How Out-of-State Health Insurance Works

Plans to Cover You When You're Out of State

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Are you going on a trip soon? Check your health insurance before you go. Depending on what kind of health insurance plan you have, your benefits may be limited when you're out of state.

Find out what out-of-state medical expenses may be covered under your health care plan. Plus, learn about multi-state health insurance plans, and what kind of health plan you should look at if you expect to travel often.

Does Your Plan Cover Medical Expenses Out of State?

In many cases, health insurance restricts you to a network of health care providers. Learning the terms of your health insurance policy will tell you if your plan includes providers out of state or not. Figuring this out on your own could be tricky. You do not want to end up getting denied for a health insurance claim. So, the first step is to call your insurer and ask them.

What Is a Health Insurance Network Provider?

Health insurance network providers are the medical service organizations. Your health plan has agreements with these groups to provide service to you. If your plan specifies a list of authorized network providers, then going "outside the network" could mean that have higher out-of-pocket costs. Your plan might also deny your claim, leaving you to pay the entire bill.

Do You Need a Travel Insurance Policy?

People do not always think about the type of health insurance they have when they are going to be out of state until it's too late. Find out what type of plan you have and learn about its limitations. This will help you decide if you need a travel insurance policy.

You may need different types of coverage depending on how often you travel. A one-time trip may merit different choices than regular travel across state lines.

5 Questions About Out-of-State Medical Insurance

Before you leave on your trip, contact your insurer and ask them these questions:

1. Are You Covered?

Ask your insurer if there are any local service providers at your destination that will cover you under your plan. Ask if any states are restricted. Will the plan cover all states?

2. What Counts as an Emergency?

Your health insurance plan may cover emergencies. But each insurer has its own idea of what is an emergency. A lot of people end up paying for expenses when the insurer decides the case was not an emergency. Ask for the exact definition. It will help you decide if you need to buy supplemental coverage, like health or medical travel insurance.

3. Is Urgent Care Covered?

Ask if urgent care facilities are covered or only emergency rooms. You don't want a claim denied for going to the wrong place.

4. What Is Covered Under Emergency Care?

Ask what additional coverage is included in the emergency medical care for you and your family. For instance, if you are going to a remote spot, you may want to know about services like air ambulances.

5. How Do You File a Claim?

Find out how claims payment works:

  • What documents will you need?
  • Will you have to pay in advance and request reimbursement?
  • Find out if there are forms for out-of-network physicians' claims.

HMO vs. PPO Health Plans

There are different types of plans for health insurance. Learn more about HMO vs. PPO plans to decide which is best for you.

For example, local HMOs may not have out-of-state coverage. But, some PPO plans may provide you with care out of state. Others may not.

Check Your Provider Directory

If you need to check on out-of-network coverage, look at the provider directory. It will list the providers your plan allows you to use.

What Are Multi-State Health Insurance Plans?

Multi-state plans or MSP options are available through the health insurance marketplace. 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 in another state. 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. It does not mean that you have access to care in all states if you have an MSP plan.

The network provider agreements in your plan will still apply. Look at the features of the plan before you buy. Compare them to PPOs that also offer out-of-state coverage to be sure the MSP is right for you.

Business or Personal?

One tip for planning out-of-state medical coverage is to think about whether you are traveling for business or personal reasons. Sometimes your employer's group insurance will provide coverage for you if you travel for work.

Check Employer Benefits

If you have employee benefits plans or group health insurance, you can contact HR or your employer plan administrator to find out more details. They will be able to tell you what is included in your plan and how it works.

Employers sometimes offer travel insurance as part of an employee benefits package. This may be the coverage you need once you compare options. It pays to ask.