Partly. If you have a medical emergency or need urgent care while you are out of state, your Medicare Advantage plan has to cover it anywhere in the United States — in network or out, with no prior authorization allowed (42 CFR 422.113(b)(2)). Routine care is the other half of the answer, and it usually is not covered: Medicare’s own comparison says that with a Medicare Advantage plan, “in many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care)” (CMS Product No. 12026).
That distinction is the whole subject. A broken wrist in Asheville is covered. A follow-up visit to an orthopedist in Asheville three weeks later, on an HMO, generally is not. And if you are gone long enough — more than six consecutive months — the question stops being about claims and becomes about whether you still have the plan at all.
This matters more in Florida than almost anywhere. Tampa Bay is on both ends of the migration: retirees arrive here from the North each winter, and Florida residents leave in July to sit out the heat with grandchildren in Ohio or Maine. Both groups are out of somebody’s service area, and the rules are not the same for the two of them.
What is always covered, no matter which state you are in
Federal law does not let a Medicare Advantage plan leave you exposed in an emergency. Under 42 CFR 422.113(b)(2), the plan is financially responsible for emergency and urgently needed services:
- regardless of whether the services are obtained inside or outside the plan’s network;
- regardless of whether there is prior authorization — and plans are forbidden from telling you in any material, “including wallet card instructions,” to seek prior authorization for emergency care, and must tell you about your right to call 911;
- based on the prudent layperson standard, “regardless of final diagnosis.” If a reasonable person with average medical knowledge would have expected serious jeopardy to their health, serious impairment to bodily functions, or serious dysfunction of an organ, it was an emergency — even if the final diagnosis turns out to be indigestion.
The regulation also defines urgently needed services in a way that maps exactly onto travel: covered services that are not emergencies, “provided when an enrollee is temporarily absent from the MA plan’s service (or, if applicable, continuation) area,” that are medically necessary and immediately required because of an unforeseen illness, injury or condition, where it was not reasonable given the circumstances to get them through the plan.
That is the walk-in clinic on a Tuesday in a town where you know nobody. It is covered.
Two more things travel with you: ambulance services, including a 911 dispatch where other transportation would endanger your health, and temporary out-of-area dialysis, which CMS lists alongside emergency and urgent care as covered whether it is delivered in network or out.
What your share of an emergency visit is capped at in 2026
The same regulation caps what a plan may charge you for emergency services. Your cost is the lower of two numbers: what the plan would have charged if the emergency services had been provided through the plan, or a per-visit ceiling tied to how low the plan’s maximum out-of-pocket limit is.
| Plan’s MOOP category | Maximum emergency cost-sharing per visit, 2026 |
|---|---|
| Mandatory MOOP limit | $115 |
| Intermediate MOOP limit | $130 |
| Lower MOOP limit | $150 |
Source: 42 CFR 422.113(b)(2)(v)(B)(4), which sets these amounts for 2026 and subsequent years. Note the direction of the trade: a plan with a lower out-of-pocket maximum is allowed a higher per-visit emergency charge.
What usually is not covered out of state
Everything else. The routine appointment, the elective procedure, the specialist your daughter recommended, the physical therapy course that follows the surgery you had at home.
How badly that bites depends on your plan type.
| Plan type | Non-emergency care outside the network / service area |
|---|---|
| HMO | Generally none. CMS describes an HMO as providing coverage “exclusively from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or temporary out-of-area dialysis).” Non-emergency care obtained out of network without authorization can leave you paying the full cost. |
| HMO-POS | Some HMOs offer a point-of-service out-of-network benefit for some or all covered benefits, “but you’ll usually pay a higher copayment or coinsurance.” |
| PPO | Typically pays out of network at a higher cost share than in network. CMS’s own summary: some plans offer non-emergency coverage out of network, “but typically at a higher cost.” |
| Original Medicare | You can go to any doctor or hospital that takes Medicare, anywhere in the U.S. There is no network and no service area. |
All quoted language above is from CMS Product No. 12026.
