Does Medicare Cover Out-of-State Hospital Bills?

by Nancy Metcalf Health Writer

If it hasn’t happened to you, it has probably happened to someone you know. An elderly parent falls ill, needs extensive medical treatment, and his or her adult daughter or son lives in a distant state. It would be easier for all concerned for the parent to get treatment near the daughter or son’s home. But will Medicare pay?

If the ailing parent has regular Medicare plus a Medigap plan, the answer is yes. Regular Medicare pays for care nationwide, and a Medigap plan, no matter where you bought it, will pick up its contracted share of the Medicare bill nationwide as well.

But if the parent has a private Medicare Advantage plan, things get more complicated. HMO Advantage plans typically only pay in full if you get your care within their geographical service area, from doctors and hospitals within their networks. Advantage Preferred Provider Organizations (PPOs) do cover out-of-network care, but you will be asked to pay significantly more out of pocket for it. The only exception is for a true emergency, such as a broken leg or a heart attack.

However, some Medicare Advantage plans have what’s known as a “visitor” or “traveler” feature that will pay for a member’s non-urgent care away from home for up to a year, explains Mitchell Clark of the Medicare Rights Center. To find out if your plan has such a feature, it’s best to call the insurer directly.

If you are enrolling in Medicare for the first time, you can protect yourself from getting into this fix in one of several ways. (By the way, this advice also applies to snowbirds who split their time between summer and winter homes.) The best option is to stick with regular Medicare plus a Medigap plan.

If you want a Medicare Advantage plan, go to the Medicare Plan Finder, and when you get your results, use the left-hand “Refine Your Search” feature. Under “Select Coverage Options” ask to see plans that have nationwide coverage. But, again, check directly with the plan because these “visitor/traveler” programs may vary. For instance, some only apply in states where the carrier maintains provider networks.

To learn more about your Medicare benefits, find the right coverage, or to understand how any existing coverage works with Medicare, contact the National Helpline.

Nancy Metcalf
Meet Our Writer
Nancy Metcalf

Nancy Metcalf is an award-winning independent journalist specializing in health topics. A senior writer and editor for Consumer Reports for more than 25 years, she is a nationally recognized expert on health insurance and health reform.