Medicare, the federal government program that provides health insurance for U.S. adults (those above 65) and individuals with certain disabilities. Medicare recognizes standard billing codes for many treatments and services. However, with frequent regulatory and coding changes, and stringent claim submission rules, getting paid is much easier with the help of medical billing services provided by experts.

Medicare has four parts: Part A, Part B, Part C, and Part D.
Part A – inpatient/hospital coverage.
Part B – outpatient/medical coverage, including medical equipment
Part C – coverage via a Medicare Advantage Plan that offers out-of-pocket maximums
Part D – prescription drug coverage

Medicare covered about 17.8 percent of the country’s population in 2018, according to Statistica. About one-third of beneficiaries get their Part A and Part B benefits through a Medicare Advantage Plan, which also offers prescription drug coverage and possibly dental and vision care, and other benefits. The remaining two-thirds of enrollees have original Medicare, along with a standalone Part D prescription drug plan and Medigap, a supplemental private health insurance plan, helps fill gaps in normal Medicare plans. Medigap pays for out-of-pocket expenses that Medicare will not cover such as deductibles, co-pays, coinsurance, and health care costs incurred when traveling abroad. Medigap plans also limit what you’ll pay out of pocket each year.

One question people are asking their physician is: can I retain my current Medicare coverage if I move to another state? If you are moving to another state, you should understand rules that apply to Medicare in that state as well as the time that you will get to switch your coverage, if you need to. Generally, making changes may be easy, but in certain cases, more information and work may be needed to make the switch to a new plan.

The first thing to do if you are moving to another state is to contact your insurance provider and make sure your insurance plan is portable and will be accepted by physicians and hospitals in that state. A special enrolment period or guaranteed issue right would be available that can be used to get new coverage in the new state of residence. Here’s what patients need to know about Medicare coverage when they move to another state:

  • Original Medicare: If you are enrolled in Original Medicare, Part A and Part B, will get the same coverage throughout the country. Original Medicare does not have provider networks, and so even if they move to another state, you can use any hospital or doctor that accepts Medicare.
  • Medicare Advantage Plan/Medicare Prescription Drug Plan: Individuals enrolled in a Medicare Advantage plan (Medicare Part C) or Medicare Prescription Drug Plan (Medicare Part D) will need to enrol in a plan that is accepted in the state to which they have moved within two months. This rule would apply even if they are moving to a new address outside their Medicare plan’s service area in the state where they are residing. If the insurance company offers the same Medicare plan in the new service area and the plan is accepting new members, the beneficiary can enrol in the same plan. On the other hand, if the member is moving to an area with limited Advantage Plan, a Medigap plan may be considered.
  • Medigap: Medigap offers 10 standardized policies designated as A, B, C, D, F, G, K, L, M and N. There are also high-deductible versions of Plan F and G in some states. As most Medigap policies are standardized, beneficiaries can remain in the same plan even if they move to another state, though the premiums may vary depending on the area or more precisely, its zip code. Here are the lowest and highest costs Medicare plan G 2020 provided by the American Association for Medicare Supplement Insurance:
    • Lowest cost for a woman age 65 – $91.78 per-month in Chicago (Zip Code 60601).
    • Lowest cost for a man turning 65 – $103.68 per-month in Chicago.
    • Highest cost for a woman turning 65 -$476.04 per month in New York (Zip Code 10012).
    • Highest cost for a man turning 65 – $509.10 in Philadelphia (Zip Code 19050).

If you have a Medigap policy and are moving to another state, your insurer can tell you what the policy will cost in your new state of residence from your zip code. If you find that the cost is higher, you can look for a cheaper policy but it would involve medical underwriting, which can be very expensive.

Part D prescription drug plan: Like Medicare Advantage, Part D prescription drug plan availability differs from state to state. Individuals moving out from one service area to another have two months before and after they move to choose new Part D coverage. If the switch is not made within this period, there would be a penalty to pay for each full month for which the person did not have coverage.

Medicare Select: Available in some places, Medicare Select plans are a type of Medigap plan that may have a lower premium than a regular Medigap plan that provides the same benefits. Insurance companies offer Medicare Select plans based on the network agreements they have with medical providers in a given area. This means it will no longer be valid if the beneficiary is moving out of state. Beneficiaries who had been enrolled in the Select plan for at least 6 months can enrol in a regular Medigap plan from their existing insurer. which may have more or fewer benefits than their Select policy. They can also choose from Medigap Plans A, B, C, F, K, or L, regardless of when they were enrolled in Medicare Select. Those who qualified for Medicare on or after January 1, 2020 cannot enrol in Plan C or F, but can opt for either Plan D or G (www.medicareresources.org).

For physicians, billing Medicare and Medicaid is an important but complicated task, especially with new codes and new rules. Outsourcing medical billing and coding is the best way to handle this challenge.