Can I Use My Health Insurance Out of State?

Whether you are traveling out or you are planning on having a medical procedure done in a different state, it’s important to find out if your health insurance will work outside of the state that you purchased it in.

In the event that an emergency arises while you are traveling and require medical care, you could be hit with an unexpected surprise and find out that your health insurance is not effective. The same is true if you are planning a procedure in a state that other than the one you purchased your policy from. As the cost of medical care in the United States continues to rise, knowing the details of health insurance coverage is crucial.

Is Health Insurance Effective in a Different State?

It depends. All healthcare plans will cover the cost of any emergency services that are offered at any medical facilities within the United States, no matter where the policy was purchased (Hawaii is the only exception). It should be noted, however, that the treatment does need to be considered life-threatening in order for coverage to work; if it is, then treatment will be covered in-network, even if the hospital where you received care is not within the network of your plan. That being said, however, there may be some restrictions, so it’s important to speak with your health insurance company to find out the details related to coverage in other states.

Health insurance plants will not provide out-of-state coverage for any medical procedures that are not considered emergencies. Therefore, if you receive treatment for something that is not life-threatening, you will likely have to pay for healthcare out of your own pocket. For instance, if you are suffering from a cold while you’re traveling and go to the doctor in a different state, you may have to pay for the care you receive yourself. But, there are caveats, as the definition of “emergency” differs from insurance carrier to insurance carrier.

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

Medical problems can arise at any time, even when you’re traveling. Therefore, if you are planning a trip, it’s important to find out if your health insurance coverage will be effective in a state other than the one where it was purchased. Contact your health insurance company to find out the specifics of out-of-state coverage.

When speaking to your carrier, ask the following questions so you can gain a thorough understanding of your coverage:

• Is coverage restricted in any state? As mentioned, while coverage will be effective in all states, regardless of where the policy is purchased (with the exception of Hawaii), that may not be the case for all plans. Every health insurance carrier and policy is different.
• What do you consider an emergency? Typically, only medical emergencies are covered out-of-state; however, the definition of “emergency” can vary from carrier to carrier; therefore, it’s important to speak to your company to find out exactly what they consider an emergency.
• Are urgent care/walk-in facilities covered? Many people opt to seek treatment – even for emergencies – at urgent care/walk-in facilities; however, not all policies will extend out-of-state coverage at these medical facilities. Your policy may only offer coverage at emergency rooms in other states.
• What services does my policy cover? It’s important to find out exactly what services are covered in another state under your health insurance plan; for instance, it may provide coverage for emergency treatment, but it may not provide coverage for ambulance transportation.
• How do claims work? The claims process for out-of-state medical treatment may be different than the claims process for in-state services. For instance, you may be required to pay for treatment up-front and then receive reimbursement after submitting the necessary documentation.

It’s always in your best interest to be fully aware of your healthcare coverage and what is included in your policy, both in the state where you purchased your policy, as well as other locations. The last thing you want is to assume that medical care that you required while you were traveling is covered and discover that it isn’t.

Are there Out-of-State Coverage Options?

There are supplemental coverage options available that you can extend the coverage that you already have. You could purchase a policy that covers critical illnesses and accidents while you are traveling. Another option is a hospital indemnity plan. If you are interested in purchasing additional coverage for out-of-state travel, speak to a reputable insurance agent that specializes in health care policies. Together, you will be able to determine which option will be the best solution for your specific needs.

In Summary

Medical emergencies can happen anywhere, but your health insurance may not be effective everywhere. Before you travel, it’s wise to find out what type of coverage your policy offers for out-of-state medical care.