Notice what that table is and is not saying. It is not saying an HMO is a bad plan. An HMO buys you something real — coordinated care, usually a lower out-of-pocket maximum, and often extra benefits Original Medicare does not cover. It is saying that the thing you traded away is geography, and if you spend three months a year somewhere else, geography is not an abstraction.
The reverse is equally true. Original Medicare with a Medigap policy buys you nationwide provider freedom and pays a monthly premium for it every month of the year, including the nine months you never leave Hillsborough County. Neither structure is the correct one. The correct one is whichever matches how you actually live.
The six-month rule almost nobody knows about
This is the part that surprises people, and it is not a plan’s fine print — it is federal regulation.
Under 42 CFR 422.74(d)(4)(ii), if you have not moved but “has left the service area (or residence) for more than 6 months, the MA organization must disenroll the individual from the plan.” Not may. Must. There is one exception.
That exception is the visitor/traveler benefit at 422.74(d)(4)(iii). A plan may choose to offer it, for absences longer than 6 months but less than 12 months within the United States, and if it does, four conditions apply:
- You are disenrolled on the first day of the 13th month after you left the service area. The extension has a hard ceiling.
- You understand and accept whatever restrictions the plan puts on getting services while you are away.
- The plan must offer the option to all enrollees who are absent for an extended period — though it may limit the option to travel in certain areas it defines, and to services from qualified providers it arranges.
- The plan must furnish all Medicare Part A and Part B services and all mandatory and optional supplemental benefits “at the same cost sharing levels as apply within the plan’s service area.”
That fourth condition is the one worth reading twice. A genuine visitor/traveler benefit is not a discount or a partial credit — while it is in force, your copays away from home are supposed to be your copays at home.
The plan also has to tell you. The notice rules at 422.74(d)(4)(iv) require written notice within the first 10 calendar days of the sixth month of a temporary absence, or — if you are using a visitor/traveler benefit — within the first 10 calendar days of the last month of the allowable absence.
One more trap in the same paragraph: you are treated as temporarily absent from the service area when required plan mailings come back to the insurer from the U.S. Postal Service as undeliverable with no forwarding address. Snowbirds who forward mail informally, or let it stack up in a Michigan mailbox all winter, can trip this without ever making a decision.
What to do with this: if you are away for a long stretch every year, ask the plan two questions before you go. Does this plan offer a visitor/traveler benefit? And what is the last date I can be outside the service area without being disenrolled? Get the answer in writing, then count the months on a calendar.
If you actually move: the two windows that open
Leaving for the season and leaving for good are different events with different paperwork.
Your Special Enrollment Period. Moving to an address outside your plan’s service area is a qualifying event under 42 CFR 422.62(b)(2). Medicare’s timing is specific: your chance to switch begins when you move and continues for 2 full months after you move — and if you tell the plan before you move, it begins the month before the month you move and still runs 2 full months after. Move in October and tell the plan in September, and you have from September through December.
The same SEP is available if you move somewhere still inside your current plan’s service area but where new plan options exist. And there is a default if you do nothing: if you move out of the old plan’s service area and do not join a new Medicare Advantage plan during the SEP, you are enrolled in Original Medicare when the old plan drops you (Medicare.gov, Special Enrollment Periods).
Your Medigap guaranteed issue right. Moving out of a Medicare Advantage plan’s service area is also one of the situations CMS lists where an insurance company cannot deny you a Medicare Supplement policy or price it on your health. From CMS Product No. 02110, the right applies when your plan is leaving Medicare, stops giving care in your area, or you move out of the plan’s service area — with three conditions attached:
- You only have the right if you switch to Original Medicare, not if you join another Medicare Advantage plan.
- You can apply as early as 60 calendar days before the date your Medicare Advantage coverage ends, and no more than 63 days after it ends.
- Medigap coverage cannot start until the Medicare Advantage coverage ends.
