Having the right health insurance is really important. Unfortunately, finding a policy that provides comprehensive coverage can be difficult. This is especially true if you routinely travel to different states or if you split your time among multiple states.
Many health insurance policies provide you with limited coverage (or none) if you leave the area where you live and where the insurer's network is centered.
If you'll be traveling to a different state or living there temporarily and you may need medical care, it's really important to understand what your insurance will -- and won't -- cover.
Can you find a health policy that covers you in a different state?
If you're shopping for insurance, you'll potentially have a choice of a few different kinds of policies. These include:
- Health maintenance organizations (HMOs): These plans have their own network of providers, and you usually receive no coverage at all for out-of-network care. Typically, in order for specialty care to be covered -- even in network -- you have to see your primary care doctor first, who will refer you to specialists if necessary.
- Preferred provider organizations (PPOs): With these plans, there's also a network of providers that have agreed to work with your insurer. But you usually get at least some coverage for out-of-network care and you don't have to see a primary care physician first in order for specialty services to be paid for.
- Exclusive provider organizations (EPOs): EPO plans usually provide a larger network of doctors than HMOs and don't require you to see a primary care physician for specialist referrals. But they typically offer no coverage for out-of-network care.
- Point of service (POS) plans: These plans require you to get specialist referrals just like an HMO, but you usually get some coverage for care provided by out-of-network doctors.
When you're trying to determine if your health insurance will cover you out of state, you'll first need to look at the insurer's network of providers.
Unfortunately, most insurers don't have a nationwide network -- participating in-network physicians are located only in the state where the policy is sold. In some cases, you can find a multistate plan that has a network spanning several states. But these plans aren't very common, and even then your coverage is limited to the states that are part of the plan.
If you can't find a plan that has in-network providers in different states, then you'll need to look at what type of coverage you have for out-of-network care. If your plan offers coverage for providers not in its network, your insurance will help you pay for care by an out-of-network physician when you travel to another state. But you may have a higher deductible, higher co-insurance costs, and a higher out-of-pocket limit when you're seeing a non-network doctor.
Unfortunately, if you can't find a plan that has a nationwide network and you can't find or afford a plan that covers out-of-network care, you'll have limited health coverage when traveling away from the state where you live.
You'll want to check in these cases if your policy covers emergency services so at least you can get care if something very bad happens, such as an accident, a stroke, or a heart attack. But be sure you understand exactly what your insurer defines as emergency care and check to see what costs you're responsible for; chances are good you'll have very high co-insurance costs even in these emergency situations.
What to do if you need coverage in multiple states
You don't have many options if you need coverage in multiple states. You can look for a plan that provides out-of-network coverage so at least you'll have some protection if you need to get care while away. You could also look into travel insurance coverage -- although there are exclusions on most policies, such as coverage for childbirth.
If you're relocating to another state, this should also qualify you for a special enrollment period. That means you can sign up for insurance coverage in your new location. You'll need documentation of the move, and your new policy will likely cover you only in the state you're moving to. So you'll face the same problem of insufficient coverage when you head to a different state in the future.
This limitation can make life difficult for those who live in multiple locales or who travel to other states often for work. It's best to be prepared so you don't face unexpected medical bills if you end up needing care while away from home.