a doctor or some other specialist while out of town, you may not be covered by your Advantage plan. It depends on your plan’s network. There are two types of networks with Advantage plans, HMO and PPO.
If you’re in an HMO network, you cannot get care outside of the network, meaning you will not have benefits everywhere in the U.S. The only time you can get care outside the network is if it's an emergency or urgent care situation. For all other health services (even cancer treatment) you will have to stay in-network.
If you’re in a PPO network, however, you can use your benefits anywhere in the U.S. Here’s how it works: Let’s say you’re on a PPO network Advantage plan, and you decide to go out of network to visit a doctor. The plan allows you to do this, but you will have to pay substantially more to go out of the network. In fact, you’ll probably have to personally cover about 40 to 50 percent of the Medicare-approved expenses. The good news is, they place a limit on your out of network expenses (usually it’s set to about $10,000). So even if the bill is $100,000, you’ll only have to pay $10,000 (or whatever your specific plan’s annual out-of-network limit is).
To review, if you’re on an HMO or PPO Advantage plan and need to visit urgent care or go to the emergency room, you can do so anywhere in the US and you’ll still be covered by your plan. If you have an HMO Advantage plan, you cannot visit a doctor or other health provider out of the network. If you have a PPO plan, however, you can see a doctor or specialist out of network, but you will pay a much higher percentage when going out of network.
If You Have a Supplemental Plan...
No matter where you are in the U.S., you can go to any emergency room or urgent care, or visit any doctor or specialist you want and expect to receive your plan’s full benefits, as long as they accept Medicare. Since Supplemental plans are within the Medicare system (not replacement plans like Advantage plans), they have no network besides Medicare. So as long as the doctor or health provider accepts Medicare, you can go to them and they will accept your Supplemental plan.
So to answer our original question, “Can I use my Medicare plan anywhere in the USA?” The answer is “Yes” if you have a Supplemental plan. If you have an Advantage plan, the answer is “maybe” or “maybe not.” With an HMO Advantage plan, you can only visit in-network doctors and health facilities (except for emergency or urgent care situations). With PPO Advantage plans, you can visit any doctor or health facility you want, but if they’re out of network you will pay extra.
We understand how difficult making the right Medicare decisions can be. To take the next step, watch our full course here, or schedule a free one-on-one call with a certified Medicare School Guide who can answer your questions, compare plans options, and even help you enroll. Click here to get started.
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