Sixty-three days is a short fuse for a decision this durable. Outside a guaranteed issue right or your one-time six-month Medigap Open Enrollment Period, an insurer is allowed to use medical underwriting and can decline you — and Florida does not add a state-level annual switching right on top of the federal rules, so once a Florida resident’s window closes, health is the gatekeeper. That asymmetry is the single most important thing to understand about moving between the two systems, and we walk through it in detail in what happens if you miss your Medigap Open Enrollment window.
The Florida version of this question
Florida has two distinct populations asking it, and they need opposite answers.
You live here year-round and travel. Your service area is here. The plan question is what happens on the road: emergency and urgent care are covered nationwide, routine care depends on plan type, and a summer longer than six months away puts your enrollment at risk. If you are choosing among plans, the network breadth in the counties you actually visit is worth as much attention as the network here.
You winter here and are enrolled up north. Same rules, mirror image. Your plan’s service area is in Pennsylvania or New York; Tampa is the out-of-area location. The six-month clock is the one to watch, because “Thanksgiving to Memorial Day” is roughly six months and it is easy to drift past it.
You are moving here permanently. Then you are shopping the local market, and the local market is unusually deep. For 2026 there are 133 Medicare Advantage and Part D plan options in Hillsborough County alone (source: CMS CY2026 MA & Part D Landscape). That is a good problem — more competition generally means better benefits — but it also means the spread between the plan that fits your doctors and drugs and the plan that does not is wide. Plan availability is set county by county, not statewide: Medicare notes that insurance companies “can decide if a plan will be available to everyone with Medicare in a state, or only in certain counties” (Medicare.gov). A plan that works in Hillsborough may not be sold in Sarasota or Collier.
One practical note for anyone splitting the year between two states: your permanent residence is what determines which plans you are eligible for. Two homes do not get you two plans, and choosing which address is the permanent one has consequences well beyond Medicare.
Does Medicare Advantage cover you outside the United States?
Generally, no. Medicare “usually doesn’t cover health care while you’re traveling outside the U.S.,” with narrow exceptions, and Medicare drug plans do not cover prescriptions bought abroad (Medicare.gov, Travel outside the U.S.).
Two things to know before a cruise or a trip abroad:
- The definition of “the U.S.” is broader than you think. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa all count as inside the U.S. A winter in Puerto Rico is a domestic-coverage question, not a foreign one — though it is still an out-of-service-area question.
- Some plans add foreign emergency coverage, and some Medigap plans include it. Medicare Advantage plans may offer an extra benefit covering emergency and urgently needed services outside the U.S., and certain Medigap policies cover foreign travel emergency care. Neither is universal. Because Medicare’s own coverage abroad is so limited, CMS suggests travel medical insurance as an option, and warns that travel insurance does not necessarily include health insurance.
The questions to ask before you go
If you are keeping the plan you have:
- Does this plan offer a visitor/traveler benefit, and what is the maximum absence it allows?
- What is my out-of-network cost share for a routine office visit, if there is one at all?
- Does the plan’s network extend to the state I am going to, or is there a partner network there?
- What does the plan want me to do if I need a prescription refilled out of area?
If you are choosing a plan and travel is a real part of your year, that fourth question and the first one belong in the comparison from the start — not discovered in January. Our Medicare cost estimator will show you what a year of Medicare costs on the published 2026 figures, and Plan G or Plan N will let you price the Medigap side against real quotes if nationwide access is what you are actually buying. If you are new to the letters and the parts, start with what Medicare Parts A, B, C and D actually cover.
Talk it through before the season, not during it
Almost every bad outcome in this article shares one cause: the calendar got ahead of the paperwork. The six-month absence that ends an enrollment, the 63-day Medigap window that closes while a family is settling into a new house, the SEP that would have been two months longer if the plan had been told before the move — all of them are timing problems, and all of them are avoidable with a conversation in advance.
Virginia Barausky, CLTC, RSSA®, works with Tampa Bay families on exactly this: matching the plan structure to how the year is actually lived, including the months spent somewhere else. If you split your year between two states, or you are planning a move in either direction, book an appointment and bring your travel calendar. This is education, not advice about your specific situation — the point of the conversation is to get to the version that is.