How Out of State Health Insurance Works

Plans To Cover You When You're Out of State

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Depending on what kind of health insurance plan you have, you may be limited to what benefits you get when traveling out of state. Here's how to know if you are covered for your out of state medical expenses on your health care plan, what multi-state health insurance plans are, and what kind of health plan you should consider if you expect to travel out of state on a one time, or regular basis.

How to Check if Your Health Plan Covers Medical Expenses Out of State

In many cases, health insurance restricts you to a network of healthcare providers. Understanding the terms of your health insurance policy will help you know if your plan includes providers out of state or not. Figuring this out on your own could be tricky and you do not want to end up not being covered for a health insurance claim, so the first step is to call your insurance provider and ask them.

What a Health Insurance Network Provider Is

The health insurance network providers are the medical service organizations that your health plan has agreements with to provide service to you. If your plan specifies a list of authorized network providers, then going "outside the network" could mean that you would not be paid for medical services or have higher out of pocket costs.

Know Your Medical Insurance Before You Travel Out of State

People do not always think about the type of health insurance they have when they are going to be temporarily out of state until it's too late. Knowing the type of insurance you have and learning about limitations and exclusions while you travel will help you decide if you need a travel insurance policy to supplement your health insurance plan.

If you will only be traveling for a trip once a year to a specific destination, vs. regularly crossing state lines you may require different types of coverage.

5 Questions To Ask About Out-of-State Medical Insurance

  1. Ask your health insurance company if there are any local service providers at your destination that will cover you under your plan. Ask if any states are restricted. It is unlikely the plan will cover all states?
  2. Your health insurance plan may cover emergencies, but how different companies define the term "emergency" is important. A lot of people end up paying for "emergency expenses" when the insurance company has a different definition of what an emergency is. Ask for the exact definition before you travel to know if you need to buy supplemental coverage, like health or medical travel insurance .
  3. Ask if urgent care facilities are covered or if only emergency rooms are covered. You wouldn't want a claim denied for going to the wrong place.
  4. Ask what additional coverage is included in the emergency medical care for you and your family at your travel destination. For example, if you are going to a remote destination, you may want to know about services like air ambulances or other emergency needs.
  5. Find out how claims payment works:
  • What documents will you need?
  • Will you have to pay in advance and request reimbursement, or do they have agreements with service providers in the state (or states) you will be traveling to to bill your insurance directly?
  • Find out if there are forms for out-of-network physicians' claims.

HMO vs. PPO Health Plans and Out of State Coverage

There are different types of plans for health insurance, for example, indemnity health plans can give you more options of where you get your medical care compared to HMO or PPO health plans. Learn more about HMO vs. PPO plans and their differences here.

For example, local HMO's may not have out-of-state coverage but some PPO health insurance plans may provide you with coverage out of state, while others may not.

Check Your Health Insurance Provider Directory

If you need to check what kind of coverage you would have out of network, look at the plan documents and provider directory which will list the providers your plan allows you to get services from.

Multi-State Health Insurance Plans

Multi-State Plans or MSP options are available through the health insurance marketplace through private insurers. Only some MSP plans offer coverage nationally or across different states. The term multi-state health insurance might lead you to believe that you would be covered out of state for your medical insurance, but some multi-state plans restrict the coverage areas, or may not cover you out of state.

The term MSP only means that the plan is operated in multiple states, not that you have access to care in all states if you have an MSP plan.

The plan provider directory and network provider agreements in your plan will still apply. Look at the features of the plan in the marketplace before you buy and compare them to PPO's that also offer out-of-state coverage to be sure the MSP is right for you.

Out-of-State Medical Coverage

One tip for planning out of state medical coverage is to consider whether or not you are traveling for business or personal reasons. Sometimes your employer's group insurance will provide coverage for you if the purpose of your trip is for business.

Employer-Provided Health Insurance and Travel Insurance

If you have employee benefits plans or group health insurance, you can contact your HR or employer plan administrator to find out more details about what is included in your employee group benefits plan and how it works. Employers sometimes offer travel insurance as part of an employee benefits package, and this may be the coverage you need once you compare options. It pays to ask so you can save money by avoiding extra costs.