Medicare for snowbirds: how your coverage works away from New York

What travels with you and what stays home

Original Medicare and Medigap: the setup that travels

Original Medicare has no network. Any doctor or hospital that takes Medicare, in any state, can treat you on the same terms as at home. A Medigap policy sits on top of that: Medicare pays its share of the approved amount, then the Medigap policy pays its share. For someone who sees doctors in two states, that's the simplest arrangement.

One exception is worth knowing. A Medicare SELECT policy is a Medigap policy that requires you to use its network hospitals (and sometimes doctors) for full benefits on non-emergency care. Medicare still pays its share wherever you go, but the SELECT policy may not. If your policy says SELECT, read that section before you book a routine visit out of state.

New York makes Medigap easier to get than most states. A New York Medigap insurer must accept your application at any time of year, and can't turn you down or charge you more because of your health. A policy can have a waiting period of up to six months for pre-existing conditions, reduced by prior coverage with no break of more than 63 days. The Medigap plans page compares the plans sold here.

Medicare Advantage: built around home

A Medicare Advantage plan is approved for a service area, usually a set of counties, and builds its network of doctors and hospitals there. Away from home, what's covered depends on the plan type:

• HMO. You generally must use the plan's network. The exceptions are emergency care, out-of-area urgent care and temporary out-of-area dialysis, which are covered in or out of network. A routine check-up or a specialist visit in another state may leave you paying the full cost. Some HMOs (HMO point-of-service plans) cover some out-of-network care at a higher copay or coinsurance.
• PPO. You can generally see out-of-network providers who take Medicare, usually for more than you'd pay in network. Emergency and urgent care are always covered. Ask the plan before an out-of-network visit so you know it will be covered.
• Visitor or traveler programs. Medicare lets plans offer a program for members who are away from the service area for an extended time. A plan can limit it to certain areas and providers. Whether your plan has one, and where it works, is a question for the plan, in writing, before you leave.

There's also a time limit. A Medicare Advantage plan must disenroll a member who is away from the service area for more than six consecutive months, unless the plan has a visitor or traveler program, which can stretch that to 12 consecutive months. A January-to-March stay is well inside six months; a stay from November through May is not.

If you already know you want routine care in two states, that's a strong reason to look at Original Medicare with Medigap. The Medicare Advantage vs. Medigap guide covers the trade-offs. Keep the timing in mind: in most cases you keep a Medicare Advantage plan for the calendar year, and Open Enrollment, October 15 to December 7, is the usual time to change.

Part D: check the pharmacy where you winter

Drug plans, whether a standalone Part D plan or the drug coverage inside an Advantage plan, price your prescriptions by pharmacy:

• Network pharmacies have agreed to discounted prices for the plan's members. Preferred network pharmacies may cost you less again.
• Out-of-network pharmacies usually charge more, and you'll likely pay full price and have to ask the plan for a partial refund.
• Mail order, where a plan offers it, can send up to a 3-month supply of covered drugs to your home, which helps if you'll be away for a season.

Before you leave, look up the pharmacies near your winter address in your plan's directory and check whether they're preferred. Medicare's own advice for people who travel often is to check that a plan has pharmacies wherever you go. A standalone Part D plan can keep you as a member through up to 12 consecutive months away from its service area. The Part D page covers how New York plans compare.

Which state is home?

Medicare Advantage and Part D plans enroll you based on your permanent residence. A temporary stay somewhere else doesn't count as a permanent residence, so wintering in another state doesn't change which plans you can join.

Changing your permanent address does. If you make your winter state your permanent home, a New York Advantage or Part D plan no longer fits, and the move opens a Special Enrollment Period:

• If you tell your plan before you move, the window starts the month before the move and runs two full months after it.
• If you tell the plan after you move, it starts the month you tell them and runs two more full months.

Original Medicare and a standardized Medigap policy come with you, and a Medigap policy renews automatically every year as long as you pay the premium. For the plans in another state, Medicare.gov's Plan Finder or 1-800-MEDICARE (1-800-633-4227) will show you what's available there. The reverse move works the same way; the moving to New York guide covers coming back.

Trips outside the U.S.

For Medicare, the U.S. means the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. Outside those places:

• Original Medicare generally doesn't pay. The exceptions are narrow, such as an emergency in the U.S. when a foreign hospital is closer than the nearest U.S. hospital that can treat you. On a cruise ship, Medicare may cover medically necessary care only while the ship is in a U.S. port or no more than 6 hours from one.
• Medigap Plans C, D, F, G, M and N (and the older E, H, I and J) include foreign travel emergency coverage. It pays 80% of billed charges for emergency care that begins in the first 60 days of a trip, after a yearly deductible and up to a lifetime limit. Plans A, B, K and L don't include it.
• Medicare Advantage plans generally don't cover care abroad, though some offer an extra benefit for emergency and urgently needed care while traveling. Check with the plan before you go.
• Prescriptions bought outside the U.S. aren't covered by Medicare drug plans. Take enough with you.

For a longer trip, a travel medical policy can fill some of the gap. Travel insurance doesn't always include health coverage, so read what a policy actually covers.

Before you leave for the winter

1. Find out whether you have Original Medicare with Medigap or a Medicare Advantage plan, and if Advantage, whether it's an HMO or a PPO.
2. If it's an Advantage plan, ask in writing how it covers routine care where you'll be, and whether it has a visitor or traveler program.
3. Look up network and preferred pharmacies near your winter address, or set up mail order.
4. Keep your Medicare, Medigap or plan card and a list of your prescriptions with you.
5. If you're going abroad, check your foreign travel coverage and decide whether you want a travel medical policy.

I'm a licensed agent in Clifton Park and I work with New York Medicare plans. I can compare New York plans against the Capital Region doctors you use, check how a plan treats care away from home, and explain what changes if you move your permanent address. The plan finder is a quick first step, or ask for a call; there's no fee for Medicare plan help.

We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.