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How Does Health Insurance Work Out of State?

Depending on what kind of health insurance plan you have, you may be limited to what benefits you can access when traveling out of state. Here’s how to know if your health care plan will cover you out of state or what kind of health plan you should consider if you expect to travel outside of state on a one time, or regular basis.

Check If Your Health Plan Covers Medical Expenses out of State

People may not 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.

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, others may not.

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 plan provider directory and network provider agreements in your plan will still apply. Getting care from an “in-network” provider may allow reimbursement, but in some cases may not. 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. Before purchasing additional coverage, know that employers may offer travel insurance in the employee benefits package, and this may be the coverage you need once you compare options. It pays to ask and save money by avoiding extra costs.

Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance. 

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Source: AmeriHealth

2023