Original Medicare has a nationwide network, so you can get care from any provider who accepts your Medicare benefits. Medicare Advantage, also known as Medicare Part C, is administered by private insurance companies, so it’s common to have networks limited to a specific state or region. This is an important distinction for snowbirds, or people who live in Florida for part of the year and another state for the rest of the year.
Before you close up your Florida home and head elsewhere, learn more about Medicare coverage for snowbirds, including how it works and how to manage your Medicare benefits if you live in two states during the year.
What Are the Medicare Rules for Dual Residency in Florida?
Medicare allows you to maintain two residences as long as you choose a primary residence in one state. For example, you might designate Florida as your primary residence and Pennsylvania as your secondary residence. Your primary residence is where you vote and pay taxes.
If you want Florida to be your primary residence, you’ll need to spend at least 183 days per year in the Sunshine State. It’s also helpful to apply for a Florida driver’s license or state ID card, file a Declaration of Domicile and register to vote in Florida.
Will You Have Access to Care in Both States with Medicare?
The Medicare dual residency rules depend on whether you have Original Medicare or Medicare Advantage. Original Medicare is administered by the federal government, so you can receive inpatient and outpatient care in any state. You just have to use providers who accept Medicare assignment.
Medicare Advantage is a bit different. This type of insurance covers many of the same benefits as Original Medicare, but you get your coverage through a private insurance company. Medicare Advantage insurers can offer extra benefits, such as paid gym memberships or coverage for dental cleanings, making it an attractive option for some snowbirds.
If you have a Medicare Advantage Plan, you have to use providers within the plan network if you want the highest level of coverage. Some plans allow you to use out-of-network providers, but you’ll have to pay more out of pocket. For example, your Medicare Advantage Plan might charge a $20 copay for a visit to an in-network doctor and $50 for a visit to an out-of-network doctor. Some Medicare Advantage Plans don’t cover any out-of-network care, so you’ll have to decide if you want to pay out of pocket or wait until you’re back in Florida.
Despite these limitations, Medicare Advantage covers emergency care in every state. If you sustain a serious injury or have symptoms of a life-threatening medical condition, you can get care without worrying about whether the hospital is in-network or out-of-network.
What Should Florida Snowbirds Know About Medicare Part A and Part B Coverage?
If you have Original Medicare, it comes with Part A and Part B coverage. Part A covers the services you receive while you’re hospitalized, such as nursing care, IV medications and surgery. Part B covers outpatient services, such as doctor visits, X-rays and lab tests. This gives you access to Medicare coverage in two states.
Contact Wandacare for personalized help navigating your Medicare options.
What Happens When You Get Routine Care Outside Florida with Medicare?
Original Medicare beneficiaries don’t have to worry about coverage limitations when getting care outside of Florida. As long as the doctor or facility you choose accepts Medicare assignment, Original Medicare will pay each claim. You’ll pay the same deductible, copays and coinsurance in another state as you do in Florida.
If you have Medicare Advantage, however, you might have to pay a larger percentage of the bill yourself. In some cases, you have to pay the entire bill out of pocket, as some Medicare Advantage Plans don’t cover routine care delivered outside your network.
What Are the Best Strategies for Managing Medicare as a Florida Snowbird?
One of the best ways to manage Medicare as a snowbird is to pick a plan that provides out-of-network coverage. If you have a Medicare Advantage Plan that doesn’t cover out-of-network care, consider switching to a different plan during the next open enrollment period.
Another option is to identify local resources in both states. Even if your Medicare plan doesn’t cover out-of-network care, you might qualify for income-based financial assistance or other programs designed to make health care more accessible.
Finally, have your providers coordinate services across state lines to save you money. For example, you might be able to find an in-network laboratory in both states. You can see a doctor in Florida and then use the lab in another state to get follow-up tests.
Wandacare has experienced Medicare advisors available to walk you through your options. Contact us today for expert guidance